|Year : 2016 | Volume
| Issue : 1 | Page : 58-61
A study of residual physical disability after a burn injury in patients admitted in tertiary care hospitals in Karnataka, India
Gowri Shankar1, Vijaya A Naik2
1 Department of Community Medicine, S Nijalingappa Medical College, Bāgalkot, Karnataka, India
2 Department of Community Medicine, Jawaharlal Nehru Medical College, KLE University, Belagavi, Karnataka, India
|Date of Web Publication||12-Dec-2016|
Professor, Department of Community Medicine, S Nijalingappa Medical College, Bāgalkot, Karnataka
Source of Support: None, Conflict of Interest: None
Introduction: Burn Injuries Are Among The Leading Causes Of Disability-Adjusted Life Years Lost In Low And Middle Income Countries. In India, About 6-7 Million People Suffer From Burn Injuries Every Year. Out Of Them, 7 Lakh Require Hospital Admission And 2.4 Lakh Become Disabled. Materials And Methods: A Prospective Study Was Conducted To Identify The Epidemiological Determinants For Residual Physical Disabilities In Burn Patients Admitted Between April 1St, 2004 And March 31St, 2005 In Two Tertiary Hospitals In Belagavi City, Karnataka, India. Out Of 316 Patients Admitted During The Study Period, 48 (15.19%) Had Residual Physical Disability At The Time Of Discharge. Data About Their Socio Demographic Profile, Total Burn Surface Area, Mode And Type Of Burn, Severity And Depth Of Burn And Type Of Disability Was Collected On A Pre Designed Proforma After Informed Consent. Data Was Analyzed By Percentages And Chi-Square Test. Results: Out Of 48 Patients With Residual Physical Disability Sustained After A Burn Injury, 15 (31.25%) Were Males And 33 (68.75%) Were Females. Maximum Number (70.83%) Were Between 15-44 Years Of Age. Majority (77.08%) Were From Rural Areas. It Was Observed That 62.5% Were Wearing Synthetic Clothes At The Time Of Burn. Majority (85.4%) Had Scar Contractures. Maximum Number (89.58%) Had Upper Limb Injury Followed By 47.9% With Chest Injury. Conclusion: Burn Injury Should Be Prevented At All Costs And Health Education Regarding Safety Measures Should Be Implemented In All Educational Institutions.
Keywords: Burn Injury, Residual Physical Disability, Contractures
|How to cite this article:|
Shankar G, Naik VA. A study of residual physical disability after a burn injury in patients admitted in tertiary care hospitals in Karnataka, India. Indian J Burns 2016;24:58-61
|How to cite this URL:|
Shankar G, Naik VA. A study of residual physical disability after a burn injury in patients admitted in tertiary care hospitals in Karnataka, India. Indian J Burns [serial online] 2016 [cited 2017 Sep 21];24:58-61. Available from: http://www.ijburns.com/text.asp?2016/24/1/58/195528
| Introduction|| |
A Burn Injury Is A Devastating Experience For The Victim And The Families Concerned. Globally, The Incidence Of Burn Injuries Severe Enough To Require Medical Care Was Almost 11 Million And Ranked Fourth In All Injuries. It Leads To More Than 3,00,000 Deaths Each Year Worldwide. Burn Injuries Are Among The Leading Causes Of Disability-Adjusted Life Years Lost In Low- And Middle-Income Countries. Depending On The Total Burn Surface Area And The Depth Of Burn, The Patient Can Completely Recover Or Succumb Or Survive With Residual Physical Disabilities. In India, About 6-7 Million People Suffer From Burn Injuries Every Year. Out Of Them, 7 Lakh Require Hospital Admission And 2.4 Lakh Become Disabled. These Deformities Leave The Patient Socially, Economically, And Psychologically Handicapped.
Disabled Persons Cannot Act Independently In Many Spheres Of Life And So Face Many Problems In Their Social Adjustments. Their Incapacity Generates Emotional Problems Such As Apathy, Self-Pity, And Resentment And Isolates Them From The Society.
Burn Injury Is A Common Public Health Problem In India. Post-Burn Scarring Is Both Physical And Psychological And Can Be As High As 95% With Hypertrophic Scarring Being 41%. Hence, This Study Was Done To Understand The Determinants And The Types Of Physical Deformities In Burn Injury Patients At The Time Of Discharge From Tertiary Hospitals In Karnataka, India.
| Materials and Methods|| |
A Prospective Study Was Conducted To Identify The Epidemiological Determinants For Residual Physical Disabilities In Burn Patients Admitted Between April 1, 2004 And March 31, 2005 In Two Tertiary Hospitals In Belagavi City, Karnataka, India. Deaths, Complete Recovery, And Discharge Against Medical Advice Were Excluded From This Study. Only The Patients Who Had A Residual Physical Disability (Contractures And Amputations) Due To A Burn Injury On Discharge From The Hospital Were Included In The Study. Out Of 316 Patients Admitted During The Study Period, 48 (15.19%) Had Residual Physical Disability At The Time Of Discharge. After Ethical Clearance From The Institutional Review Board, Data Regarding Their Sociodemographic Profile, Total Burned Surface Area (Tbsa), Mode And Type Of Burn, Severity And Depth Of Burn And Type Of Disability Was Collected On A Predesigned Pro Forma After Informed Consent. Data Was Analyzed By Percentages And Chi-Square Test. Rule Of Nines Was Used To Determine Tbsa. According To Burn Injury Classification 'A' Is Major Burn, 'B' Is Moderate Burn And 'C' Is Minor Burn.
