Twelve
patients had self-inflicted burns who had a history of psychiatric illness
which account only for 3% of the cases.
Table III
presents the highest percentage of burns sites which were in the arms and trunk
(78.3 and 76.3%) respectively, while the lowest percentage was in the genitalia
(2.3%).
Most of the
patients received burn injuries in the range of 1-2% burned BSA (48.3%)
followed by 21% to 40% burned BAS (32.3%).
Only few patients received burn injuries >40% burned BSA (19.5%). The average burned BSA was 27.2% as shown in
Table IV.
Of the 400
patients, 9 patients presented with inhalational injuries and three (3.33%) of
them died. All inhalation injuries were
caused by direct flame burns. Ninety-six
percent of the patients had no significant past medical history. Twelve patients (3%) had a psychiatric
history; four patients (1%) were epileptics on medication.
The
mortality rate was 5.8% for all patients younger than 14 years of age and 19.7%
for all patients aged 14 years and older.
The overall mortality rate was 14.3% for all the 400 patients.
Figure 5
shows the mortality rate according to age and gender. The mortality rate was
higher in males (8.3%) than in females (6%). Figure 6 shows mortality rate
according to burned BSA. Figure 7 shows the mortality rate according to the
causes of burns in adults and children. Flame burns had the highest overall
mortality rate (91.2%), followed by hot liquids in both children and adults.
Discussion
In our study,
children were frequently affected victims of burn injuries and 39% of the cases
were patients younger than 14 years of age, which are higher than the studies
conducted by Andrew et al. and Rytis et al.(3,4)
but similar to the study done by Haberal et al.(5)
The highest burn injury occurring in children indicates a higher exposure to
burn accidents at this age. The greatest number of injuries occurred to
children who were one to two years of age.(6) which is
younger than the age in other studies,(7,8,9) however,
older than the study of Francis.(10) Males were more frequently the victims of
burns than females in all age groups This male percentage is similar to that reported in
other studies.(9,11)
The cold weather in Jordan
commences in November and lasts till March. Kerosene and butane gas are
commonly used in Jordan
during cold weather and these cause the majority of the Direct Flame Burns.
This explains most of the seasonal variation in patients' numbers in our study.
While regarding to the yearly distribution further analytical studies are
needed to determine their significance.
Direct
Flame was the leading cause of burns in adults and had the highest rate of
mortality, and was mostly caused by butane gas heater or a light stove causing
stove explosions and fires. Scald burn was the second common cause of burns in adults.
These findings are consistent with most of the other studies.(1,5)
In our
study, the most common causes of burns in children were hot liquids such as water,
tea, coffee, and soup. Additionally, some traditional Jordanian customs were also
a cause of these burns. One example is the preparation Mansaf, a traditional
Jordanian dish, which requires hot yogurt (laban). Previous studies also have
shown that burn injuries in children were most frequently caused by hot liquids(7)
which is also consistent with the other regional and international studies.(12,13)
Burns
caused by flames are the second-leading cause of burn injury in children, which
is consistent with the study conducted by El-Badawy et al.(12)
In our study, we found that adult females had more scald and chemical burns
than adult males. Electrical and Direct Flame Burns (DFB) affect male more than
females. The reason is probably most of the males were burned at work, as
opposed to females, who were burned at home. Two female patients were burned by
chemicals as a victim of a criminal act. Fortunately, this is a rare event in
comparison with a study done by Asaria .(13)
Mercier
et al.(14) and Harmel et al.(15)
reported that electric burns were less common in the pediatric age group when compared
with other types of burn injuries. We found that none of the pediatric age
group had electrical burn. However other studies(8,9,11) show
quite variable frequency of electrical burns in children. El-Badawy(12)
reported that the rate of electrical burns in children was 3%, and two other studies
published in Turkey
by Haberal et al.(5) and Anlatici et al.(16)
reported that the rate of electrical injuries in the pediatric age group
was 10% and 16.8% respectively.
In our study, the overall mortality rate was
14.3%, which are lower than the study conducted by De-Souza et al.(1)
and Mukerji et al.(9) and higher than other studies.(17-19)
This difference may be partly explained
by the varying severity of burns, if we compare only the patients with an equal
burned BSA, the mortality rate observed in our unit is similar to that of other
centers. De-Souza et al.(1) reported a mortality rate
of 59.4% for patients with burned BSA of more than 40%. We found 59% mortality
rate in our unit for patients with burned BSA more than 40%.
In this
study, the elderly patients (over 65 years old) mortality rate was (41.7%), which
is higher than the younger patient groups (younger than 65 years old) 13.4%. Nguyen
et al.(19) reported that the effective initial
management of burns considerably reduced the risk of morbidity and mortality,
and since most of our patient were referred to our unit from other cities by a
land ambulance, or referred to us from other countries, a higher mortality rate
is explainable.
Conclusion
Children
are at high risk from burn injuries, the main cause of which is scalding. In
the adult age group, the main cause of burn injuries was flame burns. The
mortality correlates highly with the percentage of burn and its main cause is
direct flame burns. Most burns are preventable and, hence, educational programs
should be conducted to inform the public of the causes of burns and their
prevention.
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