Injury Pattern Analysis to Optimize Burn Injury Prevention in the Unhoused Community.

Unhoused patients are an overrepresented group in burn injury, and are a uniquely vulnerable population. Current research focuses on the consequences of homelessness on burn outcomes, with little known about the specific circumstances and behaviors leading to burn injury that may represent specific targets for injury prevention efforts. The burn registry at an urban regional burn center was queried for burn admissions in unhoused adults from 2019 to 2022. Registry data pulled included demographics, urine toxicology, mechanism of injury, and injury subjective history. Subjective injury history was reviewed to determine more specific injury circumstances and activities during which accidental burns occurred. Demographic and mechanistic trends in burn admissions were explored via descriptive statistics. Among 254 admissions for burns from the unhoused community, 58.1% of patients were positive for stimulants on admission. Among accidental injuries (69.7%), common circumstances included preparing food or beverages, cooking or using methamphetamine, smoking cannabis or tobacco, bonfires, and candles. A specific common circumstance was lighting a cigarette while handling accelerants (6.7%). Interventions for stimulant abuse, as well as outreach efforts to educate unhoused patients about situational awareness, safe handling of accelerants, safe smoking practices, and safe cooking practices, may be effective tools in reducing burn admissions in this vulnerable population.

Why do people get burned? Qualitative analysis of the causes of burns in a large survey of burn survivors.

BACKGROUND: Understanding the national epidemiology of burns is necessary for effective planning of prevention and treatment services. However, epidemiological studies of burns have often focused on short-term and retrospective investigations of a specific group of burned patients in Iran. Therefore, we conduct a comprehensive study from August 2016 to October 2017, in the Burn Research Center of Iran University of Medical Sciences on approximately 1700 hospitalized burn patients at Motahari Hospital to identify the underlying causes of burns. In this study, an open-ended question was asked about how the burn occurred in the patients. The current study was designed and conducted for the qualitatively analyzing of the responses to this question, using the content analysis method, in order to maximize its use in policymaking and prevention. METHODS: Content analysis of written responses to open-ended questions was done as a part of a large questionnaire survey. This survey was conducted by face-to-face interview at a national referral center for burn injuries. RESULTS: Answers from 1595 patients were coded and the underlying causes of injury were categorized into three themes and 43 subthemes. These underlying causes were lack of knowledge and awareness, inappropriate equipment, and inevitable accidents. The underlying cause of lack of knowledge and awareness had the highest proportion in causing burns in both men and women. The most common subthemes in descending order included lack of skills, dangerous actions, improper location of hot liquids, individual mistakes, and improper use of flammable materials. The top five subthemes with the highest average percentage of burn in patients in descending order were deficiency of residential equipment, self-immolation, accidents, inappropriate location of flammable materials, and unsafe kitchen appliances. CONCLUSION: The focus of prevention programs on educating and increasing awareness of individuals, preferably women, is suggested. Educational programs, tailored to occupational standards and workplace and household equipment, are recommended for men in work environments.

Aetiology of bioethanol related burn accidents: A qualitative study.

BACKGROUND: Since insight into the motivation of behaviour in bioethanol related burn accidents is lacking, this study aimed to qualitatively examine influencing factors in bioethanol related burn accidents. In order to identify target points for effective burn prevention. METHODS: Patients previously admitted with bioethanol related acute non-intentional burn injury to the three Dutch burn centres were eligible. One interviewer conducted fourteen semi-structured interviews. Interviews were transcribed and coded by two independent researchers. Conclusions were drawn based on generalised statements on the concerned topics. RESULTS: Four overall themes in influencing factors were found, namely 1) motivation; including non-designated use and impaired judgement, 2) knowledge and education; including unknown product and properties and information overload, 3) risk perception; including poor recognisability of risks and preferred trial and error and 4) thresholds; including easy availability and unclear liability. CONCLUSION: Trust in consumers may be over-estimated, as proper use cannot be expected. To prevent future bioethanol related burn incidents, thresholds for obtaining and using bioethanol should be increased, safe alternatives to ignite open fires and wood stoves should be provided and knowledge and warnings should be improved.

