|Year : 2019 | Volume
| Issue : 3 | Page : 144-148
Etiology and outcome of burns in Hamadan, Iran: A registry-based study
Salman Khazaei1, Fatemeh Shirani2, Maryam Afshari3, Ensiyeh Jenabi3, Zahra Hamzei4, Mohammad Torabi5, Tayebeh Bathaei6
1 Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
2 Department of Nursing, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
3 Autism Spectrum Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
4 Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
5 Department of Nursing, School of Nahavand Paramedic, Hamadan University of Medical Sciences, Hamadan, Iran
6 Department of Operating Room, School of Para Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
|Date of Submission||09-Jun-2019|
|Date of Decision||18-Aug-2019|
|Date of Acceptance||04-Sep-2019|
|Date of Web Publication||26-Nov-2019|
Ms. Tayebeh Bathaei
Department of Operating Room, School of Para Medicine, Hamadan University of Medical Sciences, Hamadan
Source of Support: None, Conflict of Interest: None
Background: Burn prevention strategies are most effective when they are based on knowledge of etiological patterns of burn injuries and considering the geographical variations and socioeconomic differences in burn epidemiology. In this regard, this study aimed to investigate the etiology and outcome of burns in Hamadan, Iran. Materials and Methods: This registry-based, cross-sectional study was conducted on 798 burn patients admitted to the Besat Hospital from March 2013 to February 2018. The medical records of all the patients were extracted from hospital information system. Results: In males, the most common cause of burn was gas explosion (41.4%), whereas in females, the most common cause was hot liquids (37.1%). In below 5 years and 6–15 years age group, burning with hot liquids was the common cause of burn, whereas in other age groups, gas explosion was the common cause of burn. In the present study, 6.9% of the patients died because of their burns. With increasing age, the odds of death increases, so that patients between 30 and 59 years had 2.2 fold (P = 0.02) and patients ≥60 years had 3.5 fold (P = 0.006) higher odds of death compared to patients aged <30 years. Conclusion: Findings of the present study show that males and people aged 26–40 years and children 0–5 years were at a greater risk of burns. Furthermore, this study shows that self-immolation with a high rate of case fatality should be considered as a mental health challenge, and it is necessary to design preventive strategies to reduce it.
Keywords: Burns, epidemiology, etiology, Iran
|How to cite this article:|
Khazaei S, Shirani F, Afshari M, Jenabi E, Hamzei Z, Torabi M, Bathaei T. Etiology and outcome of burns in Hamadan, Iran: A registry-based study. Arch Trauma Res 2019;8:144-8
|How to cite this URL:|
Khazaei S, Shirani F, Afshari M, Jenabi E, Hamzei Z, Torabi M, Bathaei T. Etiology and outcome of burns in Hamadan, Iran: A registry-based study. Arch Trauma Res [serial online] 2019 [cited 2020 May 27];8:144-8. Available from: http://www.archtrauma.com/text.asp?2019/8/3/144/271693
| Introduction|| |
Globally, burn has been considered as a serious public health problem, so that an estimated 265,000 deaths occurred annually because of fire-related burns. Over 96% of fatal fire-related burns occur in low- and middle-income countries. In addition to those who die, it imposes lifelong disabilities and disfigurements on victims of burns.
Data obtained from hospitalized burn patients indicate that incidence rates for assault by fire and scalds are from 3% to 10% in the world, whereas the incidence rates of self-mutilation and suicide attempts by burning are relatively low, but these injuries carry a significant fatality rate (65%), worldwide. Results of the systematic review study regarding the epidemiology of burn injuries in the East Mediterranean countries showed that the reported incidence of burns in these countries ranged from 112 to 518/100,000/year. The vast majority of victims were young people and approximately one-third of burn occurred in pediatrics. Hospital mortality in these countries ranged from 5% to 37%.
Results of the conducted study in Tehran showed than women aged 21–30 years and children younger than 10 years had a higher risk of burn. The fatality rate of burns in Iran is considerable, so that this rate in Kermanshah was 18.8%. Burn imposed a huge socioeconomic cost on patients, their families, and society, so that in 2012, the average cost of burns per patient in one hospital of Iran was nearly 1500 US $.
Burn prevention strategies are most effective when they are based on knowledge of etiological patterns of burn injuries and consider the geographical variations and socioeconomic differences in burn epidemiology. In view of these considerations, this study aimed to investigate the etiology and outcome of burns in Hamadan, Iran. Enhancing our knowledge of current epidemiological conditions can help health policy-makers to better planning and providing more efficient approaches for the reduction of the incidence of burns.
| Materials and Methods|| |
This registry-based, cross-sectional study was conducted on all burn patients referred to the Besat Hospital in Hamadan city (Hamadan province) from March 2013 to February 2018. Hamadan province with an area of 19,493 km2 in extent is located in West of Iran and had a population of 1,738,234 people, according to the national census held in 2016 by Statistical Center of Iran. The Besat Hospital is the sole referral burn center in the city, and most of the patients with severe burn injuries from across the province are referred to this hospital.
