|Year : 2020 | Volume
| Issue : 1 | Page : 13-17
Epidemiological analysis of chemical burns: Does it reflect any change in trends?
Sunil Sharma, Piyush K Thayal, Praveen Kumar Arumugam
Department of Burns, Plastic and Maxillofacial Surgery, V.M. Medical College and Safdarjung Hospital, Delhi, India
|Date of Submission||25-Nov-2020|
|Date of Acceptance||07-Jan-2021|
|Date of Web Publication||21-May-2021|
Dr. Piyush K Thayal
Department of Burns, Plastic and Maxillofacial Surgery, V.M. Medical College and Safdarjung Hospital, Delhi - 110 029
Source of Support: None, Conflict of Interest: None
Introduction: Chemical burns constitute small proportion of cases among the total admissions due to burn injuries. The spectrum of severity of illness can vary from mild injuries to life-threatening trauma. In the Indian scenario, the incidence of chemical burns has been reported to be 2.25%–2.4% of total burn admissions. We decided to analyze the epidemiological trends in a tertiary care center from 2013 to 2018 and observe if there has been any shift in the trends.
Materials and Methods: A retrospective chart review of all burn victims who attended our burns casualty in V. M. M. C and Safdarjung Hospital, New Delhi, India, between January 2013 and December 2018, was carried out.
Results: During the study period of 6 calendar years from 2013 to 2018, a total of 142 patients of chemical burns attended the hospital, with 47 of them requiring admission. The chemical burns accounted for 0.45% of the total burn patient's attendance. Male dominance was noted with 64% of patients being males. Nearly 59% of the chemical burn patients were from 21 to 40-year age group. Accidental chemical burns accounted for maximum cases. It was observed that acid burns have decreased in comparison to the initial 3 years.
Conclusion: Downward trend in the incidence of overall chemical burns was noted. Acid burns decreased with simultaneous increase in alkali burns. The study period coincided with the Supreme Court's verdict with the formulation of guidelines on sale of acids in 2013 and this could be the major factor in declining trends of acid burns.
Keywords: Acid attack, acid burns, alkali burns, chemical burns, epidemiology
|How to cite this article:|
Sharma S, Thayal PK, Arumugam PK. Epidemiological analysis of chemical burns: Does it reflect any change in trends?. Indian J Burns 2020;28:13-7
|How to cite this URL:|
Sharma S, Thayal PK, Arumugam PK. Epidemiological analysis of chemical burns: Does it reflect any change in trends?. Indian J Burns [serial online] 2020 [cited 2022 Jan 21];28:13-7. Available from: https://www.ijburns.com/text.asp?2020/28/1/13/316578
| Introduction|| |
Chemical burns constitute small proportion of cases among the total admission due to burn injuries with incidence reported from 2.4 to 10.7% worldwide. The spectrum of severity of illness can vary from mild injuries to life-threatening trauma.
Over 25,000 domestic and industrial chemicals have been known to cause chemical burn injuries. These chemicals can cause injury by direct contact with skin or inhalation of fumes. Nature of injury can be accidental, homicidal, occupational, or rarely suicidal. Use of chemical agents to inflict injury as to revenge as per literature accounted to as high as 75% of chemical burns in some countries.
The annual incidence of burns in India based on extrapolated data from major hospitals across the country is approximately 7 million. In the Indian scenario, the incidence of chemical burns reported to be 2.25% of total burn admissions during 2001–2007 (Ahuja et al. 2009) at a tertiary care hospital in the national capital and 2.4% from a tertiary care hospital located in tier 3 cities during the year 2008–2013.,
In our country, throwing acids over others to take revenge had attracted the attention of the highest court of the land (Supreme Court) and in the process laid down guidelines regulating sale of the acids in 2013. With this background, we decided to analyze the trends of epidemiology of chemical burns for 6 years since 2013 at our institute which is one of the largest referral burn centers of Northern India to assess any change in the trends and pattern.
| Materials and Methods|| |
A retrospective chart review of all burn victims who attended our burns casualty in V. M. M. C and Safdarjung Hospital, New Delhi, India, between January 2013 and December 2018, was carried out with the help of hospital records maintained in the hospital. Patients diagnosed with chemical burns were included in our study.