Pediatric Burns: A Systematic Review and Meta-Analysis on Epidemiology, Gender Distribution, Risk Factors, Management, and Outcomes in Emergency Departments.

Pediatric burns pose a significant public health concern, ranking as the fifth most common nonfatal injury globally. This review consolidates data on the epidemiology, outcomes, and management of pediatric burns presenting to emergency departments. A systematic review was conducted across multiple databases, yielding 22 articles from 1992 to 2020. Utilizing the methodological index for non-randomized studies (MINORS) instrument, non-comparative studies scored from 2 to 11 with an average of 6.87, while comparative studies ranged from 12 to 16, averaging 13.67. The review included a total of 828,538 pediatric patients who were evaluated in the systematic review. Predominantly male victims ranged from 53% to 83%. The youngest victims were aged between 0 to 4 years. Burn etiology was largely attributed to scalds. A majority suffered from second-degree burns, with some studies reporting up to 89%. Limited data on total body surface area (TBSA) were documented, with only 2.5% requiring hospitalization. Common interventions included immediate resuscitation and skin grafting. Essential areas for future research are identified, including household risks, pre-treatment decisions, and the significant role of family dynamics in burn injury recovery. Pediatric burns remain a considerable concern, particularly among males and in household environments. The data underline the imperative for prevention strategies and optimized emergency care to positively influence outcomes for burn victims. Future research areas range from evaluating pre-treatment decisions to assessing community awareness regarding burn first aid.

Evaluation of Patient's Knowledge of Prevention and Treatment of Burn Injuries.

Background: Burn injuries are amongst the most devastating causes of trauma worldwide. Preventive measures can be of great value in decreasing burn incidents. Increasing the knowledge and education of patients is a crucial step in this process. Methods: In this prospective cross-sectional study, we evaluated 82 patients with burn injuries who were divided into two groups randomly during the 2018 to 2019 at Shahid Motahari Hospital, Tehran, Iran. The first group received an e-Book, and the second group a paperback booklet to read before visiting their primary care. Besides, both groups received a questionnaire on their knowledge of burn injuries and prevention before and after the visit. The e-Book and paperback booklet included basic information about burn injuries and preventive measures. We compared the questionnaire results in both groups before and after reading the e-book and booklet using a paired t-test analysis. Results: There was a significant improvement in self-reported knowledge of burn prevention (P < 0.05; CI: 95%). Subjects receiving the eBook performed significantly had better post-survey (P < .01, 95% CI), despite equivalent pre-survey scores compared to those receiving the booklet. Conclusion: Increased use of interactive educational modalities, such as an e-book, can benefit patients with knowledge of their disease and improve the quality of care. These modalities may increase compliance with the physician's recommendations regarding their disease states and treatments.

Unforeseen Heat: An Accidental Superficial Partial-Thickness Hand Burn Utilizing a New Convection Oven.

Thermal burns remain a significant public health concern, and it is crucial to understand the potential risks associated with everyday activities involving heated objects or surfaces. It has been found that males have a higher susceptibility to hand burns, but when it comes to burns caused by hot liquids, females tend to be more frequently affected. Cooking remains the predominant activity associated with a higher incidence of accidental hand burns. Prompt medical attention and appropriate management are essential in mitigating the severity of burn injuries. This case report presents a previously healthy 55-year-old female that sustained a superficial partial-thickness burn to the dorsal aspect of her right hand while preparing a meal in her kitchen with her brand-new convection oven. This was her first time using a convection oven, unaware of the fans and rapidly circulating hot air within the oven. We discuss the need for a comprehensive approach to wound care, including topical antimicrobial agents, dressings, pain management, and monitoring for potential complications to achieve favorable outcomes and minimize long-term sequelae. Prevention remains the cornerstone in reducing burn injuries. Awareness campaigns, safety guidelines, and educational initiatives aimed at promoting responsible handling of hot objects should be implemented. Simple preventive measures, such as using appropriate protective equipment such as oven mitts, being mindful of oven temperatures, and maintaining a safe distance from heated surfaces, can significantly reduce the risk of household thermal burns.

