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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 28  |  Issue : 1  |  Page : 79-83

Epidemiological study of burn patients admitted in tertiary care hospital in India and associated risk factors: A retrospective observational review


Department of Plastic Surgery, Pt. Bhagwat Dayal Sharma PGIMS, Rohtak, Haryana, India

Date of Submission05-May-2020
Date of Decision29-Jul-2020
Date of Acceptance19-Oct-2020
Date of Web Publication21-May-2021

Correspondence Address:
Dr. Krittika Aggarwal
Department of Plastic Surgery, Pt. Bhagwat Dayal Sharma PGIMS, Rohtak - 124 001, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijb.ijb_10_20

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  Abstract 


Introduction: Burn injuries constitute a major part of traumatic injuries and most commonly are accidental. They have devastating mental and functional sequelae apart from increased chances of mortality. Knowledge about the prognosis of various burn injuries and the risk factors leading to complications helps treat them. This study was undertaken to document the epidemiological data of burn patients admitted in Pt BD Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India, from January 2019 to December 2019.
Materials and Methods: Demographic details including age, sex, cause and nature of injury, associated comorbidities, depth and percentage of body area involved, involvement of the face and suspected inhalation injury, survival, period of survival, and mortality rate were recorded. For the pediatric population, weight for age was taken as an indicator for nutrition. Patients who left against medical advice were excluded from the study. P < 0.05 was considered to be statistically significant.
Results: Burn injuries were most common in the age group of 21–60 years. Males were more commonly injured. Thermal injuries were most common (91%), followed by electric burns. Accidental burns were 88%, in 9% alleged history of suicide, and in rest, homicide was suspected. Out of 104 pediatric patients, 50% were undernourished. The mortality among undernourished patients had the odd's ratio of 8.5. The survival rate was 81% overall. It was noted that burns more than 40% total body surface area (TBSA) involvement had mortality of 56.25% and 9.44% in < 40% TBSA involvement (odds ratio 5.95). Face involvement for suspected inhalation injury had increased risk of mortality (odd's ratio 1.68). The most common cause of death was multi-organ dysfunction syndrome from sepsis within 10 days in 78% of cases. Among survivors, the duration of stay was dependent on the TBSA involvement.
Conclusion: Pediatric age group, inhalation injury, undernutrition, and thromboembolism are factors which contribute to increased mortality, apart from large TBSA involvement. Initial 10 days need careful monitoring to decrease mortality and initiate early treatment.
Limitation: This study has been conducted in a tertiary care hospital. Only referred cases needing hospital care were included in this study. Hence, the data represent only a part of demographic data sustaining burn injuries.

Keywords: Burn care, epidemiology, risk factor


How to cite this article:
Aggarwal K, Singh K, Singh B. Epidemiological study of burn patients admitted in tertiary care hospital in India and associated risk factors: A retrospective observational review. Indian J Burns 2020;28:79-83

How to cite this URL:
Aggarwal K, Singh K, Singh B. Epidemiological study of burn patients admitted in tertiary care hospital in India and associated risk factors: A retrospective observational review. Indian J Burns [serial online] 2020 [cited 2021 Dec 5];28:79-83. Available from: https://www.ijburns.com/text.asp?2020/28/1/79/316564




  Introduction Top


Burn injuries constitute one of the major parts of accidental injuries. They cause stress and mental anguish to patients, relatives as well as the health-care providers. According to the National Program for Prevention of Burns injuries data, 7 million individuals sustain burn injuries every year, with 0.7 million requiring hospital care and 0.14 million mortalities.[1] Burns can be caused by hot liquids, thermal injuries, chemical splashes, and electric injuries. The extent of involvement is decided usually by the Wallace rule of nine.[2] High-voltage electric burns can lead to very deep burns, lead to myocardial damage and myoglobinuria, from extensive muscle damage, leading to kidney failure. Knowing the prognosis of various types of burns in various age groups and according to the area involved helps to manage and foresee the complications. There is a paucity of epidemiological data of burn injuries in India and hence, this study was undertaken.


  Materials and Methods Top


This is a retrospective observational study conducted in tertiary care hospital, Pt. BD Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India over 1 year, from January 2019 to December 2019. Data of all the admitted patients were reviewed. Age, sex, cause and nature of injury, associated comorbidities, depth and percentage of body area involved, involvement of the face and suspected inhalation injury, survival, period of survival, and mortality rate were recorded. For inhalation injury, a history of closed space burn and face involvement was only recorded and not confirmed by bronchoscopy. The patients who left against medical advice (LAMA) were excluded from the study. In the pediatric population, weight recorded at the time of admission was taken as the parameter for nutritional status. Since weight was measured in all patients, weight for age was taken as the parameter. The actual weight was compared with the ideal weight for age.[3] Qualitative variables were expressed as percentages and quantitative variables as mean. Relative risk was calculated by Odd's ratio. A value of P < 0.05 was considered to be statistically significant.


