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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 25  |  Issue : 1  |  Page : 62-66

Epidemiological study of burn injuries and its mortality risk factors in a tertiary care hospital


1 Former Assistant Professor, Department of Surgery, BJMC, Pune, India
2 Former Senior Resident, Department of Plastic Surgery, BJMC, Pune, India
3 Professor and Head, Department of Plastic Surgery, BJMC, Pune, India
4 Assistant Professor, Department of Plastic Surgery, BJMC, Pune, Maharashtra, India

Date of Web Publication13-Dec-2017

Correspondence Address:
Dr Chirag A Bhansali
A/302, Vastu Siddhi, Rajmata Jijabai Road, Pump House, Andheri East, Mumbai 400093, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijb.ijb_28_16

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  Abstract 

Background: Burn injuries account for a significant cause of mortality and morbidity amongst the Indian population. Since prevention is more important than the treatment of such injuries, this study was undertaken to find out the exact epidemiological determinants of such injuries and thus to try and formulate effective preventive strategies.
Aims and Objectives: To find out the epidemiological characteristics of burn patients in a tertiary care hospital.
Materials and Methods: A Cohort review of patients admitted over a period of 3 years from January 2010 to September 2013 in the burns unit of our institute. Data were collected from hospital admission books which included age, sex, religion, Total body surface area burns, location, mode of burn and the cause of burns. Data were entered in MS EXCEL software and analysed.
Results: There are 3179 patients included in the study. The mean age of patients was 28 years (SD=14.7 years) and overall male to female ratio was 0.6. The percent of Total body surface area for burned patients ranged between 1% and 100% and maximum number of patients were admitted with 30 to 50 % burns (27.5%) The median hospital stay was 5 days. There was a significant association between Total body surface area burns and hospital stay (P<0.001). 7.3% patients were discharged from the hospital after successful treatment. 1733 (54.51%) deaths were recorded. Death rate was higher amongst females as compared to males. Mortality rate was highest in age group of 12–26 years. There was a significant correlation between Total body surface area burns and mortality (P<0.001). Death rate was highest amongst patients with suicidal burns as compared to accidental and homicidal burns.75% patients died within 5 days of hospitalization.
Conclusion: High mortality rate amongst patients is a major concern in the present scenario of health care towards burn injuries.

Keywords: Burns epidemiology, burns aetiology, mortality


How to cite this article:
Bhansali CA, Gandhi G, Sahastrabudhe P, Panse N. Epidemiological study of burn injuries and its mortality risk factors in a tertiary care hospital. Indian J Burns 2017;25:62-6

How to cite this URL:
Bhansali CA, Gandhi G, Sahastrabudhe P, Panse N. Epidemiological study of burn injuries and its mortality risk factors in a tertiary care hospital. Indian J Burns [serial online] 2017 [cited 2018 May 23];25:62-6. Available from: http://www.ijburns.com/text.asp?2017/25/1/62/217043


  Introduction Top


The issue of burns has always been a significant cause of morbidity and mortality in both developing and developed countries around the world and a major cause of global public health crises.[1],[2]

As per the World Health Organization, burns account for an estimated 300,000 deaths annually, majority (>95%) of which occur in developing countries, with the Southeast Asia region contributing to 57% of the deaths.[3] Extrapolated data from major hospitals indicate that about 7 million burn incidents occur in India each year, making burn injuries the second largest group of injuries after road accidents.[4] A significant proportion of these cases are contributed by thermal burns.

The survival rate of the patients with burns in India is approximately 50% for burns involving <40% of the total body surface area (TBSA).[5] Among the patients who survive, the recovery is slow, painful and never complete. The short-term and long-term sequelae of such injuries can be disabling, causing sub-optimal functioning of the patient. It may also leave a deleterious mark on the psyche of the patient, who would have to subsequently undergo multiple reconstructive surgeries to restore both form and function.[3]

The treatment of burns and its sequelae is a major drain on the public health system and also a financial burden for the family. The mean cost per patient, including the social and labour costs, was estimated to be as high as US $1060 in a study conducted at a tertiary teaching hospital of North India.[6] The best treatment for burns is, thus, undoubtedly prevention. Prevention becomes all the more important in our country, wherein the majority of the population is still uneducated, uninsured and cannot afford such costs.

