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ORIGINAL ARTICLE
Year : 2016  |  Volume : 24  |  Issue : 1  |  Page : 41-46

Five-year epidemiological study of burn patients admitted in burns care unit, Tata Main Hospital, Jamshedpur, Jharkhand, India


Department of Burns and Plastic Surgery, Tata Main Hospital, Jamshedpur, Jharkhand, India

Date of Web Publication12-Dec-2016

Correspondence Address:
Prasenjit Goswami
Flat No 40, Old Professional Flats, I C Road, Jamshedpur - 831 001, Jharkhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-653X.195536

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  Abstract 

Introduction: Burn injury remains one of the biggest health concerns in the developing world and is a formidable public health issue in terms of mortality, morbidity, and permanent disability. The incidence of burn injuries is found all over India; detailed epidemiological studies from the eastern part of the country are sparse. Materials and Methods: We present an epidemiological study form the burn care unit (BCU) of Tata Main Hospital, Jamshedpur, Jharkhand, India of a period of 5 years from January 2009 to December 2013. Results: A total of 1975 burn patients were admitted in the BCU in this 5-year period. The mean age of all the patients included in the study was 29.16 years. There was a slight female predominance in this 5-year period. The overall male to female ratio was 1:1.05. The mean percentage total body surface area (TBSA) burn of all the patients over the period of 5 years was 42.5%. Flame burns were the most common form of burn, accounting for 65.16% of all burns. The overall mortality of the patients over 5 years was 40.8%. If the data are further classified, the overall mortality of patients up to 30% burns was 3.45%, with 30-60% burns was 42.3%, and above 60% burns was 91.8%. Conclusion: Analysis of the 5-year data fairly represents the epidemiological pattern of burns in this region, which has never been studied before and this study can serve as a pilot study for any burn care-related development in this region.

Keywords: Burn epidemiology, Jamshedpur, Tata Main Hospital


How to cite this article:
Goswami P, Singodia P, Sinha AK, Tudu T. Five-year epidemiological study of burn patients admitted in burns care unit, Tata Main Hospital, Jamshedpur, Jharkhand, India. Indian J Burns 2016;24:41-6

How to cite this URL:
Goswami P, Singodia P, Sinha AK, Tudu T. Five-year epidemiological study of burn patients admitted in burns care unit, Tata Main Hospital, Jamshedpur, Jharkhand, India. Indian J Burns [serial online] 2016 [cited 2017 Nov 19];24:41-6. Available from: http://www.ijburns.com/text.asp?2016/24/1/41/195536


  Introduction Top


Burn injury remains one of the biggest health concerns in the developing world and is a formidable public health issue in terms of mortality, morbidity, and permanent disability. Ninety percent of the burns are reported from low-and middle-income countries (LMIC), of which 50% are from South and Southeast Asian countries.[1] Among these countries, India is unique for not only having the highest incidence of burns, making it a sort of “burn capital of the world,” but also for having a very high mean body surface area (BSA) of burns. Burn has been considered to be an “endemic disease” in India.[2]

Though the incidence of burn injuries is found all over the country, detailed epidemiological studies from the eastern part of the country are sparse. This study was devised to understand the epidemiological patterns of burn patients admitted in the burn care unit (BCU) of Tata Main Hospital, Jamshedpur, Jharkhand, India over a period of 5 years. This study is important because this BCU is the only unit that provides specialized burn care in this region and it caters not only to the employees and families of Tata Steel Limited but also to the general population of Jamshedpur, the district of East Singhbhum, neighboring districts, and also the neighboring states of West Bengal and Odhisha.

Burn data of all the patients admitted to the BCU for a period of 5 years were retrospectively collected from the computerized hospital management system and analyzed. Analysis of the 5-year data fairly represents the epidemiological pattern of burns in this region, which has never been studied before and this study can serve as a pilot study for any burn care-related development in this region.


  Materials and Methods Top


Retrospective data of all the burn patients admitted to the BCU in Tata Main Hospital, Jamshedpur, Jharkhand, India from January 2009 to December 2013 were collected from the hospital management system as well as the BCU records and were analyzed. In total, 1975 burn patients were admitted to the BCU in this 5-year period. [Table 1] shows the number of patients admitted in each year and the respective gender distribution for that year [Figure 1].
Figure 1: Gender distribution of patients in each year

