|Year : 2016 | Volume
| Issue : 1 | Page : 47-52
Epidemiology of burns in teaching hospital of Northern India
Mumtazudin Wani1, Mushtaq Ahmad Mir1, Shabir Ahmad Mir1, Ankush Banotra1, Yawar Watali1, Zahoor Ahmad2
1 Department of Surgery, Government Medical College, Srinagar, Jammu and Kashmir, India
2 Department of Statistics, University of Kashmir, Srinagar, Jammu and Kashmir, India
|Date of Web Publication||12-Dec-2016|
Shabir Ahmad Mir
Department of Surgery, Government Medical College, Srinagar, Jammu and Kashmir
Source of Support: None, Conflict of Interest: None
Background: There is no information on the pattern of outcomes among burn patients in relation to clinical aspects in India. Hence, the present study was undertaken in a burn unit to determine selected epidemiological variables, assess the clinical aspects (etiology, extent and anatomical location) and finally to analyze the outcomes in cases of burn injury. Materials and Methods: This prospective study was undertaken to analyze the patients admitted to the Burn Unit of Government Medical college Srinagar. The study was carried over a period 2 years from January 2013 to December 2014. Various variables including age and sex distribution, nature of burn injuries, Anatomical location, percentage of total body surface area burnt, depth of burns, Survival of expired patients and mortality were recorded and analyzed. Results: Highest incidence of burns was in the age group between 21 and 40 years; 61% patients were females and 39% were males; majority of our patients had burns in the range of 20 to 40% TBSA (total body surface area); mortality rate in our study was 36.82%; most common site of the burn injury was upper limb(30.19%);among patients who died those with TBSA burn of >60%, 41 to 60% and 31 to 40% succumbed within three, six and nine days respectively. Age ranged from 6 months to 93 years. Mean age of the patients was 31 years. Eighty percent patients belonged to rural areas and 20% belonged to Urban locality. Conclusion: People with low educational qualification should be taught about the proper and safe usage of modern appliances based on electricity, LPG or kerosene. People with psychiatric problems or low intelligence quotient (I.Q) should be helped by their care takers in avoiding the burn injuries and also devices with alarms should be used in their households. Fuel or electric devices should be checked by a trained person regularly (e.g once in month) to avoid usage of faulty devices.
Keywords: Burn, epidemiology, morbidity, mortality
|How to cite this article:|
Wani M, Mir MA, Mir SA, Banotra A, Watali Y, Ahmad Z. Epidemiology of burns in teaching hospital of Northern India. Indian J Burns 2016;24:47-52
|How to cite this URL:|
Wani M, Mir MA, Mir SA, Banotra A, Watali Y, Ahmad Z. Epidemiology of burns in teaching hospital of Northern India. Indian J Burns [serial online] 2016 [cited 2017 Nov 19];24:47-52. Available from: http://www.ijburns.com/text.asp?2016/24/1/47/195523
| Introduction|| |
Fire has served as well as destroyed humankind. Burn represents an extremely stressful experience for both the burn victims as well as their families. Despite many medical advances, burns continue to remain a challenging problem in India, due to the lack of infrastructure and trained professionals as well as the increased cost of treatment, all of which have an impact on the outcome.
There is no information on the pattern of outcomes among burn patients in relation to clinical aspects in India. Hence, the present study was undertaken in a burn unit to determine selected epidemiological variables, assess the clinical aspects (etiology, extent, and anatomical location), and finally to analyze the outcomes in cases of burn injury.
| Patients and Methods|| |
This prospective study was undertaken to analyze the patients admitted to the Burn Unit of a Teaching Hospital of Government Medical College in Northern India. The study was carried over a period 2 years from January 2013 to January 2015. Patients were resuscitated as per the standard formulas, especially the Parkland formula after calculating the percentage of burns. Proper care of nutrition, electrolytes, antiseptic dressings, surgeries (fasciotomies, split skin grafting, and amputations) was taken. Various variables including age and sex distribution, nature of burn injuries, anatomical location (site of burn injury), percentage of total body surface area (TBSA) burnt, depth of burns, postburn lifespan of patients who ultimately succumbed to burn injuries and mortality were recorded and analyzed. Data were analyzed with the help of statistical software IBM SPSS (version 20.0). Data were analyzed by descriptive statistics. Chi-square or Fisher's exact test, whichever appropriate, was used for comparing categorical data. P < 0.05 was considered statistically significant.
| Observation and Results|| |
Age and sex distribution of the patients are given in [Table 1], [Graph 1] and [Graph 2]; age-related mortality is shown in [Graph 3].
