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ORIGINAL ARTICLE
Year : 2021  |  Volume : 29  |  Issue : 1  |  Page : 15-18

Epidemiological analysis of burn patients in Hospital Melaka, Malaysia


Department of Plastic and Reconstructive Surgery, Hospital Melaka, Melaka, Malaysia

Date of Submission24-Jun-2020
Date of Decision19-Oct-2020
Date of Acceptance09-Oct-2021
Date of Web Publication08-Jun-2022

Correspondence Address:
Dr. Mohd Tarmizi Mohd Said
Department of Plastic and Reconstructive Surgery, Hospital Melaka, Jalan Mufti Haji Khalil, 75400 Melaka
Malaysia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijb.ijb_15_20

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  Abstract 


Background: Burn injury remains one of the most frequent public frequent public health concerns that are associated with significant morbidity and mortality. This study aims to understand the epidemiological profile of burn patients admitted to Burn Unit, Hospital Melaka between January 2016 and December 2018.
Methods: A retrospective study was conducted to review burn cases that were admitted to Burn Unit, Hospital Melaka from January 2016 to December 2018. The epidemiological data of 241 patients were collected and studied.
Results: The etiology of burn was determined: 230 (95.4%) thermal burns, 4 (1.7%) electrical burns, and 7 (2.9%) chemical burns. In 230 cases of thermal burn, 85 (37.0%) of accidents were caused by flames, 119 (51.7%) by scalds, and 26 (11.3%) by contact with hot objects. One hundred and eighty-nine (63.2%) of the patients were male, the remaining 110 patients (36.8%) were female. The female/male ratio was 1:1.7. The duration of hospitalization stay was 8 days. Mortality rate was 3.34% with 50% of deaths following major burn were due to sepsis with multiorgan failure.
Conclusion: This study provides an overview on demographic features of burn patients admitted to Hospital Melaka.

Keywords: Burn, etiology, epidemiology, Melaka


How to cite this article:
Mohd Said MT, Hussin I, Noran IS. Epidemiological analysis of burn patients in Hospital Melaka, Malaysia. Indian J Burns 2021;29:15-8

How to cite this URL:
Mohd Said MT, Hussin I, Noran IS. Epidemiological analysis of burn patients in Hospital Melaka, Malaysia. Indian J Burns [serial online] 2021 [cited 2022 Jun 26];29:15-8. Available from: https://www.ijburns.com/text.asp?2021/29/1/15/346901




  Introduction Top


Burn injury remains one of the most frequent public health concerns that are associated with significant morbidity and mortality. Globally, it is accountable for nearly 180,000 deaths annually with majority of these occurred in low income, developing countries. Major burn usually requires prolonged hospital stay and associated with early and long-term complications. Treatment can be challenging and demanding, and yet, the result may be unsatisfactory, especially in more severe cases with the survivors usually suffer lifelong disabilities.

While a large number of burn cases were accidental, many were preventable, thus effective prevention plan may be proposed based on the study of epidemiological characteristic, demographic features, risk factors, and identification of safety pitfalls. This study aims to understand the epidemiological profile of burn patients admitted to Burn unit, Hospital Melaka between January 2016 and December 2018.


  Materials and Methods Top


A retrospective analysis was conducted in Burn Unit, Hospital Melaka based on medical records of 241 burn patients that were hospitalized between January 2016 and December 2018. We analyzed multiple variables including age, sex, race, etiology of burn, and mortality rate using the SPSS software program (SPSS Inc., Chicago, IL).


  Results Top


A total of 299 admissions were recorded during the study period with mean annual admission rate of 100 cases per year (2016 – 99 cases, 2017 – 103 cases, 2018 – 97 cases) [Figure 1].
Figure 1: Annual Burn Admission in Hospital Melaka, 2016–2018

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There was a higher distribution of male patients with 63.2% (n = 189) of admission compared to female (36.8%, n = 110), with female/male sex ratio was 1:1.7 [Figure 2].
Figure 2: Sex prevalence

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[Figure 3] shows the distribution by age. The most affected age groups were 0–10 year olds (38.8%, n = 116) followed by 21–30 year olds (15.7%, n = 47) and 11–20 year olds (14.4%, n = 43). Majority of the patients were Malays (76.2%, n = 228), followed by Chinese (10.4%, n = 31) and Indians (6.4%, n = 19) [Figure 4].
Figure 3: Age distribution

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Figure 4: Racial distribution

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The most common etiology was thermal burns (95.4%, n = 230) followed by chemical and electrical burns (2.9%, n = 7 and 1.7%, n = 4, respectively) [Figure 5]. For thermal burns, 51.7% (n = 119) were due to scald injury, 37.0% (n = 85) were due to flames, and 11.3% (n = 26) were due to contact burn.
Figure 5: Causes of burns

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The burn admissions were categorized into three major groups according to the American Burn Association classification – mild (62.7%, n = 151), moderate (27.4%, n = 66), and major (10.0%, n = 24). From this, 23.7% (n = 57) required surgical intervention (i.e. escharotomy, serial tangential excision, and skin grafting).

The duration of hospital stay was between 1 and 67 days, with a mean of 8 days.

Upon follow-up, 10.8% (n = 14) came back with late onset complications of hypertrophic scarring and contracture.

Mortality rate was 3.34% which account to 10 deaths over a 3-year period with five patients died of sepsis, 4 patients had severe inhalational injury while one patient died from myocardial infarction.


  Discussion Top


This is the first epidemiological analysis to study the demographic features of burn cases in Melaka. Hospital Melaka has been regarded as one of the main burn center in the southern part of Peninsular Malaysia covering the state of Melaka, as well as nearby states of Negeri Sembilan and northern Johor.