  Results Top


From January 2019 to December 2019, a total of 265 patients were admitted. Thirty-seven patients LAMA and the outcome could not be recorded. Hence, they were excluded from the study, and the remaining 228 patients were analyzed.

Age and sex

Out of 228 patients analyzed, 45.6% of the patients were children. [Figure 1] shows sex distribution in various age groups.
Figure 1: Sex distribution in various age groups (age in years)

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Cause of injury

Most of the burns were accidental in nature (88%). In 3% alleged history of homicide and in 9% of the cases, alleged history of suicide was given and mental health for the cause of suicide was also managed. Nine patients suffered accidental burns while having an episode of seizure. They were known cases of seizure disorder and on irregular treatment. In six cases, the victim was suspected to be under the influence of alcohol at the time of accident. The comorbidities noted are shown in [Table 1]. Out of 228 patients, fifty patients suffered high voltage electric burns. Out of these, ten were in the pediatric age group.
Table 1: Associated comorbidities in the study group

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Most commonly thermal injuries (91.2%, 208) were noted. The distribution of various causes of burn injuries is shown in [Figure 2]. Electric injuries occurred in 19, out of which 7 sustained high voltage electric burns and chemical burns were noted in one patient. Most of the patients sustained a deep second degree or third-degree burns.
Figure 2: Pie chart showing the distribution of nature of burn injuries

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Nutrition

It was seen that 50% of the children (up to 12 years of age) admitted were underweight. The mortality among the underweight children was 23.8% with odd's ratio of 8.5. The distribution of mortality in healthy and undernourished pediatric patients is shown in [Table 2].
Table 2: Distribution of survival and mortality in pediatric burns according to weight

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Mortality

The number of deaths out of total burnt in each age group is as demonstrated in [Table 3]. The survival rate was 81% overall, in pediatric and in adult groups. In <12 years the mortality was seen in 11.5% and in >12 years was 25.8%.
Table 3: Distribution of mortality according to total body surface area percentage burnt in various age groups

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Out of fifty patients with high voltage electric burns, three died.

From [Table 4], it was noted that burns more than 40% total body surface area (TBSA) was associated with mortality of 56.25% and 9.44% in <40% TBSA involvement (odds ratio 5.95).
Table 4: Distribution of outcome according to total body surface area involved

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In case of high voltage injuries, the admitted patients had suffered burns ranging from 30% to 50% TBSA and mortality was seen in one patient. In patients with facial involvement, mortality was noted in 25 out of 100, and in patients without facial burns, mortality was noted in 19 out of 128. The odd's ratio for facial burns as a risk factor for mortality was 1.68.

Pulmonary embolism was suspected and confirmed on autopsy in two patients. In most of the cases, Multi-organ dysfunction syndrome from sepsis was the cause of death. In most of the cases (32 out of 44), mortality occurred within 10 days of injury. In two patients, pneumonia leading to respiratory failure led to mortality after 2 months of injury.

Survival

Out of 228 patients, 184 patients were discharged in healthy condition. The duration of stay according to TBSA involvement is shown in [Table 5].
Table 5: Distribution of mortality according to total body surface area percentage burnt in various age groups

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  Discussion Top


Burn injuries are accidental, mutilating injuries which need dedicated care to prevent complications.

Age

As can be seen in this study, 45.6% of the patients managed during the study were children who mostly suffered scalds or low voltage electric injuries. In the adult age group, majority of patients (98 out of 228) belonged to 20–60 years which is the economically productive group with a median of 18 years. This is consistent with previous studies conducted in a similar setup.[4],[5]

Sex

The percentage of females in the pediatric group was 42.3% and in adults, 33.87%, overall in the study group was 37.72%. This is a contradiction to the previous studies conducted in a similar setup.[4],[6],[7] This might also be due to the negligence of burns in females. Since women are also more involved with cooking on unsafe stoves, women are expected to be more affected than men with burn injuries.[6],[7]

The mortality in females was 18/86 (20.9%) and in males 26/142 (18.3%) with odds ratio of 1.14. In the pediatric age group, the mortality in males and females was equal. A similar finding has been reported in previous studies as well.[4],[7]

Mortality

Mortality was noted to be higher in the adult age group (25.8%) as compared to pediatric patients (11.54%) with a relative risk of mortality in the adult age group was 2.24. The overall mortality in the study group was comparable to that reported in previous studies.[4],[8]

More than 20% TBSA involvement in <12 years and more than 40% TBSA involved in adults was associated with increased risk of mortality (odds ratio 5.95). This fact has been demonstrated in previous studies as well.[4]

Face involvement and associated inhalation injury were associated with increased mortality and morbidity with a odd's ratio of 1.68. However, other risk factors such as older age, TBSA involvement, and undernutrition may act as confounding factors. A previous study conducted between 2010 and 2014 reported that Inhalation injury is not an independent predictor factor for mortality.[9]

Comorbidities

Psychiatric and seizure disorder was associated with burn accidents and deep burn injuries. This has been documented previously as well.[10] Two patients were pregnant at the time of injury and one had a spontaneous abortion. Burn injury stress might be responsible for the same.

