Clinical study of burn patients requiring admission: A single center experience at North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences.

BACKGROUND: Although burns are a major problem in health care, a lot of the variation in risk factors exists from region to region which if uncovered correctly could help take effective prevention measures. AIMS AND
OBJECTIVES: To assess the 3-year (January 2012 to January 2015) epidemiology of burn injuries admitted to our hospital (primary objective) and to find areas of improvement in burn care (secondary objective).
MATERIALS AND METHODS: After obtaining ethical approval data were obtained from the medical record section regarding age, sex, residence, occupation, marital status, socioeconomic status, dates of admission and discharge, circumstances regarding the place, intent, cause, and source of heat. Clinical assessment was done using Wallace's "Rule of Nine" in adult and "Lund and Browder" chart in the pediatric age groups. The interrelationships between clinical and epidemiological variables with burn injury were studied.
RESULTS: An increasing trend in the admission rates of burn victims noted in last 3 years males (55.47%) outnumbered females (44.52%). The most common age group affected is older children, adolescents, and young adults (between 11 and 30 years). Flame (38.3%) and scald (25.3%) burns contributed to most of the injuries. Females (52.30%) are the major victim of flame burns. Electrical and chemical burns affected only the males suggesting work-related injuries. Trunk (30.8%) is the most severely affected site in all cases. Depression (6.8%) and power line workers (4.7%) seem to be important risk factors in our study. Inability to complete treatment (26.7%) was a major concern in our study.
CONCLUSIONS: This study highlights the need for proper burn care that could be provided at the primary health-care level. The majority of burns were accidental in nature in school going children, young adults, and females. Flame and scald burns were the most common cause. Preventive measures directed toward burn safety and first aid measures may improve the outcome in burn injuries.

Introduction

Burn injuries which are a well-known health problem since ages continue to increase in incidence in spite of improved healthcare facilities and awareness among the masses. It is estimated that 1% of the world population will suffer from a serious burn injury sometime in their life.[12]

The etiological factors of burns vary in different countries and within various regions of the same country. India with such diverse cultural and climatic conditions has varied epidemiological factors leading to burn injuries. Consequently planning and implementing preventive programs can be made more successful if data can be accumulated from most parts of the country. The paucity of data from North-eastern India prompted us to undertake this study about the various epidemiological factors prevailing in the region.

Materials and Methods

After obtaining Institutional Ethics Committee approval, this retrospective study was carried out on a total of 146 burn patients admitted between January 1, 2012, and January 1, 2015. Patients treated on outpatient department basis were excluded from the study. Data were obtained from the medical record section, (including telephonic and personal communication) regarding (i) age, sex, residence, education, occupation, marital status, socioeconomic status (SES) of the patients, (ii) circumstances leading to the injury: place, time, agent, and (iii) chronological data: date of admission and discharge.

Clinical assessment was done in the form of general assessment of the patients, total body surface area (TBSA), degree/depth of burns and any associated illness. Depth of burns was divided into first, second, and third-degree burns. For defining the extent of burns, Wallace's rule was used in adult and Lund and Browder chart was used in children. SES was calculated using the Kuppuswamy's SES scale online tool. Routine hemogram, serum electrolytes, urea, creatinine, random blood sugar, urine albumin, urine sugar, wound swab culture, and sensitivity were done on admission and whenever felt necessary. The inter-relationship between clinical variables and epidemiological variables with burn injury were studied. This was a descriptive study, so no test for significance was applied. On the basis of the observations and analysis, results were drawn and compared with other relevant literature.

Results

The rates of hospital admission in 2012 were 25.34% whereas in 2014 it was 41.78% [Table 1], thereby showing an increasing trend in the rates of admission of burn patients. Moreover, the burn cases handled at the primary care level has also increased from 24.32% to 34.24%. There was male predominance in the number of burn patients [Figure 1]. Majority (43%) of the patients were males between 11 and 30 years of age [Table 2 and Figure 2] followed by preschool children (<6 years age). About 69.86% of patients (n = 102) belonged to low socioeconomic group [Table 3] and 69% were from rural background [Figure 3]. The ethnic group mostly affected were persons belonging to the Khasi community (38%) followed by persons belonging to the Jaintia and Bengali communities, respectively [Figure 4]. Flame (38.35%) and scald (25.34%) burns were the most common cause whereas electrical burns (6.16%) were the least common cause [Table 4]. The flame burn was more common in females (52%) due to the use of firewood and coal for cooking and wearing of synthetic apparels during cooking [Table 5]. About 28.7% patients had burn injuries involving 10–20% of TBSA and very few cases (2.1%) had burns involving more than 70% TBSA [Table 6]. Trunk (30.8%) was most common body part involved [Table 7], followed by upper limbs (27.4%) and lower limbs (26.7%). Facial burn (including head and neck) was the least common (6.8%) as few cases were associated with suicidal or homicidal injuries.

