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Indian Journal of Community Medicine

Epidemiology and Mortality of Burns in JNMC Hospitlal, AMU Aligarh: A 5 year Study

Author(s): V. Mago, M. Yaseen, L.M. Bariar

Vol. 29, No. 4 (2004-10 - 2004-12)

Introduction

Fire is a necessary evil. Even before the primitive man learned to use fire, he has been a victim of it. Burns are a common injury in the developing world and associated with the significant mortality and morbidity. Burn may be thermal, electrical, chemical or scalds etc. Most of the burns are preventable and if managed properly most of burn patients can be saved.

The aims and objectives of this research work is to study the epidemiology of burns in this region of the country and find out certain reasons and causes particular to our social set up with special emphasis on preventive aspects of the accidental burns.

Materials and Methods

This study was conducted on 1,160 patients of acute burns admitted through casualty to the burns wards of the Plastic Surgery unit (Dept. of Surgery), J.N. Medical College and Hospital, AMU, Aligarh (U.P.). This study was retrospective and covered 5 years from (1st May 1997 to 31st December 2002). The total body surface area (% BSA) burned was estimated by the 'Rule of 9' for adults and the Lund & Browder's Charts for children.

Results

During the 5 year period studied, 1160 patients (568 males and 612 females) were admitted to our hospital with burn injuries.

a) Age and Sex: Most of the patients were in 13-25 age groups followed by 26-39 age group and 6-12 age groups Female out numbered males in all types of burns (F:M = 1.17:1). Twenty one percent of the patients were children and 79% were adults.

b) Etiology of Burns: As far as the type of burn was concerned, 75% (870 pts) of the accidents were due to flames, 10% (116) were scalds, 14.1% (164) electrical and 0.9% (10) chemical burns.

c) Total body surface area burned: In our series of 1160 patients, 27.4% patients admitted were < 25% TBSA, 29% (268) had TBSA burn between 26-50%. 19.9% had TBSA burns between 51-75% and 23.1% had burns > 76% TBSA.

d) Anatomical Site: The commonest sites burnt are the legs (55%) followed by trunk (39%), arms (3%) and head (3%).

e) Length of Stay: The mean length of stay was 10 days (range 1-31 days).

f) Mortality: Outcome denotes the principal cause of death as sepsis (54%) in fatal burns in this study (Table 1)

g) Open space Vs Closed Space: Out of the 206 patients who could be interviewed 120 patients got burnt in open space and 86 sustained burns in a closed space.

h) Type of Garment: Out of the 305 patients who could be interviewed for at the time of burn, 253 patients were wearing synthetic clothes and 52 were wearing cotton clothes.

Table I: Causes of Death in Fatal Burns

Cause of Death Number Percentage
Multiple Organ Failure 57 18.6
Sepsis 165 54
Burn Shock 34 12
Burn and Inhalation Injury 50 16.4
Total 306 100

Discussion

Burns are a common injury in the developing world and are associated with significant morbidity and mortality. In our study the highest incidence of burns was in the age group 13 to 25 years. This may be explained by the fact that married women spend most of their time working in kitchen and are a susceptible lot. Also cases of bride burning is more frequently found in this group. Sex distribution in other series shows similar findings 2,3,4,5.

The high incidence of thermal burns is explained by use of oil for lamps in villages, substandard kerosene and gas stoves, use of open coal and wood fires for warmth and cooking in villages and use of pressure stoves for cooking in urban areas. Othere studies also shows the similar findings. Blocker et al (1961) studied 1,000 burn patients and found that the most common cause was flash and flame (77.1%) followed by hot liquids (13%).

The old and unsafe electrical installation in the Indian houses distribution wires passing overhead and very close to houses, use of crude electric rod for boiling water, unprotected sockets, `Kundi Connection' - a common theft of electricity in this part of the country are some of the common causes of electric burns in this part of the country.

Maximum number of deaths occurred in patients with a total body surface area burn of more than 50% and 60%. In our study no patient with more than 75% burns survived. Majority of patients who left against medical advice were females. This shows the discrimination against the female species.

The high mortality rate may be explained by the high incidence of major flame burns delay in seeking medical help, high incidence of septicaemia and lack of resources both on part of the patients and the hospital. This compares favourably with the mortality in critical burns reported by others e.g. 19.6% by Lari et al, 46% by V. Laloe, 16% by F. Calder, 18.3% by Sharma and 18% by Malla. The duration of admission is closely related to the cause of death. Sepsis was the leading cause of death in our series (54%). Principal causes of death in other series was multiple organ failure (37%) and sepsis (31%) (Bang et al).

Through this study it may be concluded that burns are largely preventable and if properly managed in burns wards may be treated with a high degree of success. The approach to prevention may be accomplished by : Education and awareness campaigns in risk group i.e. housewives, children, elderly, Passing legislation for proper safeguards in household appliances, Legislation for electricity theft, Use of less flammable garments.

References

  1. F, Calder : Four years of Burn Injuries in a Red Cross Hospital in Afghanistan, Burns, 2002, 28: 563-568.
  2. Fernandez Marales et at: Epidemiology of burns in Molaga spain. Burns 1997: 23: 323-331.
  3. Laloe, V. : Epidemology and Mortality of Burns in a general hospital of Eastern Sri Lanka. Burns 2002, 28: 778-781.
  4. Lari, A.R. et al: pidemiological study of 3341 burn patients during three years in Tehran, Iran, Burns 2000: 26:49-53.
  5. Mahaluxmivala et al : A retrospective study of etiopathological and preventive factors in a burns unit Saudi Arabia, Burns 1997:23:333-337.
  6. Subrahamanyam, M. : Epidemiology of burns in a district hospital in Western India, Burns 1996: 22: 439-42.

Division of Plastic and Reconstructive Surgery,
Deptt. of Surgery, Jawaharlal Nehru Medical College and Hospital,
Aligarh-202002 (U.P.).
E-mail: [email protected]

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