Running water while bathing is a risk factor for pediatric scald burns.

INTRODUCTION: Scalds are the most common mechanism of burn injury in pediatric populations and scald burns sustained during bathing present a unique opportunity for injury prevention. Evidence-based infant bathing educational resources recommend checking water temperature and having a caregiver present for the duration of the bath, but do not explicitly recommend avoiding running water or explain the associated risks. This study seeks to determine the incidence and role of running water in bathing scald burns at our institution. METHODS: This is a retrospective review of pediatric patients (<3 years) admitted to the University of Chicago Burn Center with scald injury from bathing between 2010 and 2020. Cases were reviewed to assess the following risk factors: whether there was running water, whether water temperature was checked before placing the child in water, and whether a caregiver was present for the entire bath. Injuries in which the manner of injury was abuse or indeterminate were excluded. RESULTS: The study cohort included 101 cases of scalds due to bathing, with a mean age of 13 months and mean burn size of 7% TBSA. Of these 101 cases, 96 (95%) involved running water. Thirty-seven cases (37%) had only one of the three risk factors and 95% of those 37 cases involved running water. Twenty-nine cases (29%) involved all three risk factors while only two cases (2%) involved none of the three risk factors. Sixty-one cases (60%), thirty-nine cases (39%), and one case (1%) occurred in a sink, bathtub, or infant tub, respectively. CONCLUSION: We found that the vast majority of bathing scald burns involved running water, identifying a specific bathing recommendation that should be added to existing guidelines to reduce the incidence of bathing scald burns.

Assessment of the proportion of households with burn victims, associated risk factors and knowledge of burn injury prevention strategies in South Western Uganda. A population based cross sectional survey.

BACKGROUND: Burn injuries are a major cause of morbidity and mortality within Low- and Middle-income countries (LMICs). Most of these burn injuries occur at home with children most at risk. The majority of burn related deaths and disability in LMICs have been described as preventable. Burns prevention requires adequate knowledge of the epidemiological characteristics and associated risk factors. The aim of this study was to assess the proportion of households with burn victims, the associated risk factors and knowledge of prevention strategies of burn injuries in Kakoba division, Mbarara city. METHODS: We did a population based cross sectional survey of households in Kakoba division. This is the most populous division in Mbarara city. Face-to-face interviews were conducted using a pretested structured questionnaire. Descriptive analysis was performed to establish prevalence and knowledge of preventive strategies for household burns. Univariate and multivariate logistic regression models were fitted to establish the factors influencing burn injuries at household level. RESULTS: Of the households in Kakoba Division, 41.2% had individuals who had previously sustained burn injuries within the household. Children were the most affected population with scald burns the most common type. The highest risk of burn injuries was associated with overcrowding in the households. Electricity as a light source was found to be protective. Candles and Kerosene lamps were the commonest alternative light sources. Majority 98% of the individuals in the households knew at least one burns prevention strategy with 93% practicing at least one. CONCLUSION: Burns within the household are still high despite knowledge of risk factors with children being the most affected. Overcrowding still plays a significant role in household burn injuries. We therefore recommend closer supervision of children within the households. Cooking areas need to be properly designated and secured to limit access. Safer alternative light sources need to be explored such as solar lamps. Political leaders need to be involved in setting up and monitoring community-based fire safety practices to ensure compliance.

Burn injuries in the older population and understanding the common causes to influence accident prevention.

