Adult thermal injuries in New Zealand resulting in death and hospitalization

doi:10.1016/S0305-4179(98)00018-7

Burns

Volume 24, Issue 3, May 1998, Pages 245-251

https://doi.org/10.1016/S0305-4179(98)00018-7 Get rights and content

Abstract

This paper provides an overview of thermal injury resulting in death or hospitalization in New Zealand adults, defined as age 15 years and over. For the 10-year period 1978–1987, there were 493 adult thermal injury deaths resulting in an overall rate of 2.1 per 100 000 person-years (95%CI: 1.9 – 2.3). For the year 1988, there were 644 hospitalizations resulting in a rate of 25.1 per 100 000 (95%CI: 23.2–27.1). The highest rates of death and hospitalization were observed in the elderly (65 years of age and over). Young males (15–29 years) also had a very high rate of hospitalization. Residential fire was the most common type of burn event resulting in death (44%), and smoking materials were the most common source of ignition in fatal residential fires (37%). Hot liquids were the most common source of thermal energy for the hospitalized injuries (34%). Typical scenarios involved burns from hot water expelled from automobile radiators, from hot water use in the workplace, from hot beverages, and from household hot tap-water. The epidemiology of the adult thermal injuries in New Zealand is similar to that reported in other developed countries. Opportunities and strategies for the prevention of these injuries are discussed.

References (38)

Y Milo et al.
Epidemiology of burns in the Tel Aviv area
Burns
(1993)
P Panayotou et al.
Epidemiological data on burn injuries in Greece: a statistical evaluation
Burns
(1991)
NS Sarhadi et al.
Burns in the elderly in the South East of Scotland: review of 176 patients treated in the Bangour Burns Unit (1982–1991) and burn inpatients in the region (1975–1991)
Burns
(1995)
G Browne et al.
Psychosocial adjustment of burn survivors
Burns
(1985)
P Tucker
Psychosocial problems among adult burn victims
Burns
(1987)
AE Waller et al.
Childhood thermal injuries in New Zealand resulting in death and hospitalization
Burns
(1993)
SP Pegg et al.
Epidemiology of burns attending a casualty department in Brisbane
Burns
(1983)
RN Matthews et al.
The Coventry thermal injury study
Burns
(1991)
P Lyngdorf
Epidemiology of severe burn injuries
Burns
(1986)
JD Langley et al.
Injury mortality and morbidity in New Zealand
Accid Anal Prev
(1989)

AE Waller et al.

An evaluation of a program to reduce home hot tap water temperatures

Aust J Public Health

(1993)

JA Clarke et al.

Barriers to the reduction of domestic hot water temperatures

Safety Science

(1995)

SP Baker et al.

The injury fact book

(1992)

CFT Snelling et al.

Trends in hospital care of burns in Canada

J Trauma

(1992)

LH Engrav et al.

Impairment, time out of school, and time off work after burns

Plast Reconstr Surg

(1987)

DP Rice et al.

Cost of injury in the United States: A report to congress

(1989)

E McLoughlin et al.

The causes, cost, and prevention of childhood burn injuries

Am J Dis Child

(1990)

Department of Statistics

1986 New Zealand census of population and dwellings, usually resident population, series B report 25

(1987)

Department of Statistics Te Tari Tatau

1991 New Zealand census of population and dwellings, New Zealand's population structure

(1992)

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Scientific and clinical paperAdult thermal injuries in New Zealand resulting in death and hospitalization

Abstract

Burns

Burns

Burns

Burns

Burns

Burns

Burns

Burns

Burns

Accid Anal Prev

Aust J Public Health

Safety Science

The injury fact book

Trends in hospital care of burns in Canada

J Trauma

Impairment, time out of school, and time off work after burns

Plast Reconstr Surg

Cost of injury in the United States: A report to congress

The causes, cost, and prevention of childhood burn injuries

Am J Dis Child

1986 New Zealand census of population and dwellings, usually resident population, series B report 25

1991 New Zealand census of population and dwellings, New Zealand's population structure

Scientific and clinical paper
Adult thermal injuries in New Zealand resulting in death and hospitalization