The spectrum and outcome of burns at a regional hospital in South Africa.

INTRODUCTION: Burns remain a major cause of morbidity and mortality in Southern Africa. The more vulnerable of our population, namely the urban poor, children and epileptics, are most often affected. This audit documents our experience with burns in a busy regional hospital in Southern Africa. PATIENTS AND METHODS: A prospective data base was maintained from September 2006 to February 2008 of all burn wound patients admitted in Edendale hospital. Standard demographic data, detailed description of the burn, surgical intervention, outcome and length of stay are recorded. The size and depth of the burn, as well as the initial fluid management are also recorded.
RESULTS: A total of 450 patients were admitted. Two hundred and thirty-five were male. There were 203 burnt children with an average age of 3 years (range 6 months to 12 years). Average age for adults was 40 years (range 13-82 years). The average surface area burnt in children was 7.5% versus 23% in adults. Of those who died, the average surface area burnt was 54%. In adults the average burn depth was superficial in 30%, deep dermal in 20% and full thickness in 50%. The aetiology of the burn was flame 70%, hot water 25% and miscellaneous 5%. In children the breakdown of burn depth was superficial in 77%, deep dermal in 15% and full thickness in 8%. The aetiology was hot water 83%, fire 6%, electrical 6% and miscellaneous 5%. The last mentioned included hot oil or porridge (15), electrical (10), chemical (6), flash burns (8) and lightning (4). Fifty percent of adults were epileptic and had sustained their burn wound during a seizure. In this group, over 40% had previously sustained burns. Fifteen percent had a delayed presentation on an average of 11 days. Hospital stay averaged 68 days (3.5 days per percent burn: range 1-161 days). Two hundred and two (45%) patients required skin grafting. The average time from burn to graft was 51 days (range 12-138). There were 40 deaths (9%) with an average age of 50 years (range 6 months to 82 years) and an average total burn surface area of 50% (range 14-85%). Aetiology of the burn in the deaths was fire in 30, lightning 4 and hot water 6. Cause of death was burn wound sepsis in 38 and inadequate resuscitation in 2.
CONCLUSION: Young children and epileptics are particularly vulnerable to sustaining burns. Our hospital sees a large number of burns predominantly involving smaller surface areas. Patients with small burns have a prolonged hospital stay and delayed grafting due to a conservative surgical approach and lack of resources. Large burns are fatal in our hands.