Burn care in practiceBurns in Madras, India: an analysis of 1368 patients in 1 year
Abstract
Analyses were made of 1368 patients who attended Kilpauk Medical College Hospital, Madras with burns between 1 May 1987 and 30 April 1988. Nine hundred and sixty-five patients were admitted, of whom 505 died. The peak age incidence was in young adults (11–30 years; 58.9 per cent of all burns). Three quarters of the patients came from the low family income group, 39.5 per cent were illiterate and 86.2 per cent of burns occurred in the home. Of those admitted 81 per cent of the injuries were flame burns; in 31.3 per cent the burn affected more than half of the body surface. Of the 505 deaths 94.8 per cent were the result of flame burns (at least 323 being caused by kerosene), and 20.4 percent were suicide. Most of the deaths (91 per cent) occurred in the first 5 days. The urgent need for burn prevention in the Madras area is discussed.
References (12)
- R.L. Bang et al.
Mortality from bums in Kuwait
Burns
(1989) - J. Benito-Ruiz et al.
An analysis of bum mortality, a report from a Spanish regional burn centre
Burns
(1991) - P. Benmeir et al.
An analysis of mortality in patients with bums covering 40 % BSA or more; a retrospective review covering 24 years (1964–88)
Burns
(1991) - A.R. Chaurasia
Mortality from bums in developing countries
Burns
(1983) - M. Gupta et al.
Paediatric bums in Jaipur, India; an epidemiological study
Burns
(1992) - M.H. Keswani
The prevention of burning injury
Burns
(1986)
Cited by (90)
Split thickness skin graft is an essential component of release of post burn contracture of neck. There are many methods of fixation of skin grafts; however, there is lack of objective comparison between different techniques. This study has been designed to compare three commonly used techniques of split thickness skin graft fixation methods. Surgical time, advantages, cost factor and post-operative outcome have been compared amongst three techniques.
A randomized interventional comparative study was conducted to compare three methods of skin graft fixation in patients of 10–50 years age group, with contracture of more than 3 month duration having more than 100 cm2 skin defects after contracture release. Resurfacing of the defects after contracture release was carried out in all the groups using autologous split skin grafts. Patients were included in three groups; Group 1: tie over method, Group 2: skin stapler fixation and Group 3: Cyanoacrylate glue fixation.
Mean duration of fixation procedure was 34 min in tie over group, in skin stapler group 7 min and in cyanoacrylate group 12 min. Mean cost of fixation material was 10.23 USD in tie-over group, 11.23 USD in stapler group and 40.06 USD in cyanoacrylate group. Mean score of pain/discomfort (visual analog score) on dressing removal in tie-over group was 3, for skin stapler group was 2.9 and that for cyanoacrylate glue group was 1.8. mean graft take was found to be 90.1% in tie-over group, 94.1% in skin stapler group & 93.8% in cyanoacrylate glue group. On logistic regression analysis, keeping all the variables constant in the groups the complications as the outcome variable, three groups are comparable. The need for regrafting remains inconclusive.
Skin stapler method for skin graft fixation was least time consuming, affordable and highly reliable when graft take success was considered. Cyanoacrylate glue fixation method was least painful and reliable in terms of graft take success though costlier than other two
Trauma care in India: A review of the literature
2017, Surgery (United States)We reviewed the published literature related to prehospital and hospital trauma care in India to identify how trauma care is defined in the literature and what factors limit the delivery of appropriate trauma care. In summarizing the evidence and recommendations regarding trauma care, this review identifies essential research and development goals to address the burden of injury in India.
A review of the literature was conducted between August 2014 and September 2014. The literature was sorted into 3 categories: prehospital care, hospital clinical care, and hospital administrative care. The characteristics of trauma care were explored using the Essential Trauma Care Project of the World Health Organization.
A total of 38 studies were included. Prehospital care lacked care provided at the scene of the injury, timely transport to a hospital, and transport via ambulance. With regard to hospital care, we found a lack of capabilities of basic clinical care, such as airway management, insertion of chest tubes, and efforts at resuscitation. There was a lack of administrative capabilities, including trauma data systems, trauma-specific training, quality improvement, and development of designated trauma teams.
