|Year : 2014 | Volume
| Issue : 1 | Page : 98-103
Epidemiology of burn patients in a tertiary care hospital in Kashmir: A prospective study
Tahir Saleem Khan, Adil Hafeez Wani, Mohhamed Ashraf Darzi, Akram Hussain Bijli
Department of Plastic, Reconstructive Surgery and Burns, Sheri-Kashmir Institute of Medical Sciences, Soura, Srinagar, India
|Date of Web Publication||15-Dec-2014|
Tahir Saleem Khan
Department of Plastic, Reconstructive Surgery and Burns, Sheri-Kashmir Institute of Medical Sciences, Soura, Srinagar - 190 001, Jammu and Kashmir
Source of Support: None, Conflict of Interest: None
Background: Burns are a common injury in developing countries creating a major public health problem and are associated with significant morbidity and mortality. Our aim was to study the epidemiology of various demographic characteristics, their outcome and prevention. Materials and Methods: All acute burn cases admitted to the burn unit of Sheri-Kashmir Institute of Medical Sciences, ( tertiary care referral centre in Kashmir, India) over a period of 2 years (2010-2011) were investigated. The registration data regarding various demographic characteristics, mode of burn injury, time of presentation after burn and associated risk factors and illness. Assessment of burn wound was done regarding site, affected body surface area, degree, depth, severity of injury and complications. Data were collected and analyzed statistically. Results: Patient's ages ranged from 1 to 65 years with a mean age of 24.2 ± 7.6 years. The most common class of the population burnt were school going children (32.70%) followed by housewives (19.10%). Eighty percentage of patients belonged to rural areas and 20% to urban areas. Flame burns were more common in females (52.1%), electric burns were more common in males (93.3%) and scalds were more common in children (64.3%). Most of the burns were accidental (96.4%). 64.5% of patients reported within 24 h to hospital. 56.3% of patients had mixed degrees of burns, and 22.7% had third degrees of burns. Mortality was 11.8% and most common causative agent responsible was flame. The outcome was significantly associated with mode of injury, degree, depth, extent, causative agent and gender. Conclusions: This study provides important aspects of burn injuries for medical and nonmedical healthcare workers. The majority of burns are accidental seen in school going children, housewives and linemen of Power Development Department as a result of scalds, flame and electric burns respectively. Measures should be taken regarding awareness and education programs about burn prevention to reduce morbidity and mortality associated with it.
Keywords: Burn, epidemiology, prevention, risk factors
|How to cite this article:|
Khan TS, Wani AH, Darzi MA, Bijli AH. Epidemiology of burn patients in a tertiary care hospital in Kashmir: A prospective study. Indian J Burns 2014;22:98-103
|How to cite this URL:|
Khan TS, Wani AH, Darzi MA, Bijli AH. Epidemiology of burn patients in a tertiary care hospital in Kashmir: A prospective study. Indian J Burns [serial online] 2014 [cited 2019 May 20];22:98-103. Available from: http://www.ijburns.com/text.asp?2014/22/1/98/147017
| Introduction|| |
Burns exert a catastrophic influence on people in terms of human life, suffering, disability, and financial loss particularly in developing countries due to high population density, poverty, sociocultural factors, illiteracy, erratic electricity supply and local religious and traditional practices.  To understand the incidence and magnitude of the problem and its preventive aspects it is important to undertake epidemiological studies in a particular location. Because of the cold weather conditions during winter months people regularly use heating gadgets like electric, kerosene and gas heaters and in particular the traditional "Kangri" (earthen fire pot) and most of the burn injuries occur in winter months of the year. We conducted a study to know the epidemiological profile of burn victims at our institution so that magnitude of the problem in our society is known, and proper preventive strategies are planned.
| Materials and methods|| |
The study included all acute burn patients (n = 110) admitted in the burn unit of Department of Plastic and Reconstructive Surgery and Burns, Sheri-Kashmir Institute of Medical Sciences, (tertiary care referral center in Kashmir, India), from January 2010 to December 2011 to determine the epidemiology of these burn patients. Patients were subjected to a questionnaire-interview to obtain the following data:
Age, gender, occupation. Residence, marital status, risk factors for burns due to various causative agents, e.g., flame, electric burns, hot liquid, etc. Any associated illness.