Age ranged from 6 months to 93 years. Mean age of the patients was 31 years. Rural versus Urban: 80% patients belonged to rural areas, and 20% belonged to urban locality. Majority of patients were Muslims (651) and rest (49) belonged to other religions such as Hindus and Sikhs.
The percentage of the patients having a minimum of 10th class educational qualification in the most vulnerable age group (21–40 years) was 41% compared to the considerably higher percentage (>70%) in the respective age group of our general population. Besides 20% of patients in the age group 21–40 years had a history of delayed milestones in childhood and/or have attended psychiatric clinics compared to <5% with similar history in the general population.
Causes of burn are analyzed in [Table 2].
Flame was the most common cause of burn injury (57.44%), followed by hot liquids-scald burn (18.6%), and kangri (6.59%).
After taking the careful history, it was found that faulty devices were responsible for 27.25% cases in kerosene and LPG group. Improper handling was found responsible in 38.5% of patients in cases of scald burn. While investigating the kangri burns, it was found that one or more of the contributing factors (damaged kangri, high-temperature coals, kangri without protective covers or careless use of kangri during the night) were present in 65.2% of patients.
Modes of burn injury are given in [Table 3].
Most common mode of burn was accidental in nature followed by suicidal.
Unaddressed conflicts or issues, highly sensitive patients, psychiatric problems and/or excessive oppression were present in about in 77.8% of patients with suicidal burns.
Percentage TBSA burnt is shown in [Table 4].
Most patients had burns in the range 21%–40% of their TBSA. Median value for TBSA % was 34%
Depth of the burn injury is detailed in [Table 5].
Mostly, burns were of a mixed type.
Percentage of deaths and their postburn survival is given in [Table 6].
|Table 6: Distribution of cases, death, and postburn survival (average number of days) of succumbed patients in relation to percentage of total body surface area burnt|
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From [Table 6], it is evident that death rate and days of survival depends on TBSA burnt.
Mortality: Out of 698 patients, 257 died making up a mortality of 36.82%.
Anatomical location of burn injuries is detailed in [Table 7].
Most common site of burn injury was upper limbs [Table 8] and [Table 9].
There is a trend toward early surgery of burn patients, especially in cases of small-sized burns (up to 15%) in our institution. From the records of our institution, it is evident that superficial burns usually heal without any deformities or contractures while as patients with 3rd or 4th degree burn, even after primary grafting do develop secondary postburn deformities in the form of contractures and other functional/cosmetic deformities to the extent of about 20%–25% [Table 10].
Mean hospital stay for patients with <15%TBSA burns was 19 days with a range of 6–44 days and 53 days for patients with 15%–45% TBSA burns with a range of 18–83 days. Patients with <15% TBSA burn received an average of two blood transfusions while those with 15%–45% TBSA burn received an average seven blood transfusions.
Two hundred and seventy-nine (40%) patients underwent split skin grafting of their raw burn wounds.
Seventy-nine patients underwent fasciotomies.
Of the 34 patients with electric burns, 22 patients (64.7%) underwent amputation of their upper or lower limbs.
| Discussion|| |
In the present study, highest percentage of burns was in age group between 21 and 40 years. This distribution is similar to those found in other studies., High percentage in this age group is explained by the fact that they are generally more active and exposed to hazardous atmosphere at home and at work., Besides suicidal tendencies are more in this age group due to various reasons including break up in love affairs, marriage not by choice, postmarriage adjustment problems, and difficulties in getting jobs.
In our study, 61% patients were female, and 39% were male. This was similar to other study.
