INTRODUCTION
Burns constitute injury of the organic tissue caused by external agent. Burns may
result from trauma caused by heat, chemicals, electricity, friction, or
radiation, leading to partial or total destruction of the skin and adjacent
tissues1. The severity and prognosis
of burns are directly related to the burned body surface area and the depth of
the burn, while the factors that indirectly influence the prognosis are the
anatomical location of the burn, the age of the patient, the etiological agent,
and preexisting diseases and associated lesions. These factors are important
indicators of the need for hospitalization for the treatment of burns2,3.
According to the World Health Organization, burns are the fourth most common type
of trauma in the world, after interpersonal violence, falls, and traffic
accidents4. The number of people with
burns is large, and burns constitute a serious public health problem. It is
estimated that six million victims per year seek medical care for some degree of
burns worldwide; however, it is difficult to determine the specific distribution
of cases for each country due to the scarcity of epidemiological data and
national reporting systems.
In some countries, the available data allow us to estimate the annual incidence
of burns, for example, the incidence is around 500,000 in the United States of
America; 10,000-15,000 hospital admissions per year have been reported in
Germany; and 700,000 to 800,000 new cases are reported in India. According to
the Brazilian Society of Burns (SBQ), it is estimated that there are
approximately 1,000,000 burn injuries per year in Brazil. Of these, about
100,000 require hospital care and 2,500 evolve to death due to burns or the
associated complications5.
Burn Treatment Units (BTUs) first appeared in the United States and England in
the 1950s to improve and strengthen the specific treatment of burn victims and
to improve the epidemiological indices of these treatments. Currently, the US
has 137 BTUs located across the country. In Brazil, there are 57 registered BTUs
throughout the national territory, as reported by the Brazilian Society of Burns
(SBQ).
These units are reference centers for hospitalization and treatment of patients
with severe complex second and third degree burns and important comorbidities.
They function as multiprofessional treatment centers, with serval professionals
that provide care to these patients. In addition to clinical care, these units
should function as centers for knowledge-building, training professionals, and
disseminating burn data6-8.
The epidemiological pattern of burns varies widely in different parts of the
world9. They represent a public health
problem in several developing countries, and the lack of public education
campaigns is one of the main factors associated with a high incidence of
accidental burns10.
Epidemiology is considered the basic science for preventive medicine and a source
of information for the formulation of public health policies. Currently,
patients who are victims of burns should be evaluated and monitored periodically
by interdisciplinary professionals in specialized centers, who have the physical
plant, facilities, and adequate equipment to perform the treatment11.
OBJECTIVE
The study involved the evaluation and analysis of the epidemiological profile of
patients hospitalized for treatment at the Burn Unit of the Governor Otávio Lage
de Siqueira (HUGOL) Emergency Hospital in Goiânia, GO.
METHODS
Data from the electronic medical records of 376 patients who were treated for
burns at the HUGOL Emergency Hospital in Goiânia, GO, between July 2015 and June
2017 was collected and analyzed.
Inclusion criteria
Patients, who visited the Emergency and outpatient clinic at HUGOL but were
not hospitalized for treatment, patients who were admitted to the Pediatrics
unit, either in the ICU or a clinical or surgical ward due to some kind of
burns were excluded.
Statistical analysis
During the analysis of the variables of this study, we considered as
inclusion criteria: age, gender, etiological agent, burned body surface
area, burn depth, body regions affected by burn, debridements, grafts,
flaps, infections, evolution to death, burns of inhaled routes, time of
hospitalization in intensive care unit of burns and time of
hospitalization.
The data was plotted in excel table and analyzed by the SPSS 24 program.
RESULTS
A total of 375 patients were admitted from July 2015 to June 2017; of these, 50%
of the patients needed treatment and follow-up in an intensive care unit (Table 1). The average hospitalization
duration for these patients in the ICU was 14.73 days.
Table 1 - Need for support in an intensive care unit.
Table 1 - Need for support in an intensive care unit.
The overall mean duration of hospitalization in the burns unit was 23.08 days.
The patients were mostly males (61%) (Figure 1). The mean age of the patients was 39.17 years. The main
etiological agent in the patients admitted to the service was alcohol in
combination with gasoline (41.06%), followed by direct flame (16.26%), scalding
(8.53%), trauma (7.73%), hot oil or (7.46% for each), gas explosion (6.4%), and
chemicals (2.93%) (Figure 2).
Figure 1 - Gender distribution of adult patients with burns.
Figure 1 - Gender distribution of adult patients with burns.
Figure 2 - Etiology of burns.
Figure 2 - Etiology of burns.
In cases of chemical burns, sulfuric acid was the major etiological agent,
accounting for 37% of the cases (Table 2). The mean SCQ was 24.67%. The 2nd degree burns were the
most prevalent type, reported in 51% of the cases, followed by a combination of
2nd and 3rd degree burns, in 47%, while 3rd
degree burns were reported in only 2% of the cases (Table 3).
Table 2 - Distribution based on the burn agents.
| Cicatricure® |
1 |
| Caustic soda |
4 |
| Sulfuric acid |
2 |
| Acid detergent |
2 |
| Tar |
1 |
| Fig leaf |
1 |
| Total |
11 |
Table 2 - Distribution based on the burn agents.
