Epidemiology of burns in patients of a Pediatric Hospital

Nancy L. Córdova-Rivera, Jesús Gómez-Ibarra, Lizbeth Moctezuma-Lugo, Martha M. Bautista Rivas ^[a]

Hospital del Niño DIF, Hidalgo. Pachuca de Soto, Hidalgo, México

Abstract

Burns in the pediatric age is a public health problem, apart from the risk of dying, they can let functional and aesthetic sequels, which cause psychological, social, family and work problems throughout life. Using secondary sources (medical records), we performed a descriptive, quantitative, and observational studies, in order to determine the frequency of burns in children treated at the Hospital del Niño DIF Pachuca Hidalgo. We retrospectively studied 171 medical records covering a period from January 2005 to December 2010, in which it was found that males had the highest incidence of this trauma, in terms of age, children aged younger have the highest risk of a burn, getting more frequent in the age of 0-4 years. Regarding the degree of burn, the most common was of 2nd degree, caused by chemical and thermal reasons mainly. It was found that only one patient died and 6 were transferred to tertiary hospitals. Dicloxacillin and ketorolac were the most commonly used in most cases. We observed that children who come to our hospital suffering from burns, these vary in length, depth and in the cause which creates them. Also, a good percentage of children treated presented squeals. This could have cosmetic, psychological and functional consequences in children, so patients must be treated from a multidisciplinary perspective.

Keywords: Children; Treatment; Frequency, Burns

Introduction

According to the International Statistical Classification of Diseases and Related Health Problems, version 10 (ICD-10), burn injuries are classified by the affected part of the body  in chapter XIX as “burns and corrosions” (Spanish: quemaduras y corrosiones) (T20-T32) and in terms of etiology, they are classified as the ones caused by smoke, fire and flame exposures (X00-X09), in contact with heat and corrosive warm substances (X46, X49), exposure to electrical current (W85-87), lighting (X33) and exposure to corrosive substances (X46, X49). Therefore, burns include scald injuries as well as injuries caused by heat of electronic devices’ heat systems, electricity, flames, friction, hot air and hot gas, hot objects, lightings and chemical burns (external and internal corrosions of caustic chemical products). Injuries on skin and subcutaneous tissues by radiations and burns from the sun are not included in this classification of burns.^{1, 2}

Burns is an important problem in developing countries. The World Health Organization (WHO) indicates that on a global level were presented more than 7.1 millions of non-intentional burns by fire in 2004, giving a global incidence of 110 per 100,000 inhabitants per year. Moreover, WHO estimates a death rate of 4.8 per 100,00 per year. ³

In our country, according to the Epidemology Vigilance Newsletter (Spanish: Boletín de Vigilancia Epidemiológica), in 2008 burns took the twentieth place with 117,435 cases and an incidence rate of 110.08 per 100,00 inhabitants.⁴ Referring to the incidences rates per each state, the State of Nuevo León took the first place with 195.56; the State of Colima took the second place with 175.14; the State of Sinaloa took the third place with 172.64; Chihuahua took the fourth place with 170.09 and Quintana Roo took the fifth place with 168.65 per 100,00 inhabitants. The incidence rate in the State of Hidalgo is between 90 and 142 per 100,000 inhabitants.⁴ According to the age group, in all the country the most affected group for number of cases was the one of 25-44 years with 38,033 cases, followed by the group of 1-4 years with 13,968 cases and the group of 20-24 years with 11,509 cases.⁵ If we take into account the incidence rate per 100,00 inhabitants, the one of 1-4 years took the first place with an incidence of 179.84; followed by the group of 1 year with 132.45 and the group of 5.-59 years with 120.68.⁵ Though, Hospital del Niño DIF does not have cases with epidemiology of burns, our objective was to determine the epidemiological characteristics of the patients who attended to the hospital with burns in a period of 5 years.

