9-Hassani

JRHS 2009; 9(1): 50-33

Copyright © Journal of Research in Health Sciences

Analysis of Hospitalized Burned Patients in Bandar Abbass, Iran

Hasani L(MSc)a, Aghamolaei T( PhD)b, Boushehri E( MSc)c, Sabili A( MSc)d

aDepartment of Public Health , School of Health, Hormozgan University of Medical Sciences, Badar Abbas, Iran

bDepartment  of Health, School of Health, Hormozgan University of Medical Sciences, Badar Abbas, Iran

cDepartment of Biostatistics& Epidemiology, School of Health, Hormozgan University of Medical Sciences. Badar Abbas, Iran

dNursing Management, Khalijefars Hospital, Social Security Organization, Badar Abbas, Iran

*Corresponding author: Laleh. Hasani MSc, E-mail: heajia@yahoo.com

Received :12 December 2009; Accepted :25 April 2009

Abstract

This study was conducted to determine the causes and outcomes of burn in patients referred to Shahid Mohammadi Hospital in Bandar Abbass, southern Iran, in which 212 burned patients were assessed from March 2007 to March 2008 .Mean age of patients was 22.14 yr. Heat contact was the main cause of burn with 92.5%. 49.1% of total burns occurred among less than 20 yr old people. Mortality rate was 10.4%. Most of burns occurred at home. An educational program is necessary to prevent thermal burning at home.

Keywords: Electrical burn, Thermal burn, Chemical burn, Burned surface, Iran

Introduction

Burns account for 5% or more of the total hospital in-patients at any time (1). In Zim­babwe, the mortality was 22% (2). Burn in­juries cause significant morbidity and mor­tality, both in developing and developed countries (3). Of major injuries, burns ac­count for over 1% of the global burden of the disease (4). Burn injuries in Iran like other developing countries, are much more common than in the USA and Europe (5). Many studies have been perf­ormed on burn injury in Iran (6, 7). These studies reported an overall incidence rate of mortality rang­ing from 2.0 to 5.6/100 000 person/yr. These studies have shown that most burn injuries are caused by handling kerosene and oc­curred at home.

A major public health issue raised by these studies is suicide attempt by self-inflicted burning in females and children, accounting for up to 37% of burn accidents in this po­pulation. Based on these findings, the main objective of this study was to assess the characteristics and outcome of burn pa­tients in Hormozgan Province in order to assess the reasons for such injuries and pos­sible strategies to reduce them. Shahid Moham­madi Hospital is the only burn center for patients in this province, which has a popu­lation of more than 1 million inhabi­tants.

Material and Methods

This was a 12-month study from 21 March 2007 to 19 March 2008 and included all burn patients admitted to Shahid Moham­madi Burn Center. Data were collected using a checklist, including age, date of admission, length of hospitalization, percentage of burn (total body surface area, TBSA), time, sea­son, cause of the burn ac­cident and outcome of treatment. Data were obtained from medi­cal records. TBSA was estimated by the “rule of nines”. Patients were divided into 3 groups based on TBSA%: group 1 with TBSA% < 30%, group 2 with TBSA% be­tween 31%- 60% and group 3 with TBSA% > 60%.

Statistical analysis was performed using SPSS, version13. The chi squared test, t-test, ANOVA, were computed. A P-value < 0.05 was considered statistically significant.

Results

During the study duration, 212 burn patients were admitted to the hospital. Most of them were female (66%). Their mean age was 22.14 (SD 16.01) yr (range: 40 days83 yr). The age distribution and data related to the injury and outcome are shown in Table 1. Of 212 patients, 22 died giving a death rate of 10.4%. Mean and median of TBSA were 30.21% (SD 25.41) and 20%, respectively (range: 1%100%) (Table 1). The mean (SD) of TBSA among the patients who sur­vived were 25.1% (19.49%) and those who died were 74.36% (28.12%), respectively (P= 0.003) (Table 2).