The medical records of all burn patients who had been admitted to the hospital in the mentioned time period were extracted from the hospital information system. In this study, the second-degree burns (partial thickness burns) and third-degree burns (full-thickness burns) were assessed and first-degree burns were excluded. A researcher-made form was used to collect demographic data of the patients, including age, gender, year of occurrence, degree of burn injury, underlying cause of burns and patient outcome. Data were retrieved from the patients' medical record folders by a trained staff.
Descriptive analyses including frequency tables and percentages were used to present and summarize the data. The Cochran–Armitage test was used to assess the trend of burn incidence during the study period. The Chi-square test was employed to assess the association between demographic characteristics of the patients and causes of burns as well as causes of burns and disease outcome. Finally, to determine the effect of predictors on patient's death, we used logistic regression by categorizing patient's outcome in two groups (dead and alive). A Hosmer and Lemeshow test was used to build a model and the model is fitted with all variables that had P < 0.2 in the crude model. All the analyses were done using Stata software (Version 11.2, StataCorp, College Station, Texas, USA). A significance level was considered <0.05.
| Results|| |
From a total of 798 patients, 66.9% were male and other were female.
The mean age for all burn patients was 29.18 years with a range from under 1–89 years.
The incidence rates of hospitalized burn patients in Besat Hospital were 8.04, 4.83, 6.6, 8.8, 13.2, and 8.7/100,000 populations in the years of 2013–2017, respectively (Pfortrend = 0.19).
Furthermore, 171 (21.5%) of the burn cases occurred in children and 7.03% occurred in people over 60 years. Burning with gas explosion and hot liquids occurred in 38.1% and 23.93% of the cases, respectively, which were the common causes of burn in this study. In 17 (2.3%) cases, self-immolation was the cause of burn. Degree of burn in 75.6% of the cases was moderate and burns in 55 people resulted in death (6.9% of the cases) [Table 1].
|Table 1: Demographic characteristics, causes of burns, and their outcomes in burn patients|
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As shown in [Table 2], in males, the most common cause of burn was gas explosion (41.4%), followed by hot liquids (32.4%), whereas in females, the most common cause was hot liquids (37.1%) followed by gas explosion (31.4%). Burning with hot liquids was the common cause of burns with the incidence rates of 66.1% and 41.4% in below 5 years and 6–15 years of age groups, respectively, whereas in other age groups, gas explosion was the common cause of burning.
|Table 2: Distribution of patients by gender, age group, and causes of burns|
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According to [Table 3], there is a significant relationship between degree of burn and causes of burns, so that in all causes of burns, majority of cases had a moderate degree of burn, while in 94.1% of self-immolation cases the degree of burn was severe (P < 0.001). In the present study, 6.9% of the patients died because of their burns. In all cases of burns except self-immolation, the rate of discharge from hospital was higher and ranged from 100% discharge in electrical and chemical causes to 90.8% in flame cause; 52.9% of the cases died due to self-immolation (P < 0.001).
|Table 3: Outcomes of burns according to causes of burns in burn patients|
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Determinants of death among burn patients are presented in [Table 4]. As shown according to the adjusted model, female patients have 1.7-fold higher odds of death compared with males, but this relationship was not statistically significant (P = 0.08). With increasing age, the odds of death increased, so that patients with 30–59 years of age had 2.2-fold (P = 0.02) and ≥60 years patients had 3.5-fold (P = 0.006) higher odds of death compared with below 30-year age patients. Patients with severe burns had 11.5 fold higher odds of death (odds ratio = 11.5 [95% confidence interval = 5.9, 22.3], P < 0.001).
| Discussion|| |
The pattern of burn injuries varies in different communities; therefore, epidemiologic studies about burn patients in each region are required to design and perform effective preventive strategies. The analysis of the demographic data revealed that males were more at risk of burn injuries than females, but females experience worse outcomes than males. The results of the present study are similar to several other published reports, which showed that men were at higher risk of burn injury than females , because of more dangerous working conditions for men. Some studies have, however, reported the contrary results., These contrasting results may suggest geographical variations in terms of gender distributions of burn injuries. Similar to several other published reports, we found that sex differences were related to clinical outcomes in burn patients and women with burn injuries were less likely to survive and died sooner than men with similar injuries., This can be due to differences in biologic factors as well as clinical care between the two genders.