Materials y methods

It was carried out a retrospective, transversal and observational study. The study protocol was authorized by the Research and Ethics Committees of the Children’s Hospital (Spanish: Comisiones de Investigación y de Ética del Hospital del Niño DIF) and the study was carried out in accordance with the Regulation of the General Health Law on Health Research and the Declaration of Helsinki (Spanish: Reglamento de la Ley General de Salud en Materia de Investigación para la Salud y la Declaración de Helsinki). In order to develop this study, it was carried out an evaluation of clinical files of patients with a diagnostic of burns and who had attended the hospital from January 1, 2005 until December 31, 2010. A descriptive statistic was used to make the analysis. Using the software Microsoft Office Excel 2007, it was obtained measures of central and dispersion tendency. Also, it was obtained the absolute frequencies and percentages.

Results

A total of 172 patients, who had their complete files from 2005 until 2010, was identified and included. It was obtained that 53.8% (n=92) of the patients were males. According to the age, 63.8 % (n=108) were 0-4 years, 22.2 % (n=38) were 5 -9 years, 13.5 % (n= 23) were 10-14 years and only 2 (1.2%) patients were older than 14 years of age. About the origin of burns, it was found out that 49.1 % (n=85) were from a chemical origin (mainly by caustic soda and powder), 41.5 % (n=71) were from a thermal origin (mainly by hot liquids) and only 8.8 % were from an electrical origin.

In figure 1, it is shown the degree burns which presented the patients. In table 1, it shows the areas of the body which were affected by burns. About the percentage of the affected body area, it was found out that 78.4 % (n=134) had from 1 to 15 % of their bodies affected, 1 patient (0.6 %) had between a 61 and 75% of his body affected and only 1 patient had between 76 and 100% of his body affected.

One hundred twenty two patients (71.3 %) only required hospitalization and 49 (28.7%) required surgery intervention. About time of hospital stay, 31% (n=53) of the patients were from 4 to 7 days, 28.7% (n=49) stayed more than 11 days, 24.6% (n=42) between 8 and 11 days and only 27 patients (15.8%) stayed hospitalized less than 4 days. A total of 88.3% (n=151) of the patients recovered without important effects, 8.8% (n=15) of the patients had important effects, 2.3% (n=4) of the patients were taken to another hospital center and only 1 patient died. The tables 2 and 3 show the analgesics and antimicrobials used in the patients.

Figure 1. Frequency of burns according to their degrees.

Table 1. Frequency of affected areas in patients.

Tabla 2. Analgesics used in patients with burns.

Tabla 3. Antimicrobials used in patients with burns.

Discussion

Although burns are ways of trauma which require optimal multidisciplinary care, they have been manipulated and studied as a separate way from the other types of injuries. In some situations, burns can produce cosmetic, functional and devastating psychological consequences, especially in growing children. ^{6, 7}

In the epidemiology newsletter of our country, it was found out that the major percentage of the cases corresponded to men with 52%⁵. Interestingly, in our study, we found out a frequency nearly similar to the last report, with frequencies between females (46.2 %) and males (53.8%). Moreover, in the newsletter before mentioned, the group of age more affected was the group from 1 to 4 years. ⁵ In our study, the most affected group was also the one of 0-4 years with 63.8% of patients. In these two variables, our data agree with the reported information on the national level.

A recent study by Bocanegra and Cols, carried out in a university hospital in Monterrey, Nuevo Leòn, Mexico found out 76 cases of children with burns, from which 75 were of second degree and one case of third degree. ⁸ This result contrasts with our result since we found out that 6% of the cases had first degree and 16% had first and second degrees. Probably, this difference is due to the fact that we registered all the patients who were in all the hospital services, while Bocanegra and Cols’ study only registered the patients who attended to emergency services.

