|Year : 2012 | Volume
| Issue : 3 | Page : 130-135
Mortality pattern of burn patients admitted in S. G. M. Hospital Rewa: A teaching institute of central India
S Lal1, GK Yadav2, Rachna Gupta2, GP Shrivastava2, S Singh3, Jayanta Bain2
1 Department of Surgery, ESIPGIMSR, Basidarapur, New Delhi, India
2 Department of Surgery, S.S. Medical College, Rewa, Madhya Pradesh, India
3 Department of Community Medicine, S.S. Medical College, Rewa, Madhya Pradesh, India
|Date of Web Publication||11-Jan-2013|
2/25 B Moti Nagar, New Delhi-India
Source of Support: None, Conflict of Interest: None
Background: Burn injuries rank among the most severe types of injuries suffered by the human body with an attendant high mortality and morbidity rate. In previous studies, incidence, severity and deaths due to burn were found higher in young married women in India. Study to find out mortality pattern in burn patient was not carried out in this part of country. Objective: To identify demographic and sociocultural factors, type, modes, causes and risk factors for burn injuries and their gender-wise association. Materials and Methods: It was a retrospective study. Data were collected from all burn patients who admitted and died while on the treatment from 2004 to 2009. A total of 586 patients were included in this study. Data were gathered from hospital records and entered in the excel sheet. Analysis of data was done by using SPSS version 17 statistical software. Results: The mean age of patients was 22.66 years (range 1 m to 80 years). Episodes of burn were 4.63 times common in female (82.25%) than in male (17.75%). It was statistically significant in females of age group 21-30 years (93.93% vs. 15.33% P < 0.0001). Married females (86.80%) burned more commonly than married males (13.19%) P < 0.0001. Flame burn was the major cause of death (95.56%). Kerosene was the most common (69%) source of flame burn. Clothes caught fire while working on Chullha were 25% cases ( P < 0.0001). Accidental (86.44%) burn was the most common intention of injury. The majority of burn deaths (68%) occurred within one week of the incident due to septicemia (57%). Conclusion: Factors associated with an increase in mortality were accidental burns, burn size, young age, married women, and flame burns. For planning and implementing prevention programs, the approach has to be multidisciplinary and coordinated.
Keywords: Burns, epidemiology, etiology, mortality
|How to cite this article:|
Lal S, Yadav G K, Gupta R, Shrivastava G P, Singh S, Bain J. Mortality pattern of burn patients admitted in S. G. M. Hospital Rewa: A teaching institute of central India. J Sci Soc 2012;39:130-5
|How to cite this URL:|
Lal S, Yadav G K, Gupta R, Shrivastava G P, Singh S, Bain J. Mortality pattern of burn patients admitted in S. G. M. Hospital Rewa: A teaching institute of central India. J Sci Soc [serial online] 2012 [cited 2019 Jul 19];39:130-5. Available from: http://www.jscisociety.com/text.asp?2012/39/3/130/105917
| Introduction|| |
Injuries generally have continued to attract the attention of researchers all over the world. Burn injuries rank among the most severe types of injuries suffered by the human body with an attendant high mortality and morbidity rate.  Burns constitute a major public health problem globally, especially in low and middle-income countries where over 95% of all burn deaths occur. Fire-related burns alone account for over 300,000 deaths per year.  Burn deaths are classified among the 15 leading cause of deaths in India. Microbial infection after burns, where a large portion of the skin is damaged, is a very serious complication that often results in the death of the patients. About 45% of the mortality in burns patients is caused by septicemia. 
Hence, this study was planned with a purpose to know the magnitude and the sociocultural factors of the problem of burns, so that a sound prevention program could be suggested, planned, and implemented for reducing the incidence of fatal burns.
| Materials and Methods|| |
This is a retrospective study conducted in 586 burn patients who were admitted and died during 2004-2009 in Department of Surgery in S.G.M. Hospital Rewa, Madhya Pradesh, a tertiary care center of central India. A total of 1,619 burn patients were admitted during the study period. The ethical clearance was obtained from the Institutional Ethical Committee. Various epidemiological information such as age, sex, type of burn, hospital stay, total body surface area (TBSA) involved, degree/depth, and cause of death were noted from hospital record. Data analysis was done using statistical product and service solutions (SPSS) version 17 statistical software.
| Results|| |
The mean age of patients was 22.66 years (±12.67). In the age group 21-30 years, 274 (46.75%) patients died in which male and female were 42 (15.32%) and 232 (84.67%), respectively. The second most common age group was 11-20 years (24.23%). Patients below 10 and above 40 years of age were minimal [Table 1].
|Table 1: Distribution of case according to age, sex, and mode of burn injury |
Click here to view
The male-to-female ratio was 1:4.6. The predominance of female deaths was observed throughout the study period except in the extreme of age groups [Table 1].