Majority of our patients had burns in the range of 21%–40% TBSA. This is in contrast to another study by Gupta et al., in which majority had >45% TBSA. The reason for this could be that flame burns were present only in 54.44% of our patients as compared to 72% in the study by Gupta et al.
Mean hospital stay for patients with <15% TBSA burns was 19 days with a range of 6–44 days, 53 for patients with 15%–45% TBSA burns with a range of 18–83 days. This is in agreement with other study.
Patients with <15% TBSA burn received an average of two blood transfusions while those with 15%–45% TBSA burn received an average seven blood transfusions, which is similar to other study.
Two hundred and seventy-nine (40%) patients underwent split skin grafting of their raw burn wounds, and 79 patients (11.3%) underwent fasciotomies. This is consistent with other study.
Causative agents of burn injuries vary highly according to culture, standard of living and life style. In our study, flame was the most common cause of burn injury (57.44%), followed by hot liquids-scald burn (18.6%), and kangri (6.59%). Flame was also most common cause in other study. Flame burn was mostly due to leakage from LPG cylinder used for cooking and lighting purposes followed by kerosene (stove or suicidal spillage). Our results are in contrast with other studies  where most of the flame burns were due to kerosene stoves. The maximum number of flame burns being due to LPG, in our study, could be because of trend changing from kerosene and chulas to LPG.
Majority of burns in our patients were accidental or unintentional in nature (86.93) whereas only 13.60 were intentional (suicidal/homicidal) in nature. Similar observations were made by other studies., The reason for this in our study could be that Kashmir is a Muslim majority state, and Muslims consider suicide a grave sin as per their holy Quran.
Of the 34 patients with electric burns, 22 patients (64.7%) underwent amputation of their upper or lower limbs, comparable to that of other study.
The majority (60.98) of our patients had mixed burns (superficial and deep burns) while isolated superficial and deep burns were present in 20.2% and 19.48% patients, respectively. The majority of our patients had flame burn injury which causes mixed superficial and deep burn injury. Our observations are consistent with those of Haik et al. and Ramcharan et al.
Mortality rate in our study was 36.82%. This is comparable to 40% mortality rate observed in another study by Gupta et al. Case fatality rate was 31.58% in another study by Gowri et al.
The most common site of the burn injury was upper limb (30.19%). Sadeghi Bazargani et al. reported the similar. However, our observation was in contrast to that reported by Mago et al. The reason for upper limbs being the most common anatomical site seems to be that they are more concerned with day-to-day activities and hence more prone to burn injuries than other body parts.
Analysis of death in relation to TBSA burnt and the average number of days survived among those who died revealed that those with TBSA burn of >60%, 41%–60%, and 31%–40% expired within 3, 6, and 9, days, respectively. As all those with burns of TBSA <25% survived and those >55% died, it is considered that the vulnerable group was those with burns of TBSA between 25% and 55% who need more care and support to overcome multiple internal and external factors contributing to the mortality.
Hence, in the event of mass casualty due to burns or in areas/hospitals with suboptimal facilities, we suggest that while triaging, priority be given to the patients with burns of TBSA of 30%–55%.,
| Conclusion|| |
People with low educational qualification should be taught about the proper and safe usage of modern appliances based on electricity, LPG, or kerosene.
People with psychiatric problems or low intelligence quotient should be helped by their caretakers in avoiding the burn injuries and also devices with alarms should be used in their households.
Fuel or electric devices should be checked by a trained person regularly (e.g., once in month) to avoid usage of faulty devices. Kangri burns (restricted to Kashmir valley) can be avoided to a greater extend by discouraging use of damaged kangris, naked kangris, careless night usage of kangris, high-temperature coals, childhood kangri usage, and kangri usage by epileptic patients. Scald burns can be avoided by proper handling of the utensils and limiting reach of the children to the utensils containing hot liquids.
Suicidal burns can be reduced to a great extent by counseling and addressing the conflicts or issues, not subjecting the highly sensitive patients to mental or physical torture and proper care of psychiatric patients.