Undernutrition in children was noted in 50% of the children admitted at the time of admission. Malnutrition was a complication of burn injury as well. Mortality in undernourished children was 23.5% and normal weight for age patients was 2.86% and odd's ratio of 8.5. There are few studies assessing the role of malnutrition as an independent risk factor. A study conducted by Grudziak et al. reported that malnutrition is associated with mortality increased by 20%–30% in 0–5 years age group.[11] Another study reported that in some cases mortality in some cases of pediatric burns was malnutrition.[12]

Days of admission in survival

As shown in [Table 5], increased TBSA involvement led to increased hospital stay which was statistically significant. This is to be expected as more area involvement leads to systemic complications and takes more time to heal.


  Conclusion Top


Burn injuries have severe morbidity and mortality. A detailed history should be taken and risk factors such as seizure disorder, alcohol abuse, and mental illness should be looked for. All these need to be treated to prevent the devastating complications and recurrent injuries. Pediatric age group, face involvement with suspected inhalation injury, undernutrition, and thromboembolism are factors which contribute to increased mortality, apart from large TBSA involvement. Initial 10 days need careful monitoring to decrease mortality and initiate early treatment.

Limitation

This study has been conducted in a tertiary care hospital. Only referred cases needing hospital care were included in this study. Hence, the data represent only a part of demographic data sustaining burn injuries.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Singh AK. Burns management in India: The way ahead. Indian J Burns 2018;26:3-5.  Back to cited text no. 1
  [Full text]  
2.
Klein MB. Thermal, chemical and electrical injuries. In: Thorne CH, Chung KC, Gosain A, Gurtner GC, Mehrara BJ, Rubin JP, et al., editors. Grabb and Smith's Plastic Surgery. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2014. p. 127-41.  Back to cited text no. 2
    
3.
Nguefack-Tsague G, Kien AT, Fokunang CN. Using weight-for-age for predicting wasted children in Cameroon. Pan Afr Med J 2013;14:96.  Back to cited text no. 3
    
4.
Tripathee S, Basnet SJ. Epidemiology and outcome of hospitalized burns patients in tertiary care center in Nepal: Two year retrospective study. Burns Open 2017;1:16-9.  Back to cited text no. 4
    
5.
Singh K, Kapoor A, Singh B, Gupta S, Pramod D, Sarita S. Socio-epidemiological study of burn patients in PGIMS, Rohtak, Haryana, India. Indian J Health Wellbeing 2015;4:379-83.  Back to cited text no. 5
    
6.
Krishnamurthy VR, Ishwaraprasad GD, Sumana M, Samudyatha UC. Pattern of burn injury admissions at a teaching hospital of Karnataka, India: a three year retrospective study. Int Surg J 2018;5:3930-4.  Back to cited text no. 6
    
7.
Bhate-Deosthali P, Lingam L. Gendered pattern of burn injuries in India: A neglected health issue. Reprod Health Matters 2016;24:96-103.  Back to cited text no. 7
    
8.
Ebenezer R, Rohit V, Isabella P, Ramakrishnan N, Krishnan G. Epidemiology of Burns Patients in a tertiary care hospital in South India A retrospective analysis. Ann Burns Trauma 2018;2:1006.  Back to cited text no. 8
    
9.
Monteiro D, Silva I, Egipto P, Magalhães A, Filipe R, Silva A, et al. Inhalation injury in a burn unit: A retrospective review of prognostic factors. Ann Burns Fire Disasters 2017;30:121-5.  Back to cited text no. 9
    
10.
Othman D, Jones O. Burns patients with epilepsy or a learning disability have a greater length of stay in hospital than those patients with a history of drug or alcohol abuse. Burns 2011;37:546-7.  Back to cited text no. 10
    
11.
Grudziak J, Snock C, Mjuweni S, Gallaher J, Cairns B, Charles A. The effect of pre-existing malnutrition on paediatric burn mortality in a sub-Saharan African burn unit. Burns 2017;43:1486-92.  Back to cited text no. 11
    
12.
Uba AF, Edino ST, Yakubu AA. Paediatric burns: Management problems in a teaching hospital in north western Nigeria. Trop Doct 2007;37:114-5.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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