There is a huge paucity of data on the exact pattern of burn injuries and their outcome in India. Having a clear idea of epidemiological characteristics is necessary to chalk out a prevention programme. Hence, this study was conducted at a tertiary care centre in western Maharashtra to assess the epidemiological characteristics of burns victims.


  Aims and objectives Top


To study the epidemiological characteristics of the patients admitted with thermal injuries in a tertiary care hospital.


  Materials and methods Top


This was a retrospective study conducted on 3179 patients, who suffered from burn injuries over 3 years from January 2010 to September 2013 and were admitted in the burns ward at our hospital. The study was approved by the institutional Ethics Committee (1013125-125 [BJMC/IEC/Pharnac/ND-Dept 1013125-125 Date: 22.10.13]).

The patients presented to the casualty and were admitted in the burns ward. On admission, after obtaining a detailed history of the injury, TBSA involved by the burn injuries was calculated according to the ’rule of nine’.[7] Burn wound was cleaned, and the blisters and the debris were removed. Resuscitation was started using the Parkland formula [4 ml RL × kg × %TBSA burn (½ in 1st 8 h, ¼ in 2nd 8 h and ¼ in 3rd 8 h)].[8] Dressing with topical antimicrobials (silver sulfadiazine, mupirocin and soframycin) was performed along with appropriate care of the eyes, the mouth and the back. All patients with electric burns were admitted for 72 h irrespective of the percentage of TBSA burnt. Long-term sequelae such as contractures were treated with physiotherapy and reconstructive surgery.

Data for the study were collected from the admission record books by the study clinicians. As per the burns ward protocol, the variables entered in the admission record books were age, sex, residence, religion, type of burn, mode of burn, TBSA percentage, duration of hospitalisation, number of patients discharged and those who took discharge against medical advice (DAMA), absconded or died during the hospital stay. The data of each patient were collected in keeping with a standard pro forma, which included these variables. The treatment received was not entered in the admission record books and, thus, was not available for analysis in this study.

The data collected were then tabulated in a MS Excel worksheet. An independent team of clinicians evaluated the quality of the data. The analysis of the data was performed using STATA 11.2 software.


  Results Top


During the study period of 3 years from 2010 to 2013, 3179 patients were admitted in the burns ward in our hospital.

Out of these, 1184 (37.24%) were males and 1995 (62.75%) were females. Male-to-female ratio was thus 0.6:1.

The patients’ age ranged from 8 months to 100 years with a median age of 26 years, mean of 28.5 years and standard deviation of 14.7 years. The majority of the patients belonged to the 12–26 years age group (40%). The mean age among the females was 28 years, and the mean age among the males was 29 years. A total of 313 (9.8%) patients were from the paediatric age group (<12 years old).

A total of 2941 (92.51%) patients were Hindus, 214 (6.7%) were Muslims, 11 (0.34) were Christians and 13 (0.40%) were Sikhs.

Around 52% of the patients came from outside Pune city, and 48% of the patients came from Pune city. Average time lapsed prior to hospitalisation for the patients from Pune was 21 h and for the patients coming from outside Pune was 36 h.

Thermal injuries from fire, hot water, etc. were responsible for 96% of the cases, while electrical and chemical burns amounted to 3.8 and 0.2% of the cases, respectively.

A total of 2656 patients (83.54%) had accidental burns, 459 (14.43%) patients had attempted suicidal burns and 64 (2%) patients were admitted with homicidal burns.