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The BCU in Tata Main Hospital, Jamshedpur, Jharkhand, India is a centrally air-conditioned unit with isolated cubicles arranged in a circular pattern with monitoring devices and wall-mounted gas pipelines along the circumference and the nurses' station in the center. During the study period, the number of beds was nine and the unit was managed by four doctors trained in burns. Along with the doctors, 15 staff nurses, 2 technician-cum-dressers, and 11 hospital attendants manned the BCU. On admission, general consent regarding treatment in the hospital is obtained from the patient/patient's attendants. Specific consent for surgery, blood transfusion, restraint, etc., is taken on a patient-to-patient basis. Burn patients are received in the resuscitation room where saline and diluted cetrimide/chlorhexidine bath is given. Urinary catheter and peripheral line are introduced. Fluid resuscitation is started with Ringer's lactate according to the Parkland's formula. The detailed history is taken and noted and burn evaluation is done in respect to total body surface area (TBSA) and depth. Lund and Browder chart is marked. Dressing is done in the dressing room with silver sulfadiazine/framycetin, and the wound is covered with Gamjee pads and bandages. Injectable antibiotics, proton pump inhibitors, and analgesics are started as initial drug therapy. Patients are taken up for surgery as the situation demands, which ranges from early excision and grafting, debridement and dressing, escharotomy, fasciotomy, and amputations. Emphasis is laid on the nutrition of the patients and Curreri formula is used to calculate the calorie requirement of each patient. Hospital dietecian is responsible to give the calculated calorie in form of various food items. Ryles tube feeding is started if the patient is unable to take an adequate amount of feed orally. Enteral nutrition is given preference over parenteral nutrition. Physiotherapy is adviced for all the patients and is done by the hospital physiotherapist who is assisted by the staff nurses of the unit. Special emphasis is laid on chest physiotherapy, spirometry, limb movements, and early mobilization. Patients are discharged when they are stable, after grafting has been done, or when there is minimal raw area remaining. They are followed up in the burns outpatient department (OPD), which runs thrice in 1 week.
Table 1: Number of admissions in each year and the respective gender distribution for that year

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  Results Top


Results have been analyzed with regard to age, sex, percentage of burns, etiology, and mode of injury, mortality, and cause of death.

Age distribution

The mean age of all the patients included in the study was 29.16 years. [Table 2] shows the mean age in each year.
Table 2: Mean age of the patients in each year

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Gender distribution

There was a slight female predominance in this 5-year period. The overall male to female ratio was 1:1.05.

Agewise distribution and gender distribution in each age group

The agewise distribution of the patients was done and the number of patients in each age group of 10 years was calculated. Further classification was done and the males and females in each age group for the study period was evaluated. [Table 3] shows the agewise distribution and gender distribution in each 10-year age group. [Figure 2] shows the distribution of patients in each age group over the period of 5 years.
Table 3: Distribution of burn patients in each 10-.year age group and their gender distribution

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Figure 2: Distribution of patients in each age group

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Total body surface area

The mean percentage of TBSA burns of all the patients included in the study over the period of 5 years is 42.5%. [Table 4] shows the number of patients in each 10% TBSA burn over the period of 5 years. Gender distribution for each group of TBSA has been done over the study period of TBSA over the study period.
Table 4: Number of patient with gender distribution in each 10% TBSA burn group over the study period

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Burn etiology

Flame burn was the most common form of burn (65.16%) followed by scald burns, which accounted for 15.8% of the total cases. Electrical burn constituted 10.37% of the cases. Given that Jamshedpur is a steel-making city, thermal contact burns, which mostly result from contact with molten metal, accounted for 75 cases (3.8%).

[Table 5] shows the number of patients in each type of burn (burn etiology) over the study period.
Table 5: Number of patients in each type of burn

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Length of stay

The length of stay of the patients admitted during the study period was analyzed. The mean length of stay of all the patients was 6.64 days. Further analysis was done and the length of stay for each 10% TBSA burn group was done for each year. [Table 6] shows the length of stay in each 10% TBSA burn group. [Figure 3] is the diagrammatic representation of length of stay in each group.
Table 6: Length of stay in each 10% TBSA burn group

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Figure 3: Length of stay in each 10% TBSA burn group over the study period

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Outcome analysis

The overall mortality of the patients over 5 years was 40.8%. If the data are further classified, the overall mortality of patients with up to 30% burns was 3.45%, with 30-60% burns was 42.3%, and with above 60% burns was 91.8%. [Table 7] shows the number of mortalities in each 10% TBSA group over the study period. [Figure 4] shows the mortality in each 10% TBSA burn group.
Table 7: Mortality in each 10% TBSA group over 5 years

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Figure 4: Mortality of patients according to 10% TBSA burn group

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  Discussion Top


Burn injury is common in all the regions of our country. Judicious extrapolation suggests that India with a population of over 1 billion has 700,000-800,000 burn admissions annually.[3] A study done in a tertiary care hospital of New Delhi, India has found that the overall incidence of burns in India seems to be plateauing [4] A positive correlation has been found between the decrease in incidence of burns with the increase of the standard of living.[5]