The results of the present study showed that the frequency of burns was highest among patients aged 26–40 years and children (0–5 years). Our results are in line with several studies that reported the higher risk of burns in children and middle age, compared to other age groups.,, This can be explained that children who spend most of the day at home close stoves and heaters where burning with hot liquids happen, so that children need more protection from family members, and workplaces should offer more protection to adults, especially males. Also, the findings of the present study reveal that the chance of death increases with increasing age. the effect of aging on burn patients' outcomes has been shown in previous studies., Elderly patients with immune dysfunction are prone to more infections and slower healing. In addition, pulmonary and cardiovascular dysfunctions and diabetes in the elderly are associated with poor outcome in these patients.
Our findings revealed that the most common cause of burn in male and female was gas explosion and hot liquids, respectively. The most common mechanism of injury in the present study was explosion from a domestic appliance or gas pipe. However, any explosion or blast involves unexpected high pressures and velocities directed at the person. It has been debated that the blast wave created by an explosion causes brain injury and neurological deficit that can affect learning and memory., This result is consistent with the findings of Patel et al. and Bayuo et al. that reported gas explosions were the major etiological factors of men burns.,
Furthermore, similar to our findings, burning with hot liquids was the most common cause of burns among females in one previous study, so that for women, the majority of burn injuries occurred at kitchen as the most common place for burn accidents. This result is in line with the findings reported in previous studies.,
The case-fatality rate in this study was 6.89% and burn had led to death in more than half of the patients with self-immolation. These results are consistent with previous several reports from other populations in developing countries, so that mortality rates from burn injuries in Taiwan, Egypt, Nigeria, and Irrua  are reported 3.7%, 4.3%, 6.5%, and 9.72%, respectively. This death rate due to burn injuries is comparatively acceptable as compared to data available internationally. This probably is due to the existence of health facilities and establishment of specialized burn centers in our country. Furthermore, over 90% of self-immolations occur in developing countries and over half of these self-immolation leads to death.
Although many people with minor burns do not need to be hospitalized. Thus, epidemiology of minor burns is not well-defined worldwide. Similar to some other studies, the most frequent burn injuries were moderate. Consistent with a study conducted in Newcastle  and because of moderate symptoms, often patients were discharge from the hospital.
The present study had some limitations. First, a small portion of burn patients registered through hospital-based surveillance systems because the vast majority of burn patients (especially mild and moderate burns) are treated outside of these referral centers and therefore the findings are prone to underreporting. Second, because of the retrospective nature of the study, some information, such as the total body surface area burned and length of stay were not reported. Finally, it was not possible to access the denominator information to calculate the incidence rate of burns by age group and gender.
| Conclusion|| |
The findings of the present study show that males and people aged 26–40 years and 0–5-year children were at a higher risk of burns. Furthermore, aging is an important factor that contributes to the poor clinical outcome of burn patients. The causes of burns in children have a different pattern compared to those in adults; gas explosion was the common cause of burns in adults, while burning with hot liquids was the most prevalent cause of burn in the below 15-year age group. The findings of this study demonstrate that self-immolation with a high rate of case fatality should be considered as a mental health concern, and preventive strategies are necessary to reduce the incidence of burn injuries.
We would like to thank the Burns Center Staffs of Besat Hospital who collaborated in data collection. Research Id is 9805224167.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Peck MD. Epidemiology of burns throughout the world. Part II: Intentional burns in adults. Burns 2012;38:630-7.
Othman N, Kendrick D. Epidemiology of burn injuries in the East Mediterranean region: A systematic review. BMC Public Health 2010;10:83.
Taghavi M, Rasouli MR, Boddouhi N, Zarei MR, Khaji A, Abdollahi M. Epidemiology of outpatient burns in Tehran: An analysis of 4813 cases. Burns 2010;36:109-13.
Karami Matin B, Karami Matin R, Ahmadi Joybari T, Ghahvehei N, Haghi M, Ahmadi M, et al
. Epidemiological data, outcome, and costs of burn patients in Kermanshah. Ann Burns Fire Disasters 2012;25:171.
Sahin I, Ozturk S, Alhan D, Açikel C, Isik S. Cost analysis of acute burn patients treated in a burn centre: The Gulhane experience. Ann Burns Fire Disasters 2011;24:157-9.
Blom L, Klingberg A, Laflamme L, Wallis L, Hasselberg M. Gender differences in burns: A study from emergency centres in the Western Cape, South Africa. Burns 2016;42:1600-8.