Within the study period, there were a total of 299 burn admissions to Burn Unit, Hospital Melaka with a mean of 100 admissions per year. The current Melaka population is 872 900, with Malay comprises the majority of it (63.3%) followed by Chinese (24.6%) and Indians (5.8%).[1] This explains higher number of cases among Malay in our study. Male predominates with male-to-female ratio of 1.7:1, which is similar to neighboring South East Asia countries (Brunei 1.1:1, Indonesia 1.22:1 and Singapore 1.9:1).[3],[4],[5]

A large number of cases were among pediatric age group, predominantly children below 5 years of age. They are at higher risk as they are unable to protect themselves and prone for domestic injuries like scald burns.[2],[3],[4],[5],[6],[7] In our study, 20.1% (n = 60) are below 2 years old, followed by young adult group between 21 and 30 years old, which comprised 15.7% (n = 27). Similar findings have been seen in other developing countries such as Brunei, Indonesia, and South Asia.[3],[4],[5]

Thermal burn is the most common cause of burn injury in all age groups, mainly due to domestic accident. Almost majority of the young age group were admitted due to scald burns secondary to hot water/liquid, hot oil, flame burn as well as contact burns. From our study, in infant <1-year-old hospitalization were mainly due to accidental scald burns either with larger total body surface area (TBSA) or affecting special area such as hands and face. We noted many of these injuries occurred due to parental or caretaker negligence, thus preventable if appropriate preventive action taken. The extent of initial injury usually worsened due to delayed presentation to health-care provider and the initial first aid was not provided.[2],[3],[4],[5],[6],[7]

In our study, open burning attributes a significant numbers of burn cases among older children and adult.[2],[5],[6] These can be seen mainly from the rural region of Melaka as open burning is still considered regular practice despite legal enforcement by local authority. Four patients with uncontrolled epilepsy had a breakthrough seizure during open burning. During festive season like Eid, many of burn injuries, especially in young children were due to recreation firecracker usage.[5]

Electrical and chemical burns are relatively rare and usually related to industrial injury.[6] Accidental industrial injury may be attributed from the lack of adherence toward standard operative procedure determined by the factory. From our study, 60% of chemical burn cases involved foreign workers who work at a chemical factory, with nitric and sulfuric acid being the most common chemical involved. Fortunately, due to effective and adherence to first-aid standard operative procedure, majority of them came with mild to moderate superficial partial thickness burns that can be managed conservatively.

The duration of stay in our study was 8 days, ranging from 1 to 67 days, in comparison to Singapore (8.4 days) and Indonesia (11.0 days).[3],[4] Majority of mild cases has the shortest duration of stay (mean of 3 days, ranging from 1 to 16 days), while moderate and major burns may stay longer for regular wound inspection, dressing and surgical intervention (mean of 15 days, ranging from 2 to 67 days). Major burn patients associated with severe inhalational injury however deteriorate faster and succumb within 5 days of burn injury.[2],[3],[4],[5]

Our overall mortality rate was 3.34%, which is comparable with Singapore (4.5%).[3] This is markedly lower in comparison to relatively similar study conducted by Ghani et al. in General Hospital Kuala Lumpur in 1987 (9.1%).[2] We contribute this to an advance burn management toward improving survival rates in burn patient.

Majority of our mortality were attributed by sepsis with multiorgan failure (50%, n = 5), followed by severe inhalational injury (40%, n = 4) and myocardial infarction (10%, n = 1). Prolonged ventilation, poorly controlled preexisting medical condition, poor nutritional status, multidrug-resistant bacterial infection, and significantly larger TBSA are among contributing factors toward mortality despite our best effort in managing burn wound.[2],[3],[4]


  Conclusion Top


Our study provides an overview on demographic features of burn patients admitted to Hospital Melaka. Children under 2 years old predominates one fifth of burn cases, with scald burn injuries as the main etiology. Flame burns affect older age groups, which can be accidental from open burning, motor-vehicle accident, or industrial-related. Chemical and electrical burns remained rare but may associate with serious complications. Despite low mortality rate, significant numbers of patient came back with disabilities and morbidity. These data present as an important role for future burn management in our local setting and hopefully can help other burn centers elsewhere.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Population by States and Ethnic Group, Department of Information, Ministry of Communications and Multimedia, Malaysia; 2015.  Back to cited text no. 1
    
2.
Ghani AN, Ibrahim SH. Burns in the Malaysian population: Two years of burns admissions for burns at the general hospital, Kuala Lumpur. Med J Malaysia 1987;42:238-41.  Back to cited text no. 2
    
3.
Chong SJ, Song C, Tan TW, Kusumawijaja G, Chew KY. Multi-variate analysis of burns patients in the Singapore General Hospital Burns Centre (2003-2005). Burns 2009;35:215-20.  Back to cited text no. 3
    
4.
Wardhana A, Basuki A, Prameswara AD, Rizkita DN, Andarie AA, Canintika AF. The epidemiology of burns in Indonesia's national referral burn center from 2013 to 2015. Burns Open 2017;1:67-73.  Back to cited text no. 4
    
5.
Pande KC, Ishak HL. Epidemiology of burns in a major referral hospital in Brunei Darussalam. Singapore Med J 2012;53:124-7.  Back to cited text no. 5
    
6.
Golshan A, Patel C, Hyder AA. A systematic review of the epidemiology of unintentional burn injuries in South Asia. J Public Health (Oxf) 2013;35:384-96.  Back to cited text no. 6
    
7.
Ibrahim SB, Omar MB, Gan EC, Rauf A, Johari NB, Yusof HB. Childhood burns at the Paediatric Institute Kuala Lumpur. Med J Malaysia 1995;50:221-5.  Back to cited text no. 7
    


    Figures

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



 

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