The high rate of injury-related deaths and disabilities in India could be in part due to the absence of integrated and organized systems of trauma care. In the prehospital setting, a multisector approach must be implemented to address the training of emergency medical service providers and community members. Prehospital transport time can be decreased through improved communication and transport modalities. The Indian trauma care system could also be strengthened through hospital-based training programs and trauma response teams.
According to the World Health Organization (WHO), burns result in more than 250,000 deaths and the loss of approximately 18 million disability adjusted life years (DALYs), more than 90% of which occur in low- and middle-income countries (LMICs), annually. This type of serious injury – one that is particularly devastating in LMICs – is preventable. To further explore the effectiveness of burn prevention strategies in LMICs, we performed a systematic review of the literature indexed in PubMed, EMBASE, Web of Science, Global Health, and the Cochrane Library databases as of October 2015. Our search resulted in 12,568 potential abstracts. Through multiple rounds of screening using criteria determined a priori, 11 manuscripts were identified for inclusion. The majority of these studies demonstrate reductions in hazardous behaviors, incidence of burns, morbidity, and mortality using educational programs, but also highlight other initiatives, such as media campaigns, as effective strategies. Given that only 11 manuscripts are highlighted in this review, it is evident that original research is lacking. Further studies of preventative efforts tailored to populations in LMICs are needed. It is also essential that these studies be founded in population-based epidemiology and use meaningful end points, such as reductions in incidence, morbidity, and mortality.
Gendered pattern of burn injuries in India: a neglected health issue
2016, Reproductive Health MattersCitation Excerpt :For women, however, burn injuries are found to occur at home. Deaths due to burns are four times higher amongst women aged 18-35 years and reports from across the country (such as Delhi, Mumbai, Kanpur, Haryana, Manipal, North West and recently Jammu) indicate that these deaths occur due to accidents such as bursting of kerosene stoves or kerosene spilling and clothes catching fire.12–24 This is further explained by the nature of clothing worn by women in India such as saree* and dupatta†.
There are an estimated 7 million burn injuries in India annually, of which 700,000 require hospital admission and 140,000 are fatal. According to the National Burns Programme, 91,000 of these deaths are women; a figure higher than that for maternal mortality. Women of child bearing age are on average three times more likely than men to die of burn injuries. This paper reviews the existing literature on burn injuries in India and raises pertinent issues about prevalence, causes and gaps in recognising the gendered factors leading to a high number of women dying due to burns. The work of various women’s groups and health researchers with burns victims raises several questions about the categorisation of burn deaths as accident, suicide and homicide and the failure of the health system to recognise underlying violence. Despite compelling evidence, the health system has not recognised this as a priority. Considering the substantial cost of burns care, prevention is the key which requires health systems to recognise the linkages between burn injuries and domestic violence. Health systems need to integrate awareness programmes about domestic violence and train health professionals to identify signs and symptoms of violence. This would contribute to early identification of abuse so that survivors are able to access support services at an early stage.
En Inde, on estime à 7 millions le nombre de blessures par brûlure chaque année, dont 700 000 exigent une hospitalisation et 140 000 sont mortelles. Selon le programme national sur les brûlures, les femmes représentent 91 000 de ces décès, un chiffre plus élevé que celui de la mortalité maternelle. Les femmes en âge de procréer courent en moyenne trois fois plus de risques de mourir de brûlures que les hommes. Cet article examine les publications sur les brûlures en Inde et pose des questions pertinentes sur la prévalence, les causes et les lacunes dans la reconnaissance des facteurs sexués qui aboutissent à un nombre plus élevé de décès de femmes. Le travail de groupes de femmes et de chercheurs en santé avec les victimes soulève plusieurs questions relatives à la catégorisation des décès par brûlure comme accident, suicide et homicide, et à l’incapacité du système de santé d’identifier la violence sous-jacente. En dépit de preuves convaincantes, le système de santé n’a pas considéré ce phénomène comme une priorité. Compte tenu du coût substantiel des soins aux brûlés, la prévention est la clé qui exige que les systèmes de santé reconnaissent les liens entre les brûlures et la violence familiale. Les systèmes de santé doivent intégrer des programmes de sensibilisation à la violence familiale et apprendre aux professionnels de santé à identifier les signes et les symptômes de la violence. Cela permettrait une identification précoce de la maltraitance afin que les survivantes aient rapidement accès à des services d’appui.