Table 1

Rates of hospital admission during the various periods

Figure 1

The number of males (n = 81) and females (n = 65) injured in percentage

Table 2

Sex differences in all age groups

Figure 2

Number of patients in each age group

Table 3

Socioeconomic status in different sex groups

Figure 3

Social background

Figure 4

Different ethnicities commonly affected

Table 4

Comparing etiology with age groups

Table 5

Etiology of burn injuries

Table 6

Body surface area with number of patients

Table 7

Most severely affected body site

Majority of the patients (57%) suffered burn from nonwork-related activities. Few cases burns due to suspected assault (6%) and child abuse (4%) were noted [Table 8]. Depression (6.8%) was the most commonly associated risk factor [Table 9], followed by workers engaged in the power line (4.7%), drug abusers (2.7%), and epileptics (2.1%). Most of the burns occurred in house (61.6%) followed by streets (22%) and workplaces [Table 10]. Third-degree burns (52.73%) were the most frequently encountered injuries [Table 11]. A good proportion of patients (26.7%) could not complete treatment [Table 12] due to financial constraints (17.1%) and lack of family support (4.1%). Eleven patients died during their course of treatment in the hospital (7.5%), who were associated with severe burn injuries or inhalational injuries.

Table 8

Circumstances of injury

Table 9

Common identifiable risk factors

Table 10

Place of injury

Table 11

Degree of burns in different sex groups

Table 12

Different modes of disposition

Discussion

Worldwide, approximately 2 lakh people die each year from burn injuries.[3] In developing countries, these injuries are one of the major cause of concerns for public health with South-eastern Asia accounting for the highest burn injury related mortality rates.[34]

With India's recent socioeconomic growth, health care has improved, but the management of burn patients and their prognosis still remains poor probably due to the lack of trained professionals and specialized burn centers.[5] Contributing to this is the high cost related to burn injuries which is unaffordable to most patients[56] as was evident in our study where 26.7% of patients could not complete their treatment due to financial constraints.

Age group of 11–30 years was most commonly affected similar to many other studies.[78910111213]

Flame burns followed by scalds were the most common causes of burn injuries seen in our patients similar to many other studies from India[14] and abroad.[13] This high incidence may be attributed to the frequent use of hot liquids and fireplaces to combat the cold and windy weather prevalent in this hilly region. Unlike other studies[15] chemical burns in this region were seen mostly in males and was accidental in nature.

Seasonal variation in burn injuries are another potential area of importance and have been reported from different regions in India like Western (Ahmedabad)[16] and Central India (Nagpur).[17] Very high temperature and low humidity during the summer in these regions are responsible for burn injuries.

However, people living in this region use “open wood fire” and “Gorsy” (burning coal on an earthen container) as a source of heat in winter months, increasing the incidence of accidental burn injuries. There is also a surge in the number of burn injuries during the windy months of March to May.

The incidence of burns is also more during Diwali festival as seen in some studies.[18]

Another factor contributing to burns in this region may be a lack of a separate kitchen area and people usually cook inside or beside their living room/cottage. Similar findings were also noted in many studies from India[1419] and other low-income countries such as Egypt[20] and Pakistan.[21]

Conclusions

Since burn injuries are a major cause of disease burden in India, studying the epidemiologic factors and identifying potential risk factors affecting mortality in burn patients may help identify patients at higher risk of death. Burns with higher TBSA, females, and burns with inhalation injuries were associated with higher mortality correlating well with many other studies.[61622]

There are many limitations of this study. First, the number of patients in this series was limited which is due to the sparse population density of this part of the country. Second, this is a single center-based study, so burn victims attending other health care facility will be missed. Third, as the North-eastern region have a mixed population with nearly 200 ethnic communities with different lifestyle and habits and also the topography of the various regions vary, so data collected from a single center may not be reflective of the whole region.

A more systematic multicenter study is required to be able to get a more comprehensive data about the region which may be reflective of the whole region, and necessary suggestions may be put forward regarding preventive and therapeutic measures to be adopted in cases of burn injuries.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.