Most of the burn cases were from rural area (71.84%). Male belonging to rural and urban area were 74% and 26%, whereas female were 71.36% and 28.6%, respectively [Table 2].
|Table 2: Distribution of burn cases according to sociodemographic profile |
Click here to view
Out of total 586 burn cases, 76.28% were married. Numbers of married male and female were 80.50% and 56.73%, respectively. This difference was found to be statistically highly significant (χ2 = 26.70, df1, P < 0.0001) [Table 2].
Circumstances of the injury
The majority of the burn injuries, that is, more than 85%, occurred at home. Flames represented the most common agent of burn injuries (95.56%) and were more common in females (98.13%) than males (83.65%). This difference was statistically highly significant (χ2 = 38.65, df5, P < 0.0001). Analysis of mode of flame burn injuries revealed that 69% burns are due to kerosene, either from a fall of kerosene lamp/chimney (33%) over the patients, pouring of kerosene oil (suicidal/homicidal) (19.28%), or burst of kerosene oil pressure stove (16.78%). In 141 (25%) cases, clothes caught fire while working on Chullha. Scalds, electrical (both were 1.7%) and chemical (1.02%) burns were more commonly seen in males, mainly sustained at their working place [Table 3]. Accidental (82.8%) burn injuries were more common than suicidal (14.7%) and homicidal (2.5%)[Figure 1].
|Table 3: Distribution of burn cases according to the various types and source of the burn |
Click here to view
Clinical assessment of the burn wound
Majority of the cases belonged to third-degree burns (69.45%), whereas the rest (30.55%) were first and second degree. Although first-degree burn was almost equally prevalent among male and female (10.58%, 10.79%), third-degree burn was more common among female than male (71.99%, 57.69%). A statistically significant relation was seen between degree of burn and sex (P < 0.0001)[Figure 2].
Sex and extent of burn
The percentage of TBSA ranged from 15% to 100% with mean of 77.57 (±22.18). Mean of TBSA for male and female was 57.13% and 70.03%, respectively. Considering 40% TBSA as a cutoff point to differentiate severity of burns, only 8.70% of cases were admitted with TBSA <40%. Average TBSA of burn in female was higher than male in all age group except in pediatric age. It was observed that females (93.98%) sustained statistically significant severe burn injuries (>40% of body surface area) than the males (80.77%) (χ2 = 17.63df1 P < 0.0001) [Table 4]. Proportions of female patients were increasing with increasing TBSA.
|Table 4: Distribution of case according to age group and body surface are involved |
Click here to view
The mean duration of hospital stay was 8.37 days (±15.36), which range from 15 min to 182 days. The majority of deaths (68%) occurred within a week of the incident out of which 39.76% died within 24 h. Mortality in second week of injury was 17.74%. Duration of hospital stay and percentage of TBSA had statistically significant association (P < 0.0001) [Table 5]. Hospital stay was found to be inversely proportional to the body surface area burned, from burns >40% TBSA onwards.
|Table 5: Lengths of hospital stay according to sex and percent age of body surface area |
Click here to view
Cause of death
More than half of the deaths (57.51%) were due to septicemia. Neurogenic (26.96%) and hypovolemic shock (13.31%) were the other causes [Table 6]. Septicemia as a cause of death was seen more in burn due to electricity, scalds and chemicals as compare with flames where it was 56.61%.
A total of 1,619 patients with burn injuries were admitted in our hospital during the study period, of which 586 patients died. The overall mortality was 36.19%. Mortality was significantly associated with the age, sex of the burn victim, TBSA, agent, degree, and severity of the burn wound.
| Discussion|| |
Burn injuries occur universally and they have plagued mankind since antiquity till the present day. In all societies which include those in the developed or in the developing countries, burns not only poses medical and psychological problems but also produces severe economic and social consequences on the victim's families and also on the society in general. Burn injuries are globally responsible for about 5% of total mortality, and the overall global annual cost was estimated around 500 billion US dollars. , Epidemiological studies of morbidity and mortality are a prerequisite for effective burn prevention programs.
Age is one of the important epidemiological determinants for burn injuries. This study revealed that about 60% of the patients were aged between 21 and 40 years, whereas those aged over 40 years represented 9.73% of the all cases. Patients below 20 years of age were 31% of all deaths. Most common age group in our study is the productive and reproductive age when they are generally active and are exposed to hazardous situations both at home and at work. Studies from Kashmir, Bombay, Madras, and Chandigarh also reported a higher mortality in young persons. ,,, However, the discrepancy between the relatively low percentage of old people in this study and the higher percentage (16.7%) reported in the previous study  might be explained by the social structure in our setup as older members usually live within the family, thus decreasing their exposure to hazardous situations. This pattern means that burns tend to occur more in certain age groups reflecting the particular developmental or behavioral patterns associated with age. In children, the lack of coordination and unawareness of dangerous substances play an important role in the occurrence of burns.
