The epidemiology of burns in secondary care, in a population of 2.6 million people

doi:10.1016/S0305-4179(98)80001-6

Burns

Volume 24, Issue 2, March 1998, Pages 139-143

https://doi.org/10.1016/S0305-4179(98)80001-6 Get rights and content

Abstract

The numbers of residents of the four counties in the west of Anglia and Oxford Region (UK) who were treated for burns (including scalds) in accident and emergency (A&E) departments or admitted to hospital in 1994–1995 were obtained from A&E departments and district health authority records. Burns comprised about 1 per cent of the workload in the A&E departments. Using the data from district health authorities, the rate of admission with a main diagnosis of burns to any hospital was 0.14 per thousand population per year. Children under five had the highest rate of admission. Approximately half the patients admitted to hospital with burns were admitted to burns units, a quarter to plastic surgery wards and the rest to different specialties including trauma and orthopaedics, paediatrics, and ophthalmology. The median length of stay was 6 days for burns units and 3 days for plastic surgery units.

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ISBI Practice Guidelines for Burn Care, Part 2
2018, Burns
Agents, mechanisms and clinical features of non-scald burns in children: A prospective UK study
2017, Burns
Citation Excerpt :
In the United States approximately 55,000 children aged less than 16 were admitted to hospital due to burns in 2006–2015, accounting for 27% of all burns admissions [2]. In the United Kingdom (UK), fewer than 10% of children with burns undergo hospital admission [3] although it is estimated that 50,000 children attend Emergency Departments (ED) with burns each year [4]. Most epidemiological studies have focused on burns admissions, which by their nature capture larger severe burns, predominantly scalds, and often with data from Burn Centers and units [5–10].
To inform childhood burn prevention by identifying demographics, clinical features and circumstances of unintentional non-scald burns.
A prospective cross-sectional study was conducted across Cardiff, Bristol and Manchester, including six emergency departments, three minor injury units and one burns unit between 13/01/2013–01/10/2015. Data collected for children aged <16 years with any burn (scald, contact, flame, radiation, chemical, electrical, friction) included: demographics, circumstances of injury and clinical features. Scalds and burns due to maltreatment were excluded from current analysis.
Of 564 non-scald cases, 60.8% were boys, 51.1% were <3 years old, 90.1% (472/524) of burns affected one anatomical site. Contact burns accounted for 86.7% (489/564), 34.8% (137/394) of which were from objects placed at >0.6 m and 76.5% (349/456) affected the hands. Hairstyling devices were the most common agent of contact burns (20.5%, 100/487); 34.1% (30/88) of hairstyling devices were on the floor. Of children aged 10–15 years, 63.7% (65/102), sustained contact burns of which 23.2% (13/56) were preparing food, and when burnt from hairstyling devices, 73.3% (11/15) were using them at the time of injury.
Parents of toddlers must learn safe storage of hazardous items. Older children should be taught skills in safe cooking and hairstyling device use.
The impact of socio-economic deprivation on burn injury: A nine-year retrospective study of 6441 patients
2016, Burns
Low socio-economic status is thought to be associated with increased burn risk, however the significance and generalisability across different populations and cultures has been questioned.
A nine-year retrospective study of burn presentations to a large teaching hospital (2005–2014) was performed to investigate the association between socio-economic status and burns. Demographic and injury data was collected via the trust ‘Information portal’. The Welsh Index of Multiple: Deprivation 2011 was used to score for socio-economic status. Chi-squared test and Odds Ratios were calculated and statistical significance defined as p < 0.05 throughout.
6441 burns were identified, with 755 (11.7%) admitted. Overall incidence rates were the highest published in the UK (0.35/1000/year) with sub group analysis showing the highest rates in under fives and males. Significant relationships between both age and burn mechanism and gender and burn mechanism (p = 0.0005) were identified. Scald (67.1%) was the most common mechanism with the upper limb (48%) most commonly burned. Chi square analysis demonstrated a significant relationship between socio-economic deprivation, age and burn incidence (p ≤ 0.0005), with a disproportionately high number of burns in patients under the age of 16 in the most deprived quintile (OR 1.23; 95% CI 1.06–1.44).
This study specifically highlights patients under the age of 16 living in poorer socio-economic areas as the most at risk of suffering burns receiving hospital attention. This study demonstrates burns as a significant public health issue, and the results should aid in designing specific burn prevention strategies to target high-risk groups.
Factors associated with length of hospital stay in minor and moderate burns at Popayan, Colombia. Analysis of a cohort study
2016, Burns
To determine the independent contribution of prognostic factors to length of hospital stay of minor and moderate burn victims at the Hospital Universitario San José (HUSJ), Popayán, Colombia, 2000–2010.
This was a retrospective cohort study of minor and moderate burn victims admitted between 2000 and 2010, at the burn unit (HUSJ). This is a further analysis of a same cohort previously published in Burns. The following variables were recorded and analyzed: age, gender, origin, depth and extent of burn, causal agent, length of hospital stay and mortality. The main outcome under study was length of stay. Survival analysis was done to explore the association of covariates and length of hospital stay and Cox regression model to adjust the effect of covariates in the outcome.
