|Year : 2021 | Volume
| Issue : 1 | Page : 82-86
Clinicoepidemiological profile of thermal burn injuries and its mortality risk factors in a tertiary care center in Uttarakhand
Pankaj Kumar Verma1, Himanshu Saxena2, Sriranjan Kala3, Mohit Singh3, Komal Tripathi2
1 Department of Surgery, Government Medical College, Almora, Uttarkhand, India
2 Department of Plastic Surgery, Government Medical College, Haldwani, Uttarkhand, India
3 Department of Surgery, Government Medical College, Haldwani, Uttarkhand, India
|Date of Submission||14-Dec-2021|
|Date of Acceptance||17-Jan-2022|
|Date of Web Publication||08-Jun-2022|
Dr. Komal Tripathi
Department of Plastic Surgery, Government Medical College, Haldwani, Uttarakhand
Source of Support: None, Conflict of Interest: None
Introduction: Burns are a major burden to the society in terms of lives lost, treatment costs, and postburn deformities. This study aims to identify the incidence, causes of burns, associated risk factors, and mortality in a tertiary care center in Uttarakhand.
Patients and Methods: This study was an observational study conducted from October 2018 to April 2021 at a tertiary care center in Uttarakhand. It includes the patients with thermal burns who were admitted in the burns unit of the hospital. The interrelationship between various risk factors and mortality was studied.
Results: A total of 247 patients were included in the study. Males outnumbered females constituting 55.47% of the population. Most of the patients were of age group 21–40 years and were from rural backgrounds, belonging to lower socioeconomic class. The literacy rate was 76.52%. Farming was the predominant occupation. Major cause of burns was flame burns with second-degree burns being the most common. Accidental burns were common, and mostly (39.68%) patients sustained burns with total burn surface area (TBSA) <25%. The mortality rate was 11.34%. Majority (56.68%) of the patients belonged to Class IV socioeconomic class (modified BG Prasad classification).
Conclusions: Young males of rural background and low socioeconomic strata were the most common victim of burn injuries. The majority of cases were accidental thermal burns. The mortality rate was high in patients with TBSA >60%, third-degree burns and housewives. Appropriate measures need to be taken regarding the education of the public for prevention of burns and improvement in healthcare to decrease the incidence and improve the outcome of burn patients.
Keywords: Burns, epidemiology, India, tertiary care hospital, Uttarakhand
|How to cite this article:|
Verma PK, Saxena H, Kala S, Singh M, Tripathi K. Clinicoepidemiological profile of thermal burn injuries and its mortality risk factors in a tertiary care center in Uttarakhand. Indian J Burns 2021;29:82-6
|How to cite this URL:|
Verma PK, Saxena H, Kala S, Singh M, Tripathi K. Clinicoepidemiological profile of thermal burn injuries and its mortality risk factors in a tertiary care center in Uttarakhand. Indian J Burns [serial online] 2021 [cited 2022 Jun 25];29:82-6. Available from: https://www.ijburns.com/text.asp?2021/29/1/82/346914
| Introduction|| |
Burn is one of the most common forms of trauma. It is a major burden to the society in terms of lives lost, treatment costs, and postburn deformities. Uttarakhand is one of the Himalayan states of India. The difficult mountainous terrain and frequent natural calamities make the availability of medical care difficult and delayed for the population. This study was done in a tertiary care center, which serves as a referral center for the entire Kumaon division of Uttarakhand, adjoining districts of western Uttar Pradesh, and border areas of Nepal. This study aims to identify the incidence, causes of burns, associated risk factors, and association of variables with mortality, so that appropriate preventive and management strategies can be devised for the same.
| Patients and Methods|| |
This study was conducted in Government Medical College, Haldwani, from October 2018 to April 2021. Institutional ethics committee clearance was taken.
Patients with thermal burns admitted to the burns unit of the hospital were included in the study.
Electric and chemical burns, minor burns treated on outpatient department basis were excluded from the study.