Patient characteristics in relation to demographics, mechanism of injury, causative agent, place of injury, and extent of burns were extracted from the records. Outcome data including mortality, length of hospital stay, associated injuries, and distribution of injury were available only for patients from 2016 to 2018. The data were then analyzed with SPSS version 23 software (IBM SPSS Statistics for Windows, Armonk, NY: IBM Corp, USA). Data were described in percentage for categorical variables.
| Results|| |
In the study period of 6 years ranging from January 2013 to December 2018, a total of 31,234 burn victims attended our casualty. Of these, 8143 burn victims required admission. Only 142 patients were diagnosed with chemical burn injuries, and 0.57% of patients among them required hospitalization. The annual average caseload of burn patients was 5205 with chemical burns accounting for 0.44% of total burn victims. The year-wise breakup of the burn victims is presented in [Table 1].
The year-wise breakup highlighted the reduction in incidence of chemical burn injuries by almost half and then almost remained constant with mild variations. Overall male predominance (64%) was noted [Figure 1]. Acid attack on females as a mode of revenge was seen in nine patients overall, four of which occurred in 2013, one each in 2015 and 2016, and 3 in 2018.
The age-wise distribution of chemical burns victim has been tabulated in [Table 2]. Majority of chemical burn victims were between 21 and 40 years, accounting to almost 60% of cases. The mean age of patients was 26.64 years (standard deviation ± 14.12).
Causative agent was identified in 75.35% of patients. Acid burns contributed to 53.52% of total chemical burns and alkalis contributed to 21.83%. The yearly data [Figure 2] show decreasing trend in acid-related burns with increase in alkali burns. The number of acid injuries has reduced from 31 patients in 2013 to 5 patients in 2018.
Mode of injury
Majority of burns were accidental in nature (85.91% of the total) with remaining 14.08% being homicidal nature of the injury. No cases of suicidal chemical burns were recorded [Figure 3]. The proportion of homicidal burns was lesser in 2016–2018 as compared to 2013–2015.
Place of injury
The most common place of injury was in the domestic setup accounting for 47.18% and the workplace constituted 21.83%. In 24 patients, the site where injury occurred could not be elicited.
Extent of burns
Majority of the patients had total body surface area (TBSA) <10%. Four patients had >50% TBSA involved [Table 3].
Median duration of hospital stay was 5.5 days (range 2–57 days) (2016–2018). In patients presenting in 2016–2018, 86.7% of patients had facial burns. Ocular injury in the form of bilateral corneal damage occurred in 20% of the patients. Unilateral ocular injury was seen in additional two patients. One patient developed renal failure. Overall mortality rate was 16.6% (2016–2018).
| Discussion|| |
The incidence of chemical burn injuries reported worldwide varied from 2.4% to 10.7% of all burn admissions. In the studies reported from our country, Ahuja et al. had carried a detailed study of burn admissions from 1993 to 2007 with study from the 1993–2000 being labeled by authors as Phase I and the data from 2001 to 2007 as Phase II. Ahuja et al. had reported 45 cases of chemical burns accounting 2.25% of burn admissions at a rate of 17.1 admissions per year in Phase II study. A study conducted between 2008 and 2013 to analyze the epidemiology of chemical burns in a burn unit at Aligarh had reported 96 cases which translated to incidence of 2.4% of all burn admission with female being victims slightly more than the male counterparts [Figure 4].,
We had analyzed the burn victim's attendance at our institute between 2013 and 2018. The incidence of chemical burns in our study is 0.58% of all burn admissions and 0.47% of overall burn victims' attendance at our center. Akhtar et al. had noted a female dominance among the chemical burn victims which is in contrast with our study.
