Changing concept in Burns Management- An Analytical study of Epidemiology, Morbidity, Mortality and Treatment in a period of forty years in the Indian state of Assam
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Abstract
There is an improvement in the morbidity and mortality in burns in the recent past due to better fluid resuscitation, use of better burn wound covers and early excision and skin grafting for full thickness burns. Burn care in the North Eastern Indian state of Assam was disorganized in the eighties, but individual efforts by some surgeons of the state, have improved outcome. This is a retrospective analysis of 8569 cases of burn injuries treated in three hospitals of Assam over a period of 40 years. The study intends to analyze the epidemiological pattern of burn injuries in order to plan preventive strategies and also to compare the results of treatment with and without an organized burn care unit. There were 7071 (82.3%) minor burns and 1518(17.7%) major burns in the series. The period of study was divided into three blocks - Block I- first 14 years of disorganized management, before establishment of Burns Unit, Block II -next 16 years of organized management after establishment of Burns Unit and Block III - last 10 years of advanced care with introduction of newer burn wound covers and early excision of burns. The data were analyzed and compared.
The overall incidence of burns was more in males, but a greater number of females were the victims of major burns.77.2% of patients were below 40 years of age. The number of accidental burns remaining constant in the three blocks, there was a significant increase in the suicidal burns in the last two blocks. Flame burns (56.7%) constituted the majority of injuries, while scald (31.3%) and electrical burns (9.3%) followed. Domestic burns (73.1%) were of most common occurrence, followed by Industrial (10.8%), Diwali related (9.6%) and Traffic burns (6.4%).
Though the overall mortality in the three blocks were almost same (Block I- 9.4%, Block II- 7.8% Block III-9.4%), mortality in major burns were reduced significantly after introduction of modern methods of management (Block I- 79.7%, Block II-52.0% Block III-38.4%). The quality of wound healing showed improvement in the subsequent years as evident by increase in number of patients with no scar (Block I -10%. Block II-20%, Block III- 37%) and decrease in number of patients with extensive scar (BlockI-18%, Block II- 15%, Block III-5%), measured by Vancouver Scar Scale.
This analytical study has given us an understanding of the magnitude of the problem of burns in the region, which will help to plan treatment and preventive strategies. It also concludes that, dedicated individual care and introduction of newer methods of treatment have improved results of burn management.
Key words: Epidemiology, treatment, morbidity and mortality
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References
2. V. Jayaraman, Anandsubramaniam, K. Mathangi Ramakrishnan (1991): Epidemiology of Burn Injury- Handbook of Burn Management, Published by Jaypee Brothers Medical Publishers Private Limited
3. Khan AA, Rawlins J, Shenton AF. The Bradford Burn Study: The epidemiology of burns presenting to an inner-city emergency department. Emerg Med J. 2007; 24:564–6.
4. S Mzezewa 1, K Jonsson, M Aberg, L Salemark . A Prospective study on the epidemiology of burns in patients admitted to the Harare burn units. Burns 1999 Sep;25(6):499-504. doi: 10.1016/s0305-4179(99)00041-8
5. Ashok K Gupta, Sanjeev Uppal, Ramneesh Garg, Ashish Gupta, Ranabir Pal. A clinico-epidemiologic study of 892 patients with burn injuries at a tertiary care hospital in Punjab, India. Journal of Emergencies, Trauma and Shock. 2011; 4, (1) 7-11
6. Wu CC, Lu P, Chao CL. Epidemiology of hospitalized burns patients in Taiwan. Burns. 2003; 29:582–8.
7. Ansari-Lari M, Askarian M. Epidemiology of burns presenting to an emergency department in Shiraz, South Iran. Burns. 2003; 29:579–81
8. Ahmed I, Farooq U, Afzal W, Salman Medicolegal aspect of burn victims: A ten years study. Pak J Med Sci 2009;25(5):797-800.
9. Gupta M, Gupta CK, Yaduwanshi RK. Burn epidemiology: The pink city scene. Burns. 1993; 19:47–51
10. Adesunkanmi K, Oyelami OA. The pattern and outcome of burn injuries at Wesley Guild Hospital, Ilesha, Nigeria: A review of 156 cases. J Trop Med Hyg. 1994; 97:108–12
11. Forjuoh SN, Guyer B, Smith GS. Childhood burns in Ghana: Epidemiological characteristics and home-based treatment. Burns. 1995; 21:24–8
12. See L.C, Lo.S.K,. Epidemiology of fireworks Injuries. The National Electronic Surveillance System 1980-89. Ann. Emerg. Medicine.1994; 24:46-50.
13. Witsman R J Comstock R D, Smith G A. Pediatric Firework Related Injury in the United States: 1990-2003. Pediatrics 2006; 118(1):296-303
14. S.P.PeggP.M.MillerE.J.SticklenW.J.Storie.Epidemiology of industrial burns in Brisbane. Burns. 1986. 12, 7: 484-490
15. K Adesunkanmi 1, O A Oyelami. The pattern and outcome of burn injuries at Wesley Guild Hospital, Ilesha, Nigeria: a review of 156 cases. J Trop Med Hyg. 1994 Apr;97(2):108-12PMID: 8170000
16. O.A. Olawoye, O.O.Osinupebi, B.A. Ayoade. Open burn wound dressing: a practical option in resource constrained settings: Ann Burns Fire Disasters. 2013 Sep 30; 26(3): 154–157.
17. Oladele A.O.,Olabanji J.K. Burns in Nigeria: A review. Annals of Burns and Fire Disasters - vol. XXIII - n. 3 - September 2010
18. Subrahmanyam M. Epidemiology of burns in a district hospital in western India. Burns. 1996; 22:439–42.
19. Tang H, Zhaofen X, Liu S, Chen Y, Ge S. The experience in the treatment of patients with extensive full thickness burns. Burns. 1999; 25:757–9.
20. Ong YS, Samuel M, Song C. Meta-analysis of early excision of burns. Burns. 2006 Mar; 32(2):145-50. Epub 2006 Jan 18.
21. Chamania S, Patidar GP, Dembani B, Baxi M. A retrospective analysis of early excision and skin grafting from 1993 - 1995. Burns. 1998; 24:177–80
22. Regina Fearmonti, Jennifer Bond, Detlev Erdmann, and Howard Levinson. A Review of Scar Scales and Scar Measuring Devices- Eplasty. 2010; 10: e43. Published online 2010 June. PMID: 20596233 PMCID: PMC2890387
23. Mehdi Ayaz, Hamid Bahadoran, Peyman Arasteh, and Abdolkhalegh Keshavarzi. Early Excision and Grafting versus Delayed Skin Grafting in Burns Covering Less than 15% of Total Body Surface Area; A Non- Randomized Clinical Trial: Bull Emerg Trauma. 2014 Oct; 2(4): 141–145
24. AnnaMiroshnychenkoaKevinKimadBramRochwergacSophoclesVoineskosab. Comparison of early surgical intervention to delayed surgical intervention for treatment of thermal burns in adults: A systematic review and meta-analysis: Burns Open. Volume 5, Issue 2, April 2021, Pages 67-77