In a study carried out by Cuenca-Pardo and collaborators, in the Unit of Burns at the Hospital of Traumatology “Magadalena de las Salinas” of the Mexican Social Security Institute (Spanish: Instituto Mexicano del Seguro Social) at the Federal District, Mexico, it was found out that the most common cause of burns was hot liquid exposure (77.7%). ⁹ In our study, only 41.5% were of thermal origin. In the same study of Cuenca-Pardo et al., they found out that the most affected group was the one of the children younger than 5 years. ⁹ This result agrees with  our group of age most affected (0-4 years).

All children with burns presented pain, independent of cause, extension, or depth. Poor management of pain can result from a breach of the treatment and, as a consequence, can take more time to be healed. A multidisciplinary approach is necessary to achieve a moderate or severe pain relief. The key to the treatment’s success is the continuing and exact evaluation of the pain and the treatment responses. The appropriate analgesic agents in a child with burns should have the following characteristics: (i) easy to be administered, (ii) well tolerated, (iii) they should provide a fast beginning of the analgesia in a short action term, and (iv) have a minimum of diverse reactions. ¹⁰ In the current study, we could observe that in general, most of the patients received an analgesic or a combination of several of them.

The infections in burn injuries are one of the most important and potentially severe complications which are produced during the acute period after an injury. Apart from the nature and extension of these thermal injuries, which influenced on the infections; the type and quantity of microorganisms which colonize the burn injury seems to influence on the risk of infection of an injury. The value when preventing an infection has been recognized in the treatment of burns. The bacterial pathogens which have been associated with the mortality in burns include Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae y Staphylococcus aureus. ¹¹ In the current study, in general the patients received different antimicrobials, such as monoteraphy or a combination of 1 or 2 pharmacological agents.

Conclusions

We could observe that children who attend our hospital suffer burns which vary in extension, depth and in the cause which origins them. Moreover, we could validate that the mortality rate was very low in the current study. However, a great percentage of children treated had effects because of the burns. This can provoke cosmetic, functional and psychological functions in children; therefore, it is mandatory to care for the patient with burns from a multidisciplinary point of view.

References

^[1]WHO. The injury chartbook: a graphical overview of the burden of injuries. Geneva. 2002. pp. 28–31.

^[2]International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Version for 2006. http://www.who.int/classifications/apps/icd/icd10online/

^[3]Annual incidence (000s) for selected causes, in WHO Regions (a), estimates for 2004. http://www.who.int/healthinfo/ global_burden_disease/estimates_regional/en/index.html

^[4]Boletín del Sistema Nacional de Vigilancia Epidemiológica. 2009. Volumen 26. Número 25. Semana 25. Páginas 1-3.

^[5]Boletín del Sistema Nacional de Vigilancia Epidemiológica. 2009. Volumen 26. Número 27. Semana 27. Páginas 1-4.

^[6]Sheridan RL. Burns. Crit Care Med 2002; 30:S500-14.

^[7]Hettiaratchy S, Dziewulski P. ABC of burns. Introduction. BMJ 2004;328: 1366-8.

^[8]Bocanegra-Cedillo IE, Garza-Alatorre AG, Barragán-Lee JR. Quemaduras en niños: Frecuencia y distribución de las lesiones. Rev Mex Pediatr 2008; 75; 65-67.

^[9]Cuenca-Pardo J, de Jesús Alvarez-Díaz C, Comprés-Pichardo TA. Related factors in burn children. Epidemiological study of the burn unit at the "Magdalena de las Salinas" Traumatology Hospital. J Burn Care Res. 2008; 29: 468-74.

^[10]Gandhi M, Thomson C, Lord D, Enoch S. Management of pain in children with burns. Int J Pediatr. 2010; 2010: 1-9.

^[11]D'Avignon LC, Hogan BK, Murray CK, Loo FL, Hospenthal DR, Cancio LC, et al. Contribution of bacterial and viral infections to attributable mortality in patients with severe burns: an autopsy series. Burns. 2010; 36: 773-9.

^[a] Contact information for correspondence: mhabari@yahoo.com.mx
Hospital del Niño DIF, Pachuca, Hidalgo, México