The patients were admitted with TBSA burns ranging from 1 to 100%, with maximum patients (27.5%) being admitted with 30–52% TBSA burns. The mean TBSA burns was 54.9%.

The average duration of hospital stay was 5.8 days. The mean length of hospital stay in <30% TBSA burns was 7.6 days, 30–52% TBSA burns was 8.3 days, 52–81% TBSA burns was 4.5 days and >81% TBSA burns was 2.6 days.

Outcome

A total of 234 (7.3%) patients were successfully treated and discharged. A total of 1160 (36.48) patients were DAMA while 20 (0.6%) patients absconded from the hospital. A total of 32 (1%) patients were transferred to other departments for further management [Table 1].
Table 1: Epidemiological characteristics

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Mortality

A total of 1733 (54.51%) patients died during the hospital stay, out of which 1254 (72.36%) were females and 479 (27.63%) were males. The risk of death among the females was, thus, 40% more than that of the males. The mortality rate in different groups is given in [Table 2].
Table 2: Mortality rate by risk groups

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Thus, the mortality rate was highest in the age group of 12–26 years and in the patients with >81% TBSA burns. The patients with suicidal burns had a higher death rate than those with accidental or homicidal burns. The death rate with flame burns was also higher than with electrical and chemical burns.

As shown in [Table 3], percentage burns (%TBSA) was the most important independent predictor of mortality due to burn injuries, because the patients with >81% burns were at 12 times more risk of dying than the patients with lesser percentage of burns injuries.
Table 3: Independent risk factors

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As shown in [Figure 1], the patients with higher %TBSA burns had a higher risk of death. In addition, the patients with higher %TBSA burns died earlier than the patients with lesser %TBSA burns.
Figure 1: Kaplan Meier estimate of the time to death.

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  Discussion Top


Burns injury is one of the major problems threatening public health in developing countries, and burn injuries are among the most devastating of all injuries and a major global public health crisis.[1],[2]

In this study, male-to-female ratio was 0.6 with slight female preponderance. This female preponderance can be attributed to the unsafe cooking practices, which employ traditional shegadi (chullas), etc. in many rural and few urban areas in India. Clothing such as duppatta and saree worn by the majority of the Indian females ignite easily on slight contact with these unsafe stoves. There is evidence to support the claim that domestic violence, which could be physical, mental or sexual, can contribute towards higher incidence of burn injuries in women in India.[9] High incidence among the females was also reported by Kumar et al.[10] in 2007 in Manipal. Ahuja et al.[11] reported a similar female preponderance.

The majority of the burns patients in our study were in the age group of 12–26 (40%) years, which also had the highest death rate (88%). These results were similar to the observation of Singh et al.[12] from Chandigarh, who reported two-thirds of fatal burn cases in the young age group (21–40 years). This predisposition of young individuals may reflect the higher exposure to inflammable agents in this section of the population.

The death rate of the patients from Pune was 87% more than the patients coming from outside Pune city (80%). The mean time taken for the patients to reach the hospital from outside Pune was 36 h, whereas the patients from Pune reached within 21 h.

In our study, the majority of the patients suffered from accidental thermal injuries from causes such as stove blast, pressure cooker blast, clothes catching fire accidentally and kitchen gas leaks. Kerosene is a very cheap and readily available fuel used for cooking in several homes in rural India. Due to the unsafe storage practices as well as hazardous stoves, it becomes a major cause of thermal burns. Villages without electricity use candle and kerosene lanterns, which easily catch fire if it accidentally falls or is damaged.In our study, the death rate among the people with suicidal burns was higher than those with accidental burns. This could be attributed to the fact that the majority of the suicidal burns (47%) had >81% TBSA burns.

