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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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