Wang Y, Yu X, Qian W, Zhou D, Yang T, Wang S, et al
. Epidemiologic investigation of chemical burns in Southwestern China from 2005 to 2016. J Burn Care Res 2018;39:1006-16.
Mzezewa S, Jonsson K, Aberg M, Salemark L. A prospective study on the epidemiology of burns in patients admitted to the Harare burn units. Burns 1999;25:499-504.
Fernández-Morales E, Gálvez-Alcaraz L, Fernández-Crehuet-Navajas J, Gómez-Gracia E, Salinas-Martínez JM. Epidemiology of burns in Malaga, Spain. Burns 1997;23:323-32.
Kerby JD, McGwin G Jr., George RL, Cross JA, Chaudry IH, Rue LW 3rd
. Sex differences in mortality after burn injury: Results of analysis of the National Burn Repository of the American Burn Association. J Burn Care Res 2006;27:452-6.
Karimi K, Faraklas I, Lewis G, Ha D, Walker B, Zhai Y, et al
. Increased mortality in women: Sex differences in burn outcomes. Burns Trauma 2017;5:18.
Elisdottir R, Lúdvígsson P, Einarsson O, Thorgrímsson S, Haraldsson A. Paediatric burns in Iceland. Hospital admissions 1982-1995, a populations based study. Burns 1999;25:149-51.
Čelko AM, Grivna M, Dáňová J, Barss P. Severe childhood burns in the Czech republic: Risk factors and prevention. Bull World Health Organ 2009;87:374-81.
Tian H, Wang L, Xie W, Shen C, Guo G, Liu J, et al
. Epidemiologic and clinical characteristics of severe burn patients: Results of a retrospective multicenter study in China, 2011-2015. Burns Trauma 2018;6:14.
Scott JR, Costa BA, Gibran NS, Engrav LH, Heimbach DH, Klein MB. Pediatric palm contact burns: A ten-year review. J Burn Care Res 2008;29:614-8.
Pham TN, Kramer CB, Wang J, Rivara FP, Heimbach DM, Gibran NS, et al
. Epidemiology and outcomes of older adults with burn injury: An analysis of the national burn repository. J Burn Care Res 2009;30:30-6.
Hicks RR, Fertig SJ, Desrocher RE, Koroshetz WJ, Pancrazio JJ. Neurological effects of blast injury. J Trauma 2010;68:1257.
Ling G, Bandak F, Armonda R, Grant G, Ecklund J. Explosive blast neurotrauma. J Neurotrauma 2009;26:815-25.
Patel JN, Tan A, Dziewulski P. Civilian blast-related burn injuries. Ann Burns Fire Disasters 2016;29:43-6.
Bayuo J, Agbenorku P, Amankwa R, Agbenorku M. Epidemiology and outcomes of burn injury among older adults in a Ghanaian tertiary hospital. Burns Open 2018;2:98-103.
Alavi CE, Salehi SH, Tolouei M, Paydary K, Samidoust P, Mobayen M. Epidemiology of burn injuries at a newly established burn care center in rasht. Trauma Mon 2012;17:341-6.
den Hertog PC, Blankendaal FA, ten Hag SM. Burn injuries in the Netherlands. Accid Anal Prev 2000;32:355-64.
Chien WC, Pai L, Lin CC, Chen HC. Epidemiology of hospitalized burns patients in Taiwan. Burns 2003;29:582-8.
El-Badawy A, Mabrouk AR. Epidemiology of childhood burns in the burn unit of Ain Shams University in Cairo, Egypt. Burns 1998;24:728-32.
Mungadi I. Childhood burn injuries in North Western Nigeria. Niger J Med 2002;11:30-2.
Dongo AE, Irekpita EE, Oseghale LO, Ogbebor CE, Iyamu CE, Onuminya JE. A five-year review of burn injuries in Irrua. BMC BMC Health Serv Res 2007;7:171.
Kumar V. Burnt wives – A study of suicides. Burns 2003;29:31-5.
Sadeghi-Bazargani H, Mohammadi R, Svanstrom L, Ekman R, Arshi S, Hekmat S, et al
. Epidemiology of minor and moderate burns in rural Ardabil, Iran. Burns 2010;36:933-7.
Türegün M, Sengezer M, Selmanpakoglu N, Çeliköz B, Nişanci M. The last 10 years in a burn centre in Ankara, Turkey: An analysis of 5264 cases. Burns 1997;23:584-90.
Cubison TC, Pape SA, Parkhouse N. Evidence for the link between healing time and the development of hypertrophic scars (HTS) in paediatric burns due to scald injury. Burns 2006;32:992-9.
[Table 1], [Table 2], [Table 3], [Table 4]