INTRODUCTION: The over 65 years old are a fast growing population leading to a future increase in patients. Burn injuries can have a serious effect on a patient's health, requiring longer hospital stays and affecting their mortality. The regional burns unit at Pinderfields General Hospital cares for all patients with burn injuries in the Yorkshire and Humber region in the United Kingdom. The aim of this study was to understand the common causes of burn injury in the elderly population and to provide scope on what actions need to be carried out to influence accident prevention in the future. METHODS: In this study, patients were aged 65 years or older and had to have been admitted for a minimum of one night to the regional burns unit at Yorkshire, England from January 2012. The data was collected from the International Burn Injury Database (iBID), which included a total number of 5091 patients. After the inclusion and exclusion criteria were applied there were a total number of 442 patients over 65 years old. The data was analysed using descriptive analysis. RESULTS: 13.0% of all patients admitted with a burn injury were over 65 years old. In the over 65 years old, 31.2% of burn injuries were most common during the activity of food preparation. Out of all the burn injuries within food preparation 75.4% were due to a scald injury. Additionally, 42.3% of scald burns from food preparation were due to hot fluid spills from a kettle or saucepan, rising to 73.1% after including burns from cups of tea and coffee. 21.2% of scalds from food preparation were caused by cooking with hot oil. CONCLUSIONS: The main cause of burn injuries in the elderly of Yorkshire and Humber was food preparation. The majority of the food preparation burn injuries were a scald burn due to the handling of hot fluids, either from a saucepan or a kettle. A prevention strategy aiming to make people aware of this finding can help reduce burn injuries in the over 65 years old age group.

"After The Fire"; The Legacy of College Dormitory Fire Twenty Years Later.

In January of 2000 the team at The Burn Center at Saint Barnabas was confronted with what is to date, the single largest burn mass casualty incident since its doors opened in 1977. Looking back through history at other catastrophes shows that, even in the wake of these "landmark events", the lessons learned remain, so that perhaps all was not in vain. 2, 6, 7, 8, 9, 11, 13, 19 While this fire took place more than twenty years ago, its legacy is still being felt today. The following discussion examines some of the key lessons learned, and underscores the fact that positive change does come from tragedy.

Understanding burn injuries in children-A step toward prevention and prompt first aid.

This study was designed to examine knowledge, attitude and practices with regards to burns prevention and first aid in the Indian community. A total of 83 caregivers aged 19 and 40 years (mean 29 years) participated in survey. Sixty-one percent of those who responded to the survey had some knowledge of first aid, mostly through health education at schools (59%). Very few (2%) received first aid education from health workers. Approximately 2/3 of responders (66-70%) were aware of applying cool running water to a burn and to stop drop and roll in case of a flame burn. However, the same number also listed a myriad of household remedies that they would use as first aid. 66-71% responders were aware of some situational risks in the home and community but only 27% considered young children to be at greater risk. 31% responders had an enclosed kitchen and 16% were still cooking on the floor. A large percentage (83%) cooked outside on a traditional wooden open fire. A quarter of the responders still used oil lamps on the floor and had little regard for the flammability of clothes. There was a weak positive correlation between knowledge and attitude (r-square 0.379) and attitude and practice (r-square 0.373), but no correlation between knowledge and practice (r-square 0.089). Our survey suggests that many responders have limited knowledge of effective first-aid techniques and live in high-risk environments. The major sources of first aid information were from school-based health education, social and electronic media. These resources can be utilized to further disseminate knowledge on first aid and practical prevention techniques.

Burn injuries in primary care in the Netherlands: Risk factors and trends.

BACKGROUND: Research to date has mainly focused on burn injuries treated in secondary care. This study aims to provide knowledge on the epidemiology of burn injuries in primary care, to give directions for burn prevention. METHODS: Data were derived from routine electronic health records of general practices and their out-of-hours service organisations in the Netherlands that participated in the Nivel Primary Care Database 2010-2015. We studied risk factors and trends. RESULTS: The average burn injury prevalence rate was 4.40 (95% CI 4.27-4.53) per 1000 person-years in daytime general practice care and 1.47 (95% CI 1.46-1.49) per 1000 inhabitants in out-of-hours care. Children of 0-4 years old, especially boys, and young adult women had a higher risk. Burn injury risk was higher during the summer months and around New Year's Eve. Living in low socioeconomic and strongly urbanised neighbourhoods was associated with a higher risk of burn injury than living in other neighbourhoods. CONCLUSION: Dutch general practitioners have a large share in burn care and therefore can play a significant role in burn prevention. Prevention may be most effective in the summer and around New Year's Eve, and specific attention seems to be warranted for low socioeconomic groups and strongly urbanised neighbourhoods.

Chemical mismanagement and skin burns among hospitalized and outpatient department patients.