Circumstances of burn
Causative agent (flame, hot liquid, Kangri, electrical, chemicals etc.). Mechanism of burn: (accidental, suicidal, homicidal etc.). The determination of accidental versus intentional burns was made on the history substantiated by police investigations in every case. Time and place of burn. Burn in an open space or closed space. Single or multiple members of the family burnt. Any first aid received at the site of an accident. Admission <24 and >24 h after burn injury. Any associated conditions like epilepsy, depression, marital conflicts, etc.
Clinical assessment of the burn wound
Site, affected body surface area (BSA), degree, depth, severity, and complications. BSA burnt was determined by Wallace's rule of nine in adults and in children by Lund and Browder chart. Burns were divided into major and minor burns as per the percentage total BSA burnt. (In case of patients aged <14 years sustaining >10% BSA and >20% BSA in patients aged >14 years were designated as having major burns). Depth of burns was divided into first, second and third-degree burns.
| Results|| |
Maximum number of the patients 32 (29.09%) were in the age group of 0-10 years. The patients' ages ranged from 1 to 65 years with a mean age of 24.2 ± 17.6 years. Majority of the patients 88 (80%) belonged to the rural areas where as 22 (20%) of the patients belonged to urban areas. In our series most common class of the population burnt were school going children (32.70%) followed by housewives (19.10%) [Table 1]. In the majority of the patients (43.64%), flame was the commonest cause of burn injury followed by electrical current (27.27%), and hot liquids (25.45%) [Table 2]. Hot liquid was the most common burning agent in children ≤10 years (18/28, 64.3%) where as flame was most common in adults 23/48 patients (48.0%) electric burn injury was more common in males (93.3%) where as flame burn was more common in females (52.1%). Among flame burns, 50% of patients were due to liquefied petroleum gas (LPG) cylinder leak followed by Kangri (16.67%) and kerosene stove (16.67%) respectively.
Majority of patients 106 (96.36%) sustained burn accidentally. Suicidal burns were present in 3 (2.73%) whereas homicidal burn was present in one patient (0.91%) [Table 3]. 86.36% of patients received first aid treatment at the site of the burn from local health care providers and family members. Maximum number of patients 71/110 (64.54%) reported within ≤24 h to our hospital. Major risk factor in our series was an ill-equipped and inadequately insulated lineman of Power Development Department (PDD) (9.10%). Six patients (5.45%) was suffering from epilepsy and one patient each (0.91%) were suffering from depression and drug addiction. Ninety-two (83.63%) patients had no history of any risk factors for burn injury [Table 4]. About 70 % of patients had up to 20% of total BSA (TBSA) burnt [Table 5]. 21/36 (58.3%) patients aged ≤14 years and 23/74 (31.1%) patients aged >14 years sustained major burns. 24/44 (54.5%) females and 20/66 (30.3%) males sustained major burn injuries [Table 3]. Most common area of burn was the upper limb in our patients (31.36%), followed by head and neck (26.47%), lower limbs (21.59%) and anterior trunk (10.28%) [Table 6]. 56.36% of patients had mixed degrees of burns, 22.73% of patients had third-degree burns which included primarily electrical and Kangri burns. Most of these patients had full thickness upper and lower limb burns [Table 7]. The most common complication in our patients was septicemia (42.85%) followed by gangrene of limbs/digits (15.71%). 60.91% of the patients in our series were managed conservatively whereas 39.09% of patients were treated surgically. The commonest surgical procedure done was split thickness skin grafting (STSG) of the postburn raw areas (46.75%) followed by fasciotomy of limbs (19.48%). In our series, 86.36% of patients were discharged, and 11.82% of patients died. Out of the total of 44 major burns, 30 (68.2%) were discharged, and 12 (27.3%) died. The most common causative agent responsible for mortality was flame. Out of 48 flame burns 10 patients (20.8%) died and 38 (79.2%) were discharged [Table 3]. The shortest stay in our series was 1 day whereas the longest stay was for 87 days. The average length of hospitalization in our patients was 24.7 days.
|Table 3: Outcome in relation with age, gender, burn severity, cause and mode of burn|
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| Discussion|| |
Burns are a common injury in the developing world and are associated with significant morbidity and mortality. Epidemiological studies are a prerequisite for effective burn prevention programs because each population seems to have its own epidemiological characteristics and knowledge of the epidemiology of burns is needed to select target groups for preventive action.