| Results|| |
Out Of 48 Patients With Residual Physical Disability After A Burn Injury During The Study Period, 15 (31.25%) Were Males And 33 (68.75%) Were Females With Male To Female Ratio Of 0.45:1. Maximum Numbers (70.83%) Of Patients Were Between 15-44 Years Of Age [Table 1]. Majority (77.08%) Were From Rural Areas. It Was Observed That 83.33% Of The Injuries Were Accidental, Followed By 6.25% Alleged Suicidal And 10.42% Alleged Homicidal. Maximum Number Of The Deformities (85.42%) Were Due To A Flame Injury. Majority (47.92%) Were From A Nuclear Family And 41.67 % Were Living In Kutcha Houses. Maximum Numbers (81.25%) Were From Low Socioeconomic Status. It Was Observed That 35.42 % Were Housewives [Table 2]; Majority (31.25%) Had Secondary Education [Table 3]. The Most Common Sources Of Burn That Led To A Disability Were Kerosene And Kerosene Stove On The Floor, Each Contributing To 16.67% Of The Cases. Maximum Number Of Injuries (72.92%) Had Occurred Indoors. It Was Observed That 62.5% Of The Victims Were Wearing Synthetic Clothes At The Time Of Burn [Table 4].
|Table 3: Distribution according to education of the burn injury patients|
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|Table 4: Distribution according to the type of clothing worn at the time of burn injury|
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It Was Observed That 60.42% Of The Study Subjects Had 20-40% Tbsa. Majority 83.33% Had Second Degree Burns Followed By 14.58% With Third Degree Burns. The Severity Of Burn In 89.58% Was 'A' (Major Burn). Majority (85.42%) Had Scar Contractures [Table 5]. Majority (89.58%) Had Upper Limb Burn Injury Followed By 47.91% With Chest Injury [Table 6]. With Regard To Duration Of Stay In Hospital More Than 50% Of The Survivors With Disability Stayed For More Than 30 Days As Shown In [Table 7].
| Discussion|| |
Out of the total admissions of burn injury during the study period of 1 year, 48 patients had a physical deformity at the time of discharge. As the sample size is small, definitive conclusion about the findings is difficult. The prevalence of residual disability after a burn injury in this study was 17.65%. In a study done in India, hypertrophic scarring was 41% and post-burn contractures were neck −6%, knee −1%, axilla −1%, elbow and wrist −4%, hands and fingers −6%. In a study done in Ghana, there was a 17.4% prevalence of burn-related functional disabilities, which were mostly keloids. In another hospital study done in India, residual physical disability was seen in 24 patients out of the total 92 burn admissions (26.1%). Our finding indicates the physical and emotional issues of the victims due to their disability and the burden on health care resources for efficient rehabilitation into society.
Nearly 70% of the burn disability survivors were females and this finding is nearly similar to other studies , and suggests the gravity of the situation for rehabilitating them with family support. Majority were between 15 years of age and 44 years of age, and this inference is similar to another study. This is the most economically productive age group and indicates the social issues that will prevail in such conditions. Additionally, maximum number of victims were from rural areas belonging to nuclear families and low socioeconomic status. These findings suggest the need for community-based rehabilitation at the primary health care level with support from the local governing bodies to bring back the survivors to the mainstream of life. The most vulnerable population is the housewives wearing synthetic clothes and using kerosene in their homes. Nonflammable garments are to be worn at home and the use of safer equipment is the need of the hour to decrease the number of accidents and the morbidity due to extensive burns that will lead to lifelong pain and dependency due to the contractures and amputations of the limbs. In another study, neck contractures were more common. More than 50% of the survivors had to stay for more than 30 days in the hospital leading to a burden on the health care system as well as their family members.
| Conclusion|| |
Extensive and deep burn injuries lead to residual physical disability, the most common being scar contractures and amputations. As the sample size was small, our findings could not be compared to other similar studies. Burn injuries should be prevented at all costs and health education regarding safety measures should be implemented in all high schools and colleges. Alternative safer cooking implements should be marketed that do not cause severe and life-threatening injury. Legislation to ban unsafe equipment should be introduced at the earliest so that the women of India will not have to suffer disability due to burns in their most productive age.
The author would like to acknowledge the patients and their caretakers for cooperation during the study period.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Peck MD. Epidemiology of burns throughout the world. Part I: Distribution and risk factors. Burns 2011;37:1087-100.
Annual Report of Department of Health and Family Welfare for the year 2013-14, Government of India; 2011. p. 209. www.mohfw.nic.in
Gupta A. A study of clinical and psychological sequelae of burns in 250 patients. Indian J Burns 2010;18:45-50.
Spires CM, Brammer CM. Manual of physical medicine and rehabilitation. Philadelphia: Hankey and Belfus Inc.; 2002. p. 19.
Forjuoh SN, Guyer B, Ireys HT. Burn-related physical impairments and disabilities in Ghanaian children: Prevalence and risk factors. Am J Public Health 1996;86:81-3.
Shankar G, Kalburgi EB, Selvan VT, Hunshikatti SS. A 1 year prospective study of burn injuries admitted in a tertiary care teaching hospital in North Karnataka, India. Indian J Forensic & Comm Med 2015;2:110-7.
Gangemi EN, Gregori D, Berchialla P, Zingarelli E, Cairro M, Bollero D, et al
. Epidemiology and risk factors for pathologic scarring after burn wounds. Arch Facial Plast Surg 2008;10:93-102.
Agbenorku P. Burns functional disabilities among burn survivors: A study in Komfo Anokye Teaching Hospital, Ghana. Int J Burns Trauma 2013;3:78-86.
Schneider JC, Holavanahalli R, Helm P, Goldstein R, Kowalske K. Contractures in burn injury: Defining the problem. J Burn Care Res 2006;27:508-14.
Saaiq M, Zaib S, Ahmad S. The menace of post-burn contractures: A developing country's perspective. Ann Burns Fire Disasters 2012;25:152-8.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]