The percentage of total burn surface area (TBSA) of the patients was noted. History of the patient was taken, and thorough examination was done. Age, gender, religion, residence (rural/urban), marital status, level of education, occupation, socioeconomic status (modified BG Prasad classification), cause of burns, and outcome of the patients were noted with respect to hospital stay (in days) and discharge from the hospital/mortality.
| Observations and Results|| |
A total of 247 patients were studied, 137 patients were males and 110 patients were females. Maximum number of patients (n = 108, 43.72%) belonged to the age group of 21–40 years followed by patients (n = 86, 34.82%) belonging to the age group of 0–20 years. Residential status showed that 141 patients belonged to rural areas, whereas 106 patients belonged to urban areas. Religion-wise distribution showed 211 patients to be Hindus, 34 patients to be Muslims, and 2 patients belonging to other religions. Marital status of the patients showed 144 patients to be married, 32 patients were as unmarried with remaining 71 patients either children or widowed.
Occupation wise, 68 patients were farmers, 61 patients were housewives, while 50 patients were students. Educational evaluation of the patients showed that 26.32% of the patients were educated up to intermediate level, followed by 23.48% of illiterate patients. High school, graduate, and postgraduate patients constituted 18.62%, 16.60%, and 14.98% of the total patients, respectively.
Maximum number of patients belonged to Class IV social class (as calculated by modified BG Prasad Classification) constituting 56.68% of the total population [Table 1].
The cause of burns was flame burns in 183 patients, scald burns in 34, contact with hot objects in 17, cylinder blast in 8, and kerosene burns in 5 patients (mean: 49.4; standard deviation [SD]: 75.533; t-test P: 0.2174). The nature of burns was accidental in 38 (06.36%), suicidal in 6 (2.43%), homicidal in 2 (0.81%), and unknown in 1 patient. Ninety-five percent (confidence interval [CI]) of this difference was taken (mean: 61.75, SD: 117.520; t-test P: 0.3705). Majority of patients (n = 121) had second-degree burns, 80 patients had first-degree burns, and 46 patients had third-degree burns (95% CI of this difference taken, mean: 82.333; SD: 37.554; t-test P: 0.0629). A total of 10.12% of patients sustained burns with TBSA of 75%–100%. About 17.41% patients had TBSA burns of 51%–75% and 32.79% patients had burns with TBSA 0%–25% (95% CI of this difference taken; mean: 61.75, SD: 33.599, t-test P: 0.0349). Hypertension and diabetes were present in four and seven patients, respectively (mean: 82.33; SD: 133.088; P = 0.3961). Duration of stay- (39.6%) patients stayed for 20–25 days in hospital. Whereas, 22 (8.9%) patients stayed for 1–7 days, 53 patients (21.598 patients %) stayed for 14–20 days, and 26 patients (10.6%) stayed 25–30+ days in hospital after thermal burns [Table 2].
Correlation between mortality and variables
Out of the total 247 patients, 28 (11.34%) patients expired and 219 (88.66%) patients survived. The mortality rate in the age group of 0–20 years was 14.29%, age group 21–40 years was 42.86%, age group 41–60 years was 10.14%, and age 61 and above was 32.14% (mean: 7; SD: 4.24, two-tailed P: 0.2952 by one-sample t-test).
Out of the 28 patients who expired 21 patients were females and 7 patients were males (mean: 14; SD: 9.90; two-tailed P: 0.2952 by one-sample t-test).
The patients belonging to urban and rural areas were 5 (17.86%) and 23 (82.14%), respectively (mean: 14; SD: 12.73; two-tailed P: 0.3638 by one-sample t-test). Community distribution showed 89.29% Hindu and 10.71% Muslim patients (mean: 14; SD: 12.73; two-tailed P: 0.3638 by one-sample t-test). Among the patients who expired, there were 24 married patients (85.71%) and 4 (14.29%) widowed patients (mean: 9.33; SD; 12.86, two-tailed P: 0.4918).
There were 16 housewives (57.14%), 5 farmers (17.86%), 2 students (7.14%), 2 laborer (7.14%), and 3 patients with other occupations (10.71%) (mean: 5.6; SD: 5.94; two-tailed P: 0.1027 by one-sample t-test).
The number of illiterates was 7 (25%), 10th passed were 5 (17.86%), 12th passed were (42.86%), graduates were 3 (10.71%), and postgraduates were 1 (3.57%) (mean value: 5.6; SD: 4.22; two-tailed P: 0.0413 by one-sample t-test. This difference was statistically significant [Table 3].
Mortality risk factors
All the expired patients had flame burns (mean: 14; SD: 19.80; two-tailed P: 0.5000 by one-sample t-test). There were 22 (78.57%) patients with flame burn, 3 (10.71%) patients with cylinder blast, and 3 (10.71%) kerosene burn (mean: 9.33; SD: 10.97; two-tailed P: 0.2786 by one-sample t-test).