The most common age group in our study was between 0 and 10 years (29.09%) and those aged >50 years comprised only 10%. The age distribution seen in our study is in concordance with that seen in other studies, , however it differs from other series where the peak age incidence is reported to be in adolescence and adulthood ,,,,, and might be explained by the lack of coordination and unawareness of dangerous substances that play an important role in the occurrence of burns in children.
In our study 66/110 (60%) patients were males with a male:female ratio of 1.5:1. Comparing data regarding the gender preponderance, our observations are in agreement with other authors. ,,, However, this is at variance with epidemiological studies of other authors where females outnumber males as burn victims. ,,,,, Reason for this could be that the typical Indian burn patient is usually a female whose loose clothes catch fire while cooking on the floor level kerosene stove. Furthermore, dowry related deaths are more prevalent in this gender group as they find burning themselves as an easy task to get rid of these issues.
Burn agents are highly individualized in each community and largely depend upon standard of living and lifestyle. Flame was the commonest cause of burn injury (43.64%), followed by electrical current (27.27%), and hot liquid (25.45%) respectively. Hot liquid was the most common burning agent in children ≤10 years (18/28, 64.3%) while as flame was the most common in adults, 23/48 patients (48.0%). Our observations are at par with other authors. ,,,,, Flame burn was mostly due to leakage from the LPG cylinder used for cooking and lighting purposes (50%) followed by Kangri (16.67%) and kerosene stove (16.67%). Our observations are in contrast with other epidemiological studies ,,,,,, where most of the flame burns were due to the kerosene stove. The reason for a maximum number of flame burns due to LPG in our study may be due to changing trend of using LPG stoves and lighting gas instead of the conventional kerosene stoves and open Chula and kerosene lighting lamp commonly known as "lalteen" for domestic use in our population. These gadgets are improperly handled without taking proper precautionary/safety measures. It is important to mention here that in spite of the fact that there are reputed national companies like Hindustan petroleum and Bharat petroleum, which provide the LPG cylinders for domestic use, due to an improper check of faulty cylinders by consumers it results in accidental flame burns due to leaks in such cylinders. Furthermore, sale of substandard LPG cylinders for lighting purposes that are manufactured locally or come from outside state are responsible for most of the LPG cylinder related burns. Majority of burn injuries in our study were accidental in nature (96.36%) whereas only 3.63% were intentional (Suicidal/Homicidal). Similar observations were made by Jaiswal et al. and Shanmugakrishnan et al.  The incidence of intentional burns is low because of the religious reasons. Most of the population is Muslim majority where suicide and/or homicide are considered grave sins and this religious belief acts as a deterrent to suicidal and/or homicidal burns. Besides dowry related cases are also less in contrast to the rest of the country.
The first aid treatment in our series was in the form of pouring of cold water on the burnt area, institution of an intravenous line, analgesics, tetanus prophylaxis, and dressing of the burn given by the local health care providers. Application of toothpastes, antiseptic ointments, turmeric paste, liquid ink, pouring of cold water over the burnt area were the forms of first aid provided by the family members and/or bystanders. 86.36% of patients received pre hospital treatment/first aid at the site of the burn from local health care providers, and 13.64% did not receive it at all. Our findings are consistent with those reported by Mzezewa et al.  and Ramcharan et al. 
77/110 (64.54%) patients reported for treatment within 24 h to our hospital from their place of burn, and this included 38/44 (86.36%) of patients with major burns. Jayaraman et al.  and Shanmugakrishnan et al.  reported major burn injury patients present within 24 h.