This study revealed that the maximum number of victims were from rural areas (71.84%), which was in accordance with the findings of other studies from various regions of India. ,, Population of rural area living in over crowded homes, this implicates unsafe cooking, heating and sleeping practices in cramped houses making the victim vulnerable to burn injury.
An analysis of the sex record in this study showed a female preponderance. High burn morbidity and mortality among young women in India have also been reported by other authors. ,,, In Egypt also women in the reproductive age were reported to be at higher risk of burn,  whereas in some other countries (Argentina, Thailand, Uruguay, and Saudi Arabia) about 70% burns cases were male.  It was observed that women suffered burn injury about eight times more as compared with men in burn ≥80% TBSA. We found the females were more prone to accidental burn injuries (86.44%) because of their domestic activities requiring association with fire sources. This also reflects the role of inadvertent human error in the etiology of burns. Accidental burn attributes to the carelessness of individuals while handling fire, which was also found in Similar studies done in Chandigarh  and Varanasi.  Moreover, Indian women wear more clothes than men, with dresses like the Saree, Salwar-Kamiz with Dupatta, often of synthetic material, covering almost the whole body. Such clothes also favor aggravation of the burn injury. It was observed that 63% of the burn victims were wearing synthetic clothes at the time of burn. Majority of the females (86.53%) were wearing synthetic clothes at the time of burn incident (not in Table). This was also true for a study conducted in Karnataka  and Aligarh.  Synthetic clothes catch fire easily and flare upward resulting in difficulty for the victim to save oneself from the burn injury. Clothing ignition has been identified as a major cause of burns in both industrialized and developing countries. However, in industrialized countries, a change to more closely fitting styles of clothing, together with decreased fabric flammability, has resulted in a significant decrease in deaths from cloth ignition, which represented only 5% of all burn deaths in the USA. 
Burn agents are highly individualized in each country, largely depending on the standard of living and lifestyle. The observation of this study that flame was the major cause (95.56%) of burn is in agreement with other studies of India. ,,,,,, In other countries (Ivory Coast, Angola and Jordon) ,, scalds were reported to be the major cause of burn mortality. Among the different sources of the flame, kerosene was the main accelerant, which accounted for burns. This was probably because kerosene was cheap and easily accessible and because it was included among the household/kitchen materials, that isthe kerosene stove and the kerosene lamp/chimney (homemade) are widely used by the people of the low socioeconomic strata in India, where obsolete and unsafe uses of fire for cooking and light are still prevalent. Pouring of kerosene on young married women and burning them (dowry deaths) has been frequently reported in Indian subcontinent. Similar facts had been previously emphasized in studies from India and other countries. ,,, On the other hand, an industrialized country differs, where flammable liquids and gas stoves were the most common source of flame burns. ,
In all age groups female exceeded male for degree/depth of burn and TBSA. The assessment of depth determines hospital stay, morbidity and mortality. In this study TBSA, degree and depth of the burn wound, sex and occurrence of clothes ignition significantly affect the mortality of patients. These findings are in agreement with others.  The occurrence of the majority (68%) of deaths within a week of the incident indicated that burns are rapidly fatal. Ragheb et al., reported 58% and Singh et al.,  reported 77% of burn deaths occurring within a week after injury.
Mortality is the most important and most readily quantifiable outcome in burn patients. In this study, the case fatality rate was 36.19%. Mortality in female patients with TBSA more than 40% was 85.28%. Burns with more than 40% TBSA were more common in females, 65% in Nagpur  and 75% in Karnataka. 
Septicemia as a major (57.51%) cause of death reflected that deaths in burns cases occurred due to secondary complications which may be tackled with better burn facilities. Singh et al., Gupta et al., Saleh et al., and Ragheb et al.,,,, also reported that infection is the major cause of death in burn cases. Thus, infection leading to secondary complications and ultimately, multi-organ failure was the major cause of death in the burn cases, which could be tackled with the use of better burn care facilities.
| Conclusion|| |
Burn injuries are serious public health problem with alarmingly high mortality and morbidity. Epidemiological studies help in understanding the role of various factors in causation of burn injuries and also identifying target population. This study indicates that majority of burns were domestic and more common in the young females involved in cooking-related activities. Burn injuries were more severe in females than in males in terms of body surface area burned and therefore, mortality was high in females. Flame of the kerosene lamps/chimney was found to be major cause of burn. Scalds burns were more common in young children. Most of our findings related to female burns are consistent with other previous studies conducted in India. Burns still continue to be a major problem of young married women of India. This indicates that the situation in India has not changed much even in the 21 st century. Burn injuries are preventable through design and promotion of more aggressive prevention programs. The approach has to be multidisciplinary and coordinated.