En India, cada año ocurren aproximadamente 7 millones de lesiones por quemadura, de las cuales 700,000 requieren ingreso hospitalario y 140,000 son mortales; de acuerdo al programa nacional de quemaduras, 91,000 de estas muertes son mujeres, una cifra más alta que la de mortalidad materna. Las mujeres en edad fértil son, en promedio, tres veces más propensas que los hombres a morir por lesiones por quemadura. Este artículo revisa la literatura sobre las lesiones por quemadura en India y plantea puntos pertinentes sobre la prevalencia, causas y brechas en reconocer los factores de género que ocasionan que un alto número de mujeres mueran por quemaduras. El trabajo de diversos grupos de mujeres e investigadores en salud con víctimas de quemaduras plantea varias interrogantes sobre la categorización de muertes por quemadura como accidente, suicidio y homicidio, así como el hecho de que el sistema de salud no reconoce la violencia subyacente. Pese a la evidencia convincente, el sistema de salud no ha reconocido esto como una prioridad. Considerando el costo significativo de brindar atención a víctimas de quemaduras, la prevención es la clave que requiere que los sistemas de salud reconozcan los vínculos entre lesiones por quemadura y violencia doméstica. Los sistemas de salud deben integrar programas de sensibilización sobre la violencia doméstica y capacitar a profesionales de la salud para que identifiquen los signos y síntomas de violencia. Esto contribuiría a la identificación temprana de maltrato, de manera que las sobrevivientes puedan acceder a servicios de apoyo en la etapa inicial.
Identifying and reducing the health and safety impacts of fuel-based lighting
2016, Energy for Sustainable DevelopmentThe inequity of costly and low-quality fuel-based lighting is compounded by adverse health and safety risks including burns, indoor air pollution, poisoning due to accidental ingestion of kerosene fuel by children, compromised visual health, maternal health issues, and reduced service in health facilities illuminated solely or sporadically with fuel-based lighting. This article compiles and synthesizes information on the health and safety impacts of fuel-based lighting from 135 reports spanning 33 countries. Energy efficient, off-grid lighting solutions offer the most promising and scalable means to eliminate adverse health outcomes, while lowering lighting costs and reducing greenhouse-gas emissions. Deployments seeking the greatest possible health benefit should target the most impacted geographical and demographic user groups. Because women and children are disproportionately impacted, improved lighting technologies for use by these groups will yield particularly significant health benefits.
Intentional burns injuries are associated with high mortality rates, and for survivors, high levels of physical and psychological morbidity. This study provides a comprehensive assessment of intentional burn admissions to the adult Burns Unit at Bir Hospital, Kathmandu, Nepal, during the period 2002–2013.
A secondary data analysis of de-identified data of patients hospitalized at Bir Hospital, Kathmandu, with a burn during the period of 1 January 2002 to 31 August 2013. Socio-demographic, injury and psychosocial factors of patients with intentional and unintentional burns are described and compared. Chi-square tests, Fisher's exact test and Wilcoxon rank sum tests were used to determine statistical significance.
There were a total of 1148 burn admissions of which 329 (29%) were for intentional burn, 293 (26%) were self-inflicted and 36 (3%) were due to assault. Mortality rates for intentional burns were approximately three times those for unintentional burns (60 vs. 22%). When compared to unintentional burns, patients with intentional burns were more likely to be female (79 vs. 48%), married (84 vs. 67%), younger (25 vs. 30 years), have more extensive burns (total body surface area, %: 55 vs. 25) and higher mortality (60 vs. 22%). Intentional burns were more likely to occur at home (95 vs. 67%), be caused by fire (96 vs. 77%), and kerosene was the most common accelerant (91 vs. 31%). A primary psychosocial risk factor was identified in the majority of intentional burn cases, with 60% experiencing adjustment problems/interpersonal conflict and 32% with evidence of a pre-existing psychological condition. A record of alcohol/substance abuse related to the patient or other was associated with a greater proportion of intentional burns when compared with unintentional burns (17 vs. 4%).
The majority of intentional burn patients were female. Almost all intentional burns occurred in the home and were caused by fire, with kerosene the most common accelerant used. Underlying psychosocial risk factors were identified in most cases. Intentional burns resulted in severe burns with high mortality. Intentional burns are not only a serious medical issue; they represent significant public health and gender issues in Nepal.