Changes in burn referrals and injuries during CoVid-19.

Dear Editor,

We read with interest the article “Management strategies for the burn ward during COVID-19 pandemic” by Li et al. [1] and share our experiences within the Southwest adult burns unit based at Southmead Hospital, Bristol, United Kingdom.

In 2019 the service reviewed 1495 patients: with 294 being admitted for inpatient care, the average length of stay being 5.39 days. The most frequent mechanism of injury was burn by scalding (n = 708) with these most commonly occurring in the kitchen.

On the 23rd March, the government announced new measures to limit the spread of the SARS-CoV-2 (CoVid-19) pandemic. These included a nationwide closure of all schools, advising that the public should avoid non-essential travel and to work from home if able.

Many aspects of healthcare provision within the NHS have been reconfigured [2] to accommodate the predicted numbers of patients requiring inpatient care due to infection with SARS-CoV-2. However the referral criteria to our burns services remain unchanged and this snapshot review, following the imposed government restrictions, provides an insightful reflection into the daily activities of the general public and changes that have presented to our unit.

To ensure that changes reflected the lockdown, data was collected from the 30th March to the 5th April in 2020. This week was mapped onto the previous 5 years. Information was retrieved from the local database from the International Burn Injury Database (IBID). This included the demographics of patients presenting to our service, the total body surface area of burn (TBSA) and also the place and mechanism of injury.

In 2015, 27 patients (15 males, 12 females) were seen with 3 admitted following review of their burn injury. The average age was 42.4 years and TBSA of 0.96%. Mechanism of burn injuries included flash (n = 4), scald (n = 13), chemical (n = 3), contact (n = 4) and flame (n = 3). 68% of patient sustained their injury at home (n = 18), 15% at work (n = 4) and 3% in other localities (n = 1). Table 1

Table 1

Indicating yearly trends and locality of where burn injuries were sustained.

Year	Total	Place of injury
		Home	Work	Other
2015 (n = 27)	27	18	4	1
2016 (n = 19)	19	13	2	4
2017 (n = 25)	25	14	6	5
2018 (n = 19)	19	13	1	5
2019 (n = 25)	25	15	5	5
2020 (n = 18)	18	15	2	1

Results of IBID interrogation showed the following results, over the same week between 2015 to 2020.

In 2016 a total of 19 patients (11 males, 8 females), with an average TBSA of 0.83% and age of 40.2 years, were reviewed and 1 patient was admitted. Injuries included flash (n = 3), scald (n = 12), chemical (n = 2) and contact (n = 2). These occurred at home in 68% of patients (n = 13), 11% at work (n = 2) and 21 others (n = 4).

In 2017, 25 patients (male = 11, female = 14) with an average age of 40.9 years TBSA of 0.52% were assessed for their burn injuries, with 4 patients admitted. These were secondary to flash (n = 2), scald (n = 12), chemical (n = 6), contact (n = 5). The locality of these occurring at home in 56% (n = 14), at work in 24% (n = 6) and in other places in 20% (n = 5).

In 2018, 19 patients (male = 12, female = 7) with burn injuries presented to our services with an average age of 45.8 years. They sustained an average burn size of 0.40% TBSA. 2 patients were subsequently admitted. Scald injuries were most prevalent (n = 10), followed by contact (n = 3), flash (n = 3), others (n = 1) and chemical (n = 1). 68% of patients sustained their injury at home (n = 13), 5% at work (n = 1) and 26% (n = 5) in other localities.

In 2019, 25 patients (male = 13, female = 12) were reviewed with an average age of 49.5 years with 6 admissions into hospital. The average TBSA burn was 0.84% secondary to scald (n = 12), chemical (n = 4), contact (n = 3), flash (n = 2), flame (n = 2) and others (n = 2).60% of these occurred at home (n = 15), 20% at work (n = 5) and 20% in other localities (n = 5).

In 2020, 18 patients were, with an average TBSA burn of 1.36%, reviewed by our burns services (male = 12, female = 6) with an average age of 35.6 years. Injuries were secondary to scald (n = 5), chemical (n = 4), contact (n = 3), flash (n = 2) and flame (n = 1). These occurred most commonly at home in 83% of patients (n = 15), 11% at work (n = 2) and in 6% in other places (n = 1).

As of result the pandemic in 2020 and due public engagement to avoid undertaking risk-related activities, we have seen 28% reduction in patients presenting for review in our acute outpatient service from the previous year.

Secondary to the enforced restrictions in 2020 an increase in home-related injuries has occurred, equating to 85% compared to 60% seen in 2019, with the highest number since 2015. Similarly, there has also been a reduction in work-related injuries presenting to our service.

We found a global reduction in patients presenting to our burns unit likely secondary to a reduction in activities which may have occurred outside of enforced lockdown. However, the general reduction in the public attending the emergency department would have played a role (Reference).

At the time of analysis we found no changes to our referral pathway for burn injuries and upon review of data of the same week over the previous years, the figures from 2020 show that we have had the lowest presentation of injuries to our services and the highest number of injuries occurring at home [3].

Following the changes in medical practice following the pandemic, we have seen a reduction in referrals of burn injury and direct presentation of such patients to our emergency department, thereby allowing resources to be directed to the appropriate setting. However, the majority of injuries that have presented were sustained within the home environment secondary to isolation. We advocate the public be cautious when undertaking such activities.

Conflict of interest

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

No other conflict of interest to declare.