Purpose. This article attempts to elucidate the nature of chemicals causing major and minor skin burns, and their associated characterization across different industries, using Fujian provincial hospitals' admission and outpatient department records. Materials and methods. Data were collected from the provincial hospitals of Fujian through a questionnaire, sent via email, from June 1, 2017 to November 30, 2017. The collected responses were statistically analyzed using SPSS version 19 through the interquartile range, median, Mann-Whitney U test and Fisher's exact test with two-tailed significance. Results and conclusions. The results of 306 collected responses reveal that the majority of skin burn cases are due to a lack of technical education and professional training among workers handling chemicals. This study suggests that management's effective supervision and governmental regulations may help to prevent chemical skin burns at work, and can further be controlled by hiring professional workers alongside providing training to them in chemical handling as well as using protective equipment and developing appropriate management policies to improve victims' well-being and quality of life. Findings will help workers, doctors, hospitals, industries, government and other stakeholders to understand and control chemical hazards on site to minimize the risks of chemical skin burn incidents.

Safety profile of atorvastatin in the role of burn wound injury conversion.

BACKGROUND: Atorvastatin could be beneficial in the treatment of burn patients to prevent burn wound progression from partial to full thickness. Our primary aim is to evaluate the safety of atorvastatin in burn patients. METHODS: Single center retrospective chart review of burn patients receiving atorvastatin during admission May 2016-May 2019 with historic controls was performed. Demographics, burn total body surface area, atorvastatin doses, creatinine phosphokinase, aspartate aminotransferase levels and adverse events were analyzed. RESULTS: 48 burn patients received atorvastatin during admission. Nine patients experienced elevated CK or AST levels during admission, but did not correlate with timing of atorvastatin administration and were comparable to levels in control patients. No adverse events associated with atorvastatin were identified. CONCLUSIONS: Atorvastatin administered to patients with burn injuries was not associated with any adverse events or attributable lab abnormalities. We believe that atorvastatin is safe to use in patients with burns and can be safely studied to determine the drug's effect on the prevention of burn wound conversion.

Epidemiological analysis of pediatric burns in the Dominican Republic reveals a demographic profile at significant risk for electrical burns.

OBJECTIVE: Pediatric burns are preventable with legislative and infrastructural changes. Although retrospective audits of many low- and middle-income countries have aided preventative efforts, the epidemiological status of burns in the Caribbean is not known. This study characterizes pediatric burns in the Dominican Republic (DR) and compares these to age-matched North American records captured by the National Burn Repository. METHODS: A retrospective audit of 1600 patients admitted to the Unidad de Niños Quemados Dra. Thelma Rosario Hospital, the island's only major pediatric burn center, between January 2010 to March 2017 was performed. Epidemiological variables analyzed included age, gender, burn mechanism, year, month, city, admission duration, nationality, mortality, and %TBSA. RESULTS: Pediatric burn patients in the DR sustained larger burns (8.2% vs. 6.5% TBSA) and spent more days in the hospital (10 vs. 6 days). Females were overrepresented (M:F=1:1.5) and mortality amongst admitted patients was 4-fold higher (2.8% vs. 0.7%). Electrical burns were significantly overrepresented in DR (21%) compared to age-matched North American patients (2%). Although electrical burns were smaller (4% TBSA), compared to scald (14% TBSA), and flame (19% TBSA), these burns preferred hands and had a high mortality rate (3%). No significant seasonality in burn mechanisms were observed. Finally, we report geographical and age group differences in the distribution of burn mechanisms and highlight particularly vulnerable subpopulations. CONCLUSION: This investigation identifies a demographical profile where electrical burns account for a significant percentage of the burn population. This provides a basis for concentrating preventative efforts in vulnerable populations.

Acceptability and functionality of the "Kettle Strap": An attempt to decrease kettle related burns in children.