- Children more often get burn injuries because of unrestricted movements and evolving conditioning reflexes. This can be taken care of by educating the children about risk factors for burn injuries and the ways by which they can be avoided
- Burn injuries can be reduced by bringing about the regulations to develop safer appliances, promoting less inflammable fabrics to be worn in kitchens, enforcing special task forces to check selling of faulty appliances, and educating the community, especially women through mass media and programs about the risk factors and the safety measures for avoiding accidental burns. Women should not be subjected to mental or psychological stress which at times culminates in suicidal burns, rather their needs and demands should be addressed
- Occupational workers, for example, lineman should be provided with properly insulated equipment while repairing the electric lines. There should not be lack of communication between the repairing persons and the person controlling switching on/off process of the power supply
- In the event of mass casualty due to burns in areas/ hospitals with suboptimal facilities, we suggest that while triaging, priority be given to those patients with burns of TBSA of 30%–55%
- Most common causes of burn injuries in our region are LPG and kerosene burns while burn injury unique to our region is kangri burn. All these can be prevented to a greater extent by adopting above measures.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Xu RX. Brief introduction to history of burn medical science. Burn Regenerative Medicine and Therapy. Basel Karger; 2004. p. 1-3. doi:10.1159/000076426.
Akther JM, Nerker NE, Reddy PS, Khan MI, Chauhan MK, Shahapurkar VV. Epidemiology of Burned patients admitted in burn unit of a rural tertiary teaching hospital. Pravara Med Rev 2010;2:11-7.
Hanumadass ML. Some thoughts on organization of delivery of burn care in India. Indian J Burns 2003;11:18-20.
Subrahmanyam M. Topical application of honey in treatment of burns. Br J Surg 1991;78:497-8.
Ytterstad B, Søgaard AJ. The Harstad injury prevention study: Prevention of burns in small children by a community-based intervention. Burns 1995;21:259-66.
McCullough JE, Henderson AK, Kaufman JD. Occupational burns in Washington State, 1989-1993. J Occup Environ Med 1998;40:1083-9.
Lyngdorf P. Occupational burn injuries. Burns 1987;13:294-7.
Shanmugakrishnan RR, Narayanan V, Thirumalaikolundusubramanian P. Epidemiology of burns in a teaching hospital in South India. Indian J Plast Surg 2008;41:34-7.
Gupta AK, Uppal S, Garg R, Gupta A, Pal R. A clinico-epidemiologic study of 892 patients with burn injuries at a tertiary care hospital in Punjab, India. J Emerg Trauma Shock 2011;4:7-11.
Gupta M, Gupta OK, Yaduvanshi RK, Upadhyaya J. Burn epidemiology: The Pink City scene. Burns 1993;19:47-51.
Jaiswal AK, Aggarwal H, Solaki P, Lubana PS, Mathur RK, Odiya S. Epidemological and sociolocultural study of burn patients in M. Y. Hospital in Indore, India. Indian J Plast Surg 2007;40:158-63.
Haik J, Liran A, Tessone A, Givon A, Orenstein A, Peleg K; Israeli Trauma Group. Burns in Israel: Demographic, etiologic and clinical trends, 1997-2003. Isr Med Assoc J 2007;9:659-62.
Ramcharan R, Dass S, Romany S, Mohammed F, Ali T, Ragbir M. Epidemiology of adult burns in North Trinidad. Internet J Third World Med 2003;1:1-9.
Gowri S, Naik VA, Powar R, Honnungar R, Mallapur MD. Epidemiology and outcome of burn injuries. J Indian Acad Forensic Med 2012;34:312-4.
Sadeghi Bazargani H, Arshi S, Ekman R, Mohammadi R. Prevention-oriented epidemiology of burns in Ardabil provincial burn centre, Iran. Burns 2011;37:521-7.
Mago V, Yaseen M, Barier LM. Epidemiology and mortality of burns in JNMC Hospital, AMU Aligarh. Indian J Commun Med 2004;29:10-2.
Bhattacharya S, Ahuja RB. Management of burn disasters. Indian J Burns 2003;11:57-60.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10]