Table 1: Mortality and extent of burn injury in total patients by age group

Age group

(years)

Patients No.

(%)

Deaths No.

(%)

TBSA (%)Mean (SD)

Hospital  stay (days) Mean (SD)

< 5

45(21.2)

2(4.4)

19.66(13.90)

7.13(5.91)

61 5

26  (12.3)

1(3.8)

23.53(19.95)

11.3(11.91)

1625

68(32.1)

11(16.2)

33.82(28.85)

7.51(9.82)

2640

50(23.6)

3(6)

28.62(17.58)

8.42(6.78)

4160

18(8.5)

2(11.1)

48.50(35.76)

5.44 (11.75)

> 60

5 (2.4)

3(60)

61(42.48)

2.6(2.50)

Total

212(100.0)

22(10.4)



TBSA= total body surface area

SD = standard deviation.

Table 2: Mortality and length of hospitalization in total patients by total body surface area (TBSA) burnt

% TBSA

Patients No. (%)

Deaths No.

(%)

Hospital  stay days Mean (SD)b

< 20

108 (50.9)

1(4.5)

7.91(7.59)

2140

58 (27.4)

3 (13.6)

10.89(11.61)

4160

16 (7.5)

3 (13.6)

5.81(7.86)

6180

14 (6.6)

3 (13.6)

3.21(6.14)

> 80

16(7.5)

12 (54.5)

2.18(2.53)

TBSA= total body surface area

SD = standard deviation.

Thermal burning was the commonest cause of burn (92.5%), followed by electrical burning (7.1%) and chemical burning (0.5%) (Table 3). Of 196 patients with flame inju­ries, 130 (77.8%) were caused by oil and gasoline, 98(22.2%) by gas explosion and 55 (16.28%) by scald. Among the age groups less than 20 yr and 21-40 yr and more than 40 yr, there were 10 (4.7%) cases of self-in­flicted burn injury (suicide attempts). Most of burning occurred at home 57(74.1%).

The mean length of hospital stay of the pa­tients was 7.8 (SD 8.9) days (range: 1 to 52 days). There was a significant between mean length of hospitalization and TBSA (Anova, P= 0.002) and with post hoc tukey. There were significant between mean length of hospitalization and TBSA between group one(less than 30% TBSA) with group three (more than 60%) P= 0.001, and between group two (between 31%and 60%) with group three (more than 60%) P= 0.04.

The total mortality rate was 10.4%. Most of the patients were admitted in the winter months (33%), followed by spring (22.2%), summer (21.7%) and autumn (23.1%).

Table 3: Causes of burn injuries and length of hos­pital stay in total patients

Variable

No.(n=212)

%

Type of burn



Thermal

196

92.5

Electrical

15

7.1

Chemical

1

0.5

Hospital stay (days)



< 10

157

74.1

1120

40

18.9

2130

10

4.7

3140

1

0.5

> 40

4

1.9

Discussion

Burns are one of the most significant health problems throughout the world, leading to prolonged hospitalization and hence in­creased expense for the patients, their fami­lies and society. In this study, the majority of patients (49.1%) were younger than 20 years, which indicates greater exposure to burn agents in these age groups than in any other age group, a finding that has also been observed by another (8). In this study, 4.7% of burn injuries were self-inflicted, which is less than the result of another study (7). This was suicide attempts due to family disturb­ances, marriage problems, etc. and most of them used oil and gasoline because of their ready availability at home and the context. This information was obtained by inter­viewing the patients; there were no data re­corded in their files. Also in a cohort of 152 burned wives in India, 47 (31%) were homi­cidal burns and most of them were 16-25 years of age (77%) (9).

In this study, similar the other one (8), the majority of burns was caused by flame, with oil or gasoline being the flammable liquids most frequently involved. This is probably due to their wide availability and common use as domestic fuels in different parts of Hormozgan.