The analysis of chemical burn exclusively done at the burn unit of Aligarh Medical college had revealed majority of the chemical burns were due to domestic accidental burns (58%), followed by homicidal accounting to 29% of cases. They also recorded 12 cases of suicidal burns. In another study on chemical burns from southern part of India, accidental chemical burns were most common, especially among adults. In the pediatric group, especially in the age group of 13–18 years and females, nonaccidental injuries were more common. In our study, the majority of cases of chemical burns were accidental in nature (81.65%) and homicidal burns constituted 18.34% which is lesser than that observed by Akhtar et al. (29%). A brief comparison of our study with the one done by Akhtar et al. is shown in Tabl[e 4].
|Table 4: Comparison of the present study with previous study during 2008-2013|
Click here to view
The 226th Report of the Law Commission of India on “The Inclusion of Acid Attacks as Specific Offences in the Indian Penal Code and a Law for Compensation for Victims of Crime” submitted to Honorable Supreme Court of India for its consideration in the pending proceedings filed by one Laxmi in W. P.(Crl.) No. 129 of 2006 examined in detail technicalities of the legal provisions along with effectively giving insight on the consequences of acid attacks, it's medical treatment with after care necessary for the rehabilitation of the victim. The Honorable Supreme court of India had laid down guidelines on the sale and access of acids to public at large along with making the acid attack as nonbailable offence and giving compensation to the acid attack victim for medical treatment and rehabilitation in 2013 on the PIL based on the 226th report of Law Commission of India.
On year-to-year basis analysis of chemical burns at our institute, we found a downward trend in the chemical burns with more so specific to acid burns. The year-to-year basis of cases reported to the department did show a dip in the initial 3 years (2013–2015) with a rising trend in the past 3 years. However, on careful observation as depicted in [Figure 2], there has been downward trend in acid-related burns. The increase of alkali-related burns has been the reason of upward trend of chemical burns. Thus, we are of opinion that the guidelines laid down by the Supreme Court have been strictly adhered to by the respective governments through the implementing agencies had a positive desired effect in reducing acid burns.
In 2018, alkalis were the most common cause of chemical burns in this study. Although the number of acid burn injuries has reduced in this study, we did find that there were nine cases of vitriolage against women. Three of these attacks occurred in 2018. It should be stressed that, in order to bring about further improvement in the scenario, the laws against acid attacks must be enforced strictly to prevent these heinous crimes from occurring. Once chemical burns do occur, significant morbidity and need for repeated reconstructive surgeries cause significant economic costs. Prevention of such injuries by better and safe industrial practices has resulted in drop in chemical injuries occurring the industrial setting. The need of the hour is to further reduce these injuries through means of education and awareness. Awareness through social media makes it a convenient method in today's tech age. Organizing public events such as marathons which involve the general public helps to gain attention. Electronic media such as TV programs make it easy to reach every part of the country.
Limitations of the study
This is a retrospective study which is a limitation. In addition, there could be a referral center bias as our center being a tertiary center for burns. Larger studies from multiple centers around the country would be helpful to understand the scenario in other parts of the country as well.
| Conclusion|| |
There has been a downward trend in the incidence of acid burns in particular. Increase trend of the alkali burns is more due to the workplace related. The Supreme Court-induced stricter norms for sale of acids did have impact on reducing numbers. To reduce the incidence further, preventive strategies and awareness regarding these kinds of injuries are the need of the hour.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Hardwicke J, Hunter T, Staruch R, Moiemen N. Chemical burns—An historical comparison and review of the literature. Burns 2012;38:383-7.
Seth R, Chester D, Moiemen N. A review of chemical burns. Trauma 2007;9:81-94.
Olaitan PB, Jiburum BC. Chemical injuries from assaults: An increasing trend in a developing country. Indian J Plast Surg 2008;41:20-3.
] [Full text]
Gupta JL, Makhija LK, Bajaj SP. National programme for prevention of burn injuries. Indian J Plast Surg 2010;43:S6-10.
] [Full text]
Ahuja RB, Bhattacharya S, Rai A. Changing trends of an endemic trauma. Burns 2009;35:650-6.
Akhtar MS, Ahmad I, Khurram MF, Kanungo S. Epidemiology and outcome of chemical burn patients admitted in burn unit of JNMC hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India: A 5-year Experience. J Family Med Prim Care 2015;4:106-9.
] [Full text]
Ramakrishnan KM, Mathivanan T, Jayaraman V, Babu M, Shankar J. Current scenario in chemical burns in a developing country: Chennai, India. Ann Burns Fire Disasters 2012;25:8-12.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3], [Table 4]