Table 3 - Distribution based on the degree of burns.
| Second degree |
189 |
| Second + third degree |
178 |
| Third degree |
8 |
Table 3 - Distribution based on the degree of burns.
A total of 1490 surgical procedures were performed, with an average of 3.97
surgeries per patient. Of these, 268 were grafting; 24, flap placement; 1117,
debridement; and 81, other procedures, among them tracheostomies (Figure 3). Forty patients died; of them, 29
presented airway burns (72.5%; Figure 4).
The total number of patients with airway burns was 73.
Figure 3 - Surgical procedures performed.
Figure 3 - Surgical procedures performed.
Figure 4 - Death and airway burns.
Figure 4 - Death and airway burns.
DISCUSSION
Burns are a serious public health problem in Brazil. Knowledge of epidemiological
data is of great importance in supporting programs for the prevention and
treatment of burns, and for defining a parallel between national and
international experiences. The data obtained in this study were, in general,
compatible with those reported in other national and international studies.
In the period studied, we observed a prevalence of accidents in males (61%),
corresponding to the national and international epidemiological profile12-16.
The burning agent was the open flame (57.32%), particularly on contact with
flammable liquids, mainly alcohol and gasoline (41.06%), followed by heated
liquids (15.99%), similar to that data reported by Macedo and Rosa16 and data from other countries13. The use of flammable liquids to light a
fire is very common in Brazil, and the use of alcohol in the gel form is an
effective method for reducing the incidence of burns by this agent.
The electrical and chemical burns were the least frequent (7.46% and 2.93%,
respectively) with a lower burned body surface area, but a greater burn depth;
these data correspond with data from the literature review16-20.
The mean burned body surface area was 24.67%, leading to an average hospital stay
of 23.08 days. This duration of hospitalization was similar to that described by
Macedo and Rosa16 and also to the
international statistics21-23. The
severity of the patients, such as the depth and area of the burns, and the
presence of airway lesion were related.
The mortality rate in this study was 10.66%, higher than that observed by Macedo
and Rosa16 and in other Brazilian
studies11; being compatible with an
increase in the mean age of the patients studied, the depth and area of burns,
and the presence of airway injury.
Traditionally, the burned body surface, the severity of the lesion, and the age
of the patient were important determinants of the mortality rate in patients
with burns. With the advancements in studies on this health impairment, other
factors, such as inhalation injury, pre-admission shock, sepsis and
thrombocytopenia, became important.
The highest mortality rates are among the older patients, especially those aged
more than 60 years. We observed this in our study, since the mean age of the
patients in our study was 39.17 years, which is about 30% higher than the
average age reported by Gimenes et al.13
from Sorocaba, SP; the mean age of the patients is usually less than 30 years in
national and international studies. This may be because patients under 12 years
of age, who are usually victims of a hot liquid (scalding) accident, acquire
more superficial lesions, with lower mortality rates in this age group.
Another factor that explains this high mortality rate is the high prevalence of
inhalation burns, often not mentioned in other studies due to the difficulty in
documenting such burns. We observed a higher mortality rate in patients with
evidence of airway burns. Of the 40 deaths, 29 had airway burns (72.5%) (Figure
4). The total number of patients with airway burns was 73, that is, 39.72% of
the patients suffered burns in various areas and died, which is consistent with
the world literature.
Burns remain the worst injury that can suddenly happen to individuals, marking
them for the rest of their life. Burns are responsible for significant morbidity
and high mortality rates worldwide, despite advances in the available
treatments24.
The study provided a profile of burn injuries and hospitalizations in the Burns
unit of HUGOL; this profile corresponds with those from other specialized
centers for this type of treatment.
This study contributes to the evidence that epidemiological studies are
indispensable tools for acquiring knowledge about the population to be treated,
thus, enabling the development of strategies for the prevention of burns and for
the progressive decrease of its prevalence. The study also proposes the
importance of continuously educating the population to prevent avoidable
accidents.
The negligent use of inflammable products also accounts for a large number of
these accidents; the incidence of such accidents may decrease if effective
social awareness measures are implemented.
COLLABORATIONS
|
FCFA
|
Analysis and/or interpretation of data; statistical analyses; final
approval of the manuscript; conception and design of the study;
completion of surgeries and/or experiments; writing the manuscript
or critical review of its contents.
|
|
BCOC
|
Analysis and/or interpretation of data; conception and design of the
study; writing the manuscript or critical review of its
contents.
|
|
JFM
|
Statistical analyses; conception and design of the study; writing the
manuscript or critical review of its contents.
|
|
WJVJ
|
Statistical analyses; conception and design of the study; writing the
manuscript or critical review of its contents.
|
|
GMDR
|
Analysis and/or interpretation of data; statistical analyses; final
approval of the manuscript; conception and design of the study;
writing the manuscript or critical review of its contents.
|
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1. Sociedade Brasileira de Cirurgia Plástica, São
Paulo, SP, Brazil.
2. Hospital de Urgências Governador Otávio Lage de
Siqueira, Goiânia, GO, Brazil.
Corresponding author: Fabiano Calixto Fortes
de Arruda, Rua T 50 n, 540 - Setor Bueno - Goiânia, Goiás, Brazil.
Zip Code 74215-200. E-mail: arrudafabiano@hotmail.com
Article received: December 14, 2017.
Article accepted: May 17, 2018.
Conflicts of interest: none.