In our study, the death rate in 37–52% TBSA burns was 97%, and in >81% TBSA burns, it was 99.8%. Studies from Angola[13] revealed 100% mortality in the patients with over 40% burns. Similarly, 80% mortality rate in burns of over 40–50% TBSA have been reported from India, Albania and Saudi Arabia.[10],[14],[15] It is important to note here that the mortality among the patients with <30% burns was 37%, which is also quite high. As shown in [Table 2], TBSA burns injury was the most important independent risk factor for mortality.

In our study, 75% of the patients died within 5 days, and 90% of the patients died within 8 days. In a study conducted by Kumar et al.,[10] 60% of the patients died within 1 week of admission to the hospital.


  Conclusion Top


  1. Mortality rate among the females was higher than the males.
  2. The mortality increased in the older age groups.
  3. The percentage of the TBSA burnt in a patient was the most important predictor of mortality.
  4. Mortality among the patients with history of suicidal burns was higher than that in homicidal and accidental burns.
  5. Larger demographic data need to be studied in a prospective manner to come up with guidelines for preventive practises for burn injury prevention.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Forjuoh SN. Burns in low- and middle-income countries: A review of available literature on descriptive epidemiology, risk factors, treatment, and prevention. Burns 2006;32:529-37.  Back to cited text no. 1
[PUBMED]    
2.
Peck MD, Kruger GE, van der Merwe AE, Godakumbura W, Ahuja RB. Burns and fires from non-electric domestic appliances in low and middle income countries. Part I. The scope of the problem. Burns 2008;34:303-11.  Back to cited text no. 2
    
3.
World Health Organization (WHO). A WHO Plan for Burn Prevention and Care. Geneva: WHO; 2008.  Back to cited text no. 3
    
4.
Gupta JL, Makhija LK, Bajaj SP. National programme for prevention of burn injuries. Indian J Plast Surg 2010;43:S6-10.  Back to cited text no. 4
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Batra AK. Burn mortality: Recent trends and socio-cultural determinants in rural India. Burns 2003;29:270-5.  Back to cited text no. 5
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6.
Ahuja RB, Goswami P. Cost of providing inpatient burn care in a tertiary, teaching, hospital of North India. Burns 2013;39:558-64.  Back to cited text no. 6
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7.
Warden GD, Heimbach DM. Burns. In: Schwartz SI, Shires GT, Spencer FC, editors. Principles of Surgery. 7th ed. New York: McGraw-Hill; 1999. p. 223-62.  Back to cited text no. 7
    
8.
Baxter CR, Shires T. Physiological response to crystalloid resuscitation of severe burns. Ann N Y Acad Sci 1968;150:874-93.  Back to cited text no. 8
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9.
Garcia-Moreno C. Gender inequality and fire-related deaths in India. Lancet 2009;373:1230-1.  Back to cited text no. 9
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10.
Kumar V, Mohanty MK, Kanth S. Fatal burns in Manipal area: A 10 year study. J Forensic Leg Med 2007;14:3-6.  Back to cited text no. 10
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11.
Ahuja RB, Bhattacharya S. An analysis of 11,196 burns admissions and evaluation of conservative management techniques. Burns 2002;28:555-61.  Back to cited text no. 11
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12.
Singh D, Singh A, Sharma AK, Sodhi L. Burn mortality in Chandigarh zone: 25 years autopsy experience from a tertiary care hospital of India. Burns 1998;24:150-6.  Back to cited text no. 12
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13.
Adamo C, Espocito G, Lissia M, Vonella M, Zagaria N, Scuderi N. Epidemiological data on burns in Angola: A retrospective study of 7230 patients. Burns 1995;21:536-8.  Back to cited text no. 13
    
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Gupta M, Gupta OK, Yaduvanshi RK, Upadhyaya J. Burn epidemiology in Pink City scene. Burns 1993;19:47-51.  Back to cited text no. 14
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El Danaf A. Burn variables influencing survival: A study of 144 patients. Burns 1995;21:517-20.  Back to cited text no. 15
[PUBMED]    


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    Tables

  [Table 1], [Table 2], [Table 3]



 

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Introduction
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