BACKGROUND: Extensive hot water burns (HWB) are common at Red Cross War Memorial Children's Hospital (RCWMCH). The majority are caused by kettle scalds. These burn injuries usually affect toddlers living in poor socio-economic circumstances. The majority of these injuries are preventable. AIM: This trial aims to demonstrate the acceptability and functionality of the Kettle Strap as a kettle safety device. The feedback will be used for a public awareness program marketed by the Child Accident Prevention Foundation of Southern Africa and ChildSafe as part of their mandate to reduce kettle related thermal injuries. METHODS: 50 caregivers of children at RCWMCH were given a Kettle Strap for use in their homes, 25 with kettle related burns (Group I) and 25 who had no history of burns (Group II). All participants were instructed on Kettle Strap installation and use. Telephonic interviews on the acceptability and functionality of the strap occurred 1 month and 1 year later. RESULTS: The average age in Groups I and II was 25 and 22 months respectively. In Group I, the average burn surface area was 15%. Nineteen (76%) of the accidents occurred in the kitchen. Eighteen (72%) received immediate first aid. Twelve (48%) in Group I and 15 (60%) in Group II lived in formal housing. The majority of caregivers (90%) indicated that installation was quick and easy and thought that the Kettle Strap would prevent kettle burns. At 1 month follow-up, all the participants in Group I indicated that they would continue using the apparatus and felt greater protection compared to 84% of Group II. Only 40% indicated that use of the Kettle Strap raised awareness of other possible household dangers. Thirty participants were available telephonically after 1 year, 22 of these were still using the device, others had moved or lost their homes to fire. All participants had informed neighbors about the Kettle Strap and burn safety. The participants were prepared to pay ZAR 44 for the complete apparatus. CONCLUSION: The Kettle Strap is an acceptable, affordable device to improve kettle safety in the home.

Five-year epidemiology of liquefied petroleum gas-related burns.

BACKGROUND: The incidence of liquefied petroleum gas (LPG)-related burns has increased over recent years, and it has become a serious public health issue in developing countries such as India and Turkey. This paper aims to investigate the epidemiological characteristics of LPG-related burns to provide assistance and suggestions for planning prevention strategies. METHODS: A 5-year retrospective study was conducted in patients with LPG-related burns admitted to the Department of Burns & Wound Care Center, Second Affiliated Hospital of Zhejiang University, College of Medicine, between 1st January 2011 and 31st December 2015. Information obtained for each patient included age, gender, education status, occupation, medical insurance, average hospital cost, length of hospital stay, monthly distribution of incidence, place of burns, mechanism of burns, extent of burns, site of burns, accompanying injuries, and treatment outcomes. RESULTS: For the first 4 years (2011-2014), the yearly incidence of LPG-related burns was at approximately 10% of all burns; however, in the fifth year (2015) alone, there was a surge to 26.94%. A total of 1337 burn patients were admitted during this period. Of these, 195 patients were admitted because of 169 LPG-related accidents; there were 11 accidents involving more than one victim. LPG-related burns occurred most frequently in patients aged 21-60 years (73.85%). The majority of injuries occurred from May to August (56.41%), and the most common place was home (83.08%, 162 patients). Gas leak (81.03%) was the main cause of LPG-related burns, followed by inappropriate operation (7.69%) and cooking negligence (2.05%). The mean burn area was 31.32±25.40% of TBSA. The most common sites of burns were the upper extremities (37.47%), followed by the head/face and neck (24.80%) and lower extremities (19.95%). The most common accompanying injuries included inhalation injury (23.59%), shock (8.71%), and external injury (7.18%). The average hospital stay was 22.90±19.47days (range 2-84 days). Only 48 patients (24.62%) had medical insurance, while 124 patients (63.59%) had no medical insurance. The average hospital cost of the no medical insurance group was significantly higher (p<0.0001) than that of the medical insurance group. In addition, 72.73% of patients who left against medical advice (LAMA) were uninsured. The number of patients who recovered at our hospital was 165 (84.62%), while 22 patients (11.28%) LAMA. The overall mortality rate was 4.10% (8 patients). CONCLUSION: Our study shows that the exponential increase in LPG-related burns is alarming. This calls for rigorous precautions. Because gas leak was the main cause of LPG-related burns, any part of LPG stove system that shows signs of weathering should be replaced regularly. In addition, we also found that most of the LAMA patients were uninsured. Thus, comprehensive medical insurance should be involved early in the recovery process to assure a safe and adequate discharge.