| Acknowledgements|| |
Authors gratefully acknowledge the help of Dr. A.P.S. Gaharwar, Professor of Surgery, Shyam Shah Medical College and S.G.M. Hospitals Rewa in revision of this manuscript by doing peer review and valuable suggestions.
| References|| |
|1.||Obalanji JK, Oginni FO, Bankole JO, Olaside AA.A ten-year review of burn cases seen in a Nigerian Teaching Hospital. J Burns Wounds 2003;2:1-11.[Last cited 2003 Nov 08]. |
|2.||A WHO plan for burn prevention and care. Geneva: World Health Organization; 2008. |
|3.||Bloemsma GC, Dokter J, Boxma H, Oen IM. Mortality and causes of death in a burn centre. Burns 2008;34:1103-7. |
|4.||Nordberg E. Injuries as a public health problem in sub-Saharan Africa: Epidemiology and prospects for control. East Afr Med J 2000;77:S1-43. |
|5.||Attia AF, Reda AA, Mandil AM, Arafa MA, Massoud N. Predictive models for mortality and length of hospital stay in an Egyptian burns centre. East Mediterr Health J 2000;6:1055-61. |
|6.||Malla CN, Misgar MS, Khan M, Singh S. Analytical study of burns in Kashmir. Burns Incl Therm Inj 1983;9:180-3. |
|7.||Jha SS. Burn mortality in Bombay. Burns 1981;8:118-22. |
|8.||Jayaraman V, Ramakrishnan KM, Davies MR. Burns in Madras, India: An analysis of 1368 patients in 1 year. Burns 1993;19:339-44. |
|9.||Singh D, Singh A, Sharma AK, Sodhi L. Burn mortality in Chandigarh zone: 25 years autopsy experience from a tertiary care hospital of India. Burns 1998;24:150-6. |
|10.||Glasheen WP, Attinger EO, Anne A, Haynes BW, Heibert JT, Edlich RF. Identification of the high-risk population for serious burn injuries. Burns Incl Therm Inj 1983;9:193-200. |
|11.||Shankar G, Naik VA, Power R. Epidemiological study of burn injuries admitted in two hospitals of north Karnataka. Indian J Community Med2010;35:509-12. |
|12.||Gupta R, Kumar V, Tripathi SK. Profile of the fatal burn deaths from theVaranasi Region, India. J Clin Diagn Res 2012;6:608-11. |
|13.||Saleh S, Gadalla S, Fortney JA, Rogers SM, Potts DM. Accidental burn deaths to Egyptian women of reproductive age. Burns Incl Therm Inj1986;12:241-5. |
|14.||Chaurasia AR. Mortality from burns in developing countries. Burns Incl Therm Inj 1983; 9:184-6. |
|15.||Mago V, Yaseen M, Bariar LM. Epidemiology and mortality of burns. Indian J Community Med 2004;29:187-91. |
|16.||Byrom RR, Word EL, Tewksbury CG, Edlich RF. Epidemiology of flame burn injuries. Burns Incl Therm Inj 1984;11:1-10. |
|17.||Bilwani PK, Gupta R. The epidemiological profile of burn patients in 2.6 Hospital Ahmedabad. Indian J Burns 2003;11:63-4. |
|18.||Subrahmanyam M, Joshi AV. Analysis of burn injuries treated during a one year period at a district hospital in India. Ann Burns Fire Disasters 2003;16:74-6. |
|19.||Naralwar UW, Meshram FA. Epidemiological determinants of burns and its outcome in Nagpur. Milestone J DMER 2002;2:19. |
|20.||Vilasco B, Bondurand A. Burns in Abidjan, Cote d'Ivoire. Burns 1995;21:291-6. |
|21.||Adamo C, Esposito G, Lissia M, Vonella M, Zagaria N, Scuderi N. Epidemiological data on burn injuries in Angola: A retrospective study of 7230 patients. Burns 1995;21:536-8. |
|22.||Abu Ragheb S, Qaryoute S, el-Muhtaseb H. Mortality of burn injuries in Jordan. Burns Incl Therm Inj 1984;10:439-43. |
|23.||Jay KM, Bartlett RH, Danet R, Allyn PA. Burn epidemiology: A basis for burn prevention. J Trauma 1977;17:943-7. |
|24.||Pegg SP, McDonald GP, Tracey-Patte CE, Mayze TD. Epidemiology of burns attending a casualty department in Brisbane. Burns Incl Therm Inj 1983;9:416-21. |
|25.||Kamel FA. Some epidemiological features of burn patients admitted to the emergency department of the Main University Hospital and to Ras El-Teen Hospital in Alexandria [MPH thesis]. Alexandria, Egypt, dhood burns in Ghana: Epidemiological characteristics and home-based treatment. Burns1995;21:24-8. |
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]