The nature of the burn of the expired burns was accidental in 23 (82.14%) patients, suicidal in 3 (10.71%) patients, and homicidal in 2 (7.14%) patients (mean: 9.33; SD: 11.85; P: 0.3059 by one-sample t-test). The degree of burn of the expired patients was evaluated in which patients with first-, second-, and third-degree burns were 1 (3.57%), 9 (32.14%), and 18 (64.29%), respectively (mean: 9.33; SD: 8.50; two-tailed P: 0.1976 by one-sample t-test).
On considering the TBSA burn of expired patients, 6 (21.43%) patients had 0%–50% TBSA burns, 5 (17.86%) patients had 51%–75% TBSA burns, and 15 (53.57%) patients had 75%–100% TBSA burns (mean: 8.67; SD: 5.51; two-tailed P: 0.1124 by one sample t-test).
Correlation between associated systemic illness and mortality was evaluated. There were three (10.71%) hypertensive patients and six (21.43%) diabetic patients.
(mean: 9.33; SD: 8.50; two-tailed P: 0.1976 by one-sample t-test). [Table 4]
| Discussion|| |
A total of 247 patients were included in the study, with female-to-male ratio of 1:1.33. This was an interesting finding as most of the epidemiological studies showed female predominance.,,, These studies showed that women got burned while working in kitchen. In contrast, most of the patients in our study were either farmers or laborers belonging to young age group which may account for the male predominance seen in our study.
Our results were similar to Pal et.al., who concluded that males were more affected in comparison to females.
Young adults were found to be most susceptible based on our findings with majority in the age group of 20–40 years (n = 108; 43.72%) and 0–20 years age group (n = 86; 34.82%), these findings are consistent with other studies.,
Our nation has a large population of adults and young adults which form the workforce. Such individuals are more likely to be involved in hazardous activities and get burned accidentally. About 93.36% of the burn in our patients were accidental in nature, indicating a need for education and implementation of preventive measures regarding fire safety. The rate of suicidal burns was less in our study. This finding is in accordance to the other studies done in India.
In our study, the number of the patients belonging to rural areas outnumbered the patients belonging to urban areas. Most of the patients were Hindus (n = 211: 85.43%) followed by Muslims (n = 34; 13.77%). We also observed that 144 patients were married and 32 patients were unmarried. The remaining 71 patients were either children or widowed. This corresponds to the demographics of the region.
In our study, 76.52% of patients declared that they were literate and attended formal schooling, whereas 58 patients were observed to be illiterate (23.48%). Highest number of expired patients belonged to the 12th pass group. This implies that mere acquisition of formal education does not translate into behavioral change. Most of the people still lack information regarding fire safety.
In our study, most patients belonged to poor economic background, socioeconomic Class IV. While males predominated in our study, the mortality rate was higher among females. Similar studies have shown women in the reproductive age group from the lower socioeconomic strata to be the most frequent victims.
In our study, the majority of burns were flame burns which were mostly accidental in nature. This was followed by suicidal burns and homicides. These results were similar to other studies.
The majority of patients sustained second-degree burns, and 39.68% of patients sustained burns with TBSA <25%. While in other studies, the mean TBSA burns were either comparable or higher.,,
In our study, we found only a few patients with associated systemic illnesses. Only four patients were hypertensive and seven patients were diabetic.
Out of 247 patients, 219 survived, whereas remaining patients expired (n = 28), the mortality rate was 12.7%. This was comparable to a study in Turkey where the mortality rate was found to be 14% with significantly older nonsurviving patients. Older patients were found to have higher mortality rates in our study also. While higher mortality rates were seen in other studies.,
In our study, duration of hospital stay was recorded, from the day of admission to death or discharge of the patient. A study by Vidhate et al showed that most of the patients survived for more than 3 days.
In our study maximum number of patients stayed for 20–25 days, in hospital after thermal burns. This might be because most of the patients in our study came from remote areas of Uttarakhand hills. The patients were discharged only after complete or near-complete healing of the wounds due to the lack of regular dressing facilities at their homes.
| Conclusions|| |
Based on our findings, we feel that a developing country like India needs an aggressive public education program to spread awareness regarding the prevention of burns. There is also necessity of easily accessible and affordable burn care hospitals, especially in the remote areas of the country.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]