Although majority of the patients (83.63%) in our series had no known risk factor for burn injury but ill-equipped and inadequately insulated linemen of PDD evolved as a major risk factor for sustaining high voltage electric burn injuries. Out of 30 electric burns 10 (33.33%) were linemen of PDD who became a victim of major electrical burns while at work mostly due to the poor coordination and communication between them and their colleagues responsible for turning on and off the power supply at power grids/stations. Since these patients were in productive age group/young adults who sustained a lot of morbidity in the form of multiple surgeries, amputation of their charred and gangrenous hands and feet, it is strongly advocated that they should be provided with proper insulated equipments while going for repair of these high tension electrical lines. Further strong communication between those repairing these lines and those responsible for switching on and off of the power supply in these areas is necessary. The second important risk factor was epileptic patients 6/110 (5.45%). These patients had burns due to fire resulting from overturning of Kangri during the course of an epileptic fit or they sustained burns from an open Chula while they had a fit. All these patients were on erratic antiepileptic treatment and had deep burns of the hands. Similar observations were noted by Jiburum et al.  Poor understanding of the epilepsy seems to be the main problem that predisposes these patients to burn injury in our environment and therefore education of such patients, and their families are the only solution to the problem. This will increase the compliance of taking of antiepileptic drugs and will help in avoidance of an unsafe environment by these patients.
In our study majority of the patients (70%) had ≤20% of BSA burnt. Considering percentage BSA burnt with regard to age of the patients 21/36 (58.3%) children sustained major burns (>10% BSA) whereas 23/74 (31.1%) adults sustained burns major burns (>20% BSA). With regard to the gender distribution of TBSA burnt 20/66 (30.3%) males and 24/44 (54.5%) females sustained major burns. Our findings are at par with other authors. ,,, The most common site of the burn was the upper limb (31.36%), followed by face (26.47%). Sadeghi Bazargani et al.  reported the same. However, our observation was in contrast to that reported by Mago et al.,  Forjuoh and Muhammad  and Kalaya and Muhammad  where the most common site burnt were the legs, followed by trunk. The reason for the majority of our patients sustaining upper limb and facial burns could be that most of them sustained burn due to flame (LPG) and electric current while cooking or while fiddling/repairing of electric wires putting these body parts more at risk of burning by these agents. 56.38% of patients had mixed type (second and third degree) of burn, followed by isolated third degree burn (22.73%) which included primarily electrical and Kangri burns. Majority of patients in our study were due to flame that usually causes mixed second and third-degree burns. Our observations are consistent with those of Haik et al.,  Ramcharan et al.  and Burton et al. 
Systemic sepsis continues to be a life-threatening condition in burn patients.  In our study most common, complication was septicemia (42.85%), followed by gangrene of limbs/digits (15.71%). Mago et al.  and Jaiswal et al.  reported the same. 60.91% of the patients were managed conservatively, whereas 39.09% of patients were treated surgically and the most common surgical procedure performed was STSG (46.75%). A proportion of patients (14.28%) had to undergo amputations of their upper or lower limbs at varied levels, and all of them sustained electrical or Kangri burns. Our findings are in accordance with that observed by Ramcharan et al.  and Mzezewa et al. 
| Conclusion|| |
This study provides important aspects of burn injuries for medical and nonmedical healthcare workers:
- Since young school going children are very prone to burn injuries at home as well as outside home due to their behavior, they need to be educated about burn prevention, risk factors and first aid management at their schools and through media.
- Majority of the burns occurring accidentally and that too with flame from substandard and callously handled LPG stoves and lightening gases and heaters need once again mass education and proper legislation to check this menace that most of the time leads to crippling lifelong morbidity and sometimes ends up with fatal injuries.
- Ill-equipped and inadequately insulated lineman of PDD evolved as a major risk factor for sustaining high voltage electric burn injuries. It is strongly advocated that they should be provided with proper insulated equipments, while going for repair of these high tension electrical lines. Further strong communication between those repairing these lines and those responsible for switching on and off of the power supply in these areas is necessary to decrease the human error, which costs much to these poor victims. Further regular awareness and education programs through mass media are advocated.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]