During the study period 2000–2010, 842 of 921 (91.5%) patients treated at the Burn Unit of HUSJ that had complete data were included. There were 520 (61.8%) males and 322 (38.2%) females with a male to female ratio of 1.6:1. Their median age was 9 years (IQR 3–28). The median of percent total body surface area burned (TBSA) was 12% (IQR 7–21) and the most common degree of burn was 2nd degree with 58% (488 patients). There were 12 deaths (censored data) and 830 patients were discharged alive. After multivariate adjustment, significant associations with length of hospital stay remained for age group, burn degree and extension of the burn. The strongest relationship found was for burn degree (2nd degree superficial vs. 3rd degree hazard ratio = 2.66 CI 95% [2.13–3.33]).
In patients admitted with mild and moderate burns at HUSJ, the main predictors of length of stay were age, burn degree and extension of the burn.
Burn related mortality in Greater Manchester: 11-year review of Regional Coronial Department Data
2015, Burns
Citation Excerpt :
The descriptions in literature have also failed to present population-based mortality statistics limiting their usefulness to either monitor temporal changes in mortality in response to prevention programmes or to compare mortality across different geographic regions [16–20]. On the other hand studies that do report population-based statistics have suffered from a lack of consistency in presenting patient demographics, injury characteristics as well as age- and gender-specific injury rates [17,21–23]. Coroners’ services in England and Wales form a statutory service that inquires into the circumstances of death of all unexpected, unexplained, suspicious, violent and work-related/industrial deaths.
The Coroners Department (CD) records hold important demographic, injury and death details for victims of burn injuries derived from various sources yet this rich source of data has been infrequently utilised previously in describing the epidemiology of burn related mortality. The aim of this study was to use CD data to comprehensively investigate burn related mortality in the Greater Manchester region of United Kingdom.
A retrospective study design was used to collect data for deceased demographics, injury details, site of death and cause of death from four CD offices in GM over an 11-year period (2000–2010 inclusive). Office of National Statistics (ONS) population metrics were used to calculate age- and gender-specific population denominators and mortality rates. Index of Multiple Deprivation (IMD) was used to correlate mortality with deprivation. Linear regression and Pearson's/Spearman's rank correlation were used to calculate trends and correlations. Poisson regression was used to calculate relative risk (IRR) between age- and gender groups.
There were 314 recorded deaths in the region over the study period and thermal injury was 3-times less likely to result in death in 2010 compared to 2000. The largest proportion of these deaths (24.8%) was comprised of individuals ≥75 years in age. The relative risk of mortality in males was nearly 1.5-times higher and a significant majority of victims (77%) sustained their burn injury at their own home/residence. Inhalation injury without cutaneous burns was the most frequent type of injury (33%) and accidental house fires caused nearly half (49%) the injuries resulting in death. Sixty-five percent of deaths during this period were recorded to have occurred outside of regional burn service (RBS) hospitals and the commonest cause of immediate death on the death certificates was “inhalation of products of combustion” (32.1%). Within the >75 years age group the risk of death significantly increased with every quintile reduction in deprivation.
Our data shows that despite reducing overall mortality, certain age groups and causation patterns are associated with significantly higher risks of mortality in our region. Further reduction in burn mortality should focus on the use of prevention efforts with established effectiveness in these high-risk groups. In addition, as a significant proportion of deaths occur outside a burn service environment hence epidemiology data based solely on mortality statistics from burn services will underestimate true burn related mortality.
Development and implementation of prospective outcome monitoring in a regional burns service using cumulative sum (CUSUM) techniques
2013, Burns
Real-time monitoring of mortality in burns units has the potential to immediately mark when mortality rates are significantly higher or lower than predicted. Rapid feedback from targeted internal audit allows early intervention, to reinforce positive practices, and improve systems where outcomes are unsatisfactory.
This is the first study to describe prospective use of cumulative sum (CUSUM) methodology in mortality monitoring outside of cardiac surgery.
An eight-year retrospective study of mortality was performed on all admissions to a regional burns intensive care unit in the UK. Risk-adjusted CUSUM charts, variable life adjusted displays (VLADs) and zeroed VLADs were produced to track mortality against that predicted by the Belgium burns score. The same techniques were implemented prospectively for one year (76 admissions) using the Osler modification of the Baux score for risk adjustment.
Internal audit would have been triggered on nine occasions using zeroed VLAD monitoring in the retrospective study. The Belgium score overpredicts mortality in the elderly.
Internal audit was triggered for better than predicted outcomes on two occasions in the prospective study.
This study describes a successful design for an early-warning system to monitor outcomes in a burns intensive care setting.

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Scientific and clinical paperThe epidemiology of burns in secondary care, in a population of 2.6 million people

Abstract

Burns

Burns

Burns

The incidence, causes and treatment of minor burns

J. Wound Care

Scientific and clinical paper
The epidemiology of burns in secondary care, in a population of 2.6 million people