The burn problem is decreasing and is being contained in high-income countries because of efficient burn prevention programs and extensive use of fire safety measures such as smoke alarms, regulation of consumer products, occupational safety, and improvement in the treatment protocols.[6],[7],[8],[9],[10],[11],[12],[13],[14]

There is a paucity of large epidemiological studies on burns from the eastern part of India. Epidemiological studies are important to analyze the burden, distribution, and causes of burns in a particular region. These studies form the basis of disease prevention programs; hence, they are significant.[15] This study is extremely important as a study of this magnitude has never been published from the eastern part of India. The value of this study further increases because our BCU caters to a vast geographical region and there is no other dedicated burn care facility in this region and thus, is an indicator of the burn epidemiology of this region.

The age group most affected by burn injuries in our study was of 20-40 years, which accounted for 48.8% of all patients. This was similar to other epidemiological studies done in the country.[2],[3],[4],[5],[15],[16] The mean age of the patients in this study was 29.16 years. This age group is most frequently involved in burn injuries because this is the age group, which is actively involved both in indoor and outdoor work. The age group of 60 years and above amounted accounted for only 6.2% of all patients, which was similar to the other studies published in the country.

In our study, there was a slight female predominance in the sex ratio. This was in accordance with some recent Indian studies [15],[16] but in contrast to other studies.[4], 5, [17],[18],[19],[20],[21],[22],[23],[24],[25] A female predominance can be explained as females in the younger age group are mostly engaged in cooking and wear loose-fitting clothes such as saree, dupatta, etc., which inadvertently catch fire easily.[26]

Flame burns were predominant in our study and accounted for for 65.16% of all the burn cases followed by scald burns, which constituted 15.8%. This was similar to other Indian studies [2],[3],[4],[5],[15],[16],[27],[28],[29],[30],[31],[32] that also have shown a predominance of flame burns. Given that Jamshedpur is a steel-making city, contact burns, which mostly result from contact with molten metal, accounted for 75 cases (3.8%) that needed admission for the same. This is only the tip of iceberg as many patients with contact burns of a lesser severity are treated on an outpatient basis.

The mean length of stay in our study was 6.62 days. The maximum length of stay was for 30-50% TBSA burn, which accounted for 10.42 days. The length of stay was shorter for those patients with less than 30% and more than 60% TBSA burns. A similar length of stay has been reported from Delhi, India [33] The short length of stay can be explained by the fact that the patients are discharged from the BCU whenever they are stable either before or after surgery even with some remaining post-burn raw areas because of financial constraints of the patient party as most of the patients are from a lower socioeconomic strata without any health insurance. These patients are called to the OPD and are dressed regularly and some need to be readmitted for skin grafting. Adequate advice is given to the attendants of these patients regarding the requirement of high protein, high calorie diet for these patients after discharge, and the need for maintaining proper hygiene in the dwelling place of these patients during the course of treatment as an outpatient. The employees of Tata Steel and associated companies and their family members are treated free of cost and the cost of treatment is borne by the company. The number of nonemployee patients far exceeds the number of employee patients and accounts for almost 85% of all the patients.

The mean percentage of TBSA burns of all the patients included in the study over the period of 5 years was 42.5%. The overall mortality of the patients over 5 years was 40.8%. If the data are further classified, the overall mortality of patients with up to 30% burns was 3.45%, with 30-60% burns was 42.3%, and with above 60% burns was 91.8%. From the data published from one burn center in Delhi, India we see that in a 2002 study, the mean TBSA was 49.12% and mortality was 51.8%.[4] In a 2009 study, the mean TBSA was 44.39% and mortality was 40.02%.[5] In a 2013 study, the mean TBSA was 42.26% and mortality was 32.37%.[33]

The predominant cause of death was sepsis, multiple organ failure, and respiratory complications. In our case, the high mortality rate can be attributed to the fact that the majority of the patients came from remote areas where the initial care was not proper and there was a delay in getting admitted in the BCU, which adversely affected the prognosis. Moreover, the nutritional status reiterates the fact that proper burn care training and facilities should be made available in public sector hospitals and dispensaries in this region to manage burn patients initially before shifting them to the advanced BCUs.


  Conclusion Top


The positive correlation between an increase in the standard of living and decrease in the incidence of burns has been established. This fact needs to be taken into consideration when measures to reduce burn incidence are taken up holistically, especially in this region where a huge percentage of population have a low socioeconomic status. Trainings on safer kitchen practices should be given at the grass-roots level. Doctors serving in villages should be trained in the first aid management of burns as a state as well as a nongovernment organizational initiative.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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