We had a death rate of 10.4%. A death rate of 19.6% was reported in another study (10) .This was because the most common cause of burn in our study was flame and this type of burn is deeper and associated with more severe destruction of tissue than other causes of burn. It is also accompanied by consider­able immunosuppression, which makes the patient vulnerable to infection (11).  This is supported by the observation of a significant correlation between TBSA and mortality (P= 0.002). Furthermore, there was a significant difference between the mean length of hos­pitalization and TBSA (P= 0.002) indicating that with an increase in TBSA, the total length of hospitalization was reduced be­cause of early death and transfer to the other provinces or referring. This concurs with observations from another study (10).

Of course, one major reason for the high mortality in our patients is the lack of burns intensive care unit (BICU) since 14 patients (15.4%) died within the first 72 hours of admission. The lack of a BICU leads to a delay in early excision of the burn wound and skin grafting, procedures that are essen­tial for the optimal care for a burn patient (12). As found in other studies, the most fre­quent admissions occurred in winter (10) due to greater use of heating devices.

In conclusion, most of burns occurred at home and the most important cause of burning was thermal burn. Hence, educa­tional programs are necessary in order to prevent burning especially thermal burn at home.

Acknowledgements

We would like to thank the Deputy for Re­search at Bandar Abbass University of Medical Scie­nce, Iran for the financial sup­port of this project. We would also like to thank the administrator of Shahid Moham­madi Hospital and medical workers of this hospital especially Burn Emergency Unit. The authors declare that there is no conflict of interests.          

References

  1. Bowen-Jones JR, Coovadia YM, Bo¬wen-Jones EJ. Infection control in a third world burn facility. Burns .1990; 16: 445-48.
  2. Mzezewa S, Jonsson K, Aberg M, Sa¬lemark L. A Prospective study on the Epidemiololgy of burns in patients admitted to the Harare burns unit. Burns. 1999 Sep; 25(6):499-504.
  3. Barret JP, Gomez P, Solano I, Gonzalez-Dorrego M, Crisol FJ. Epidemiology and mort¬tality of adult burns in Ca¬talonia. Burns. 1999; 25: 32529.
  4. Leistikow BN, Martin DC, Milano CE. Fire injuries, disasters and costs from cigar¬rettes lights, a global overview. Preventive medicine. 2000; 31: 919.
  5. 5.        Rajabian MH, Aghaei S,Fouladi V. analysis of survival and hospitalization time for    2057 burn patients in shiraz, southwestern iran.Med Sci Monit.2007 Aug; 13(8): CR353-5.
  6. Maghsoudi H, Pourzand A, Azarmir G. Etiology and outcome of burns in Tabriz, Iran. An analysis of 2963 cases. Scandin¬navian journal of sur¬gery. 2005; 94(1):7781.
  7. Saadat M. Epidemiology and mortality of hospitalized burn patients in Ko¬hkiluye va Boyerahmad province, Iran (20022004). Burns. 2005; 31(3): 3069.
  8. Avsarogullari L, Sozuer E,Ikizceli I, Kekec Z, Yurumez Y, Ozkan S. Adult burn injuries in an emergency depart¬ment in central Anat¬tolia, Turkey: a 5-year analysis. Burns. 2003; 29(6):5717.
  9. Kumar V, Tripathi CB. Burnt wives: a study of homicides. Medicine, science, and the law.2004; 44(1): 5560.
  10. Rastegar Lari A, Alaghehbandan R, Nikui R. Epidemiological study of 3341 burns patients during three years in Tehran, Iran. Burns. 2000; 26: 49-53.
  11. Bang RL, Gang RK, Sanyal SC, Mo¬kaddas E, Ebrahim MK. Burn septice¬mia. Burns. 1998; 24(4):35461.
  12. Merrel SW, Saffle JR, Larson CM. The declining incidence of fatal sepsis following thermal injury. Journal of trauma. 1989; 29:136266.


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