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Original Article - Year 2020 - Volume 35 - Issue 1

http://www.dx.doi.org/10.5935/2177-1235.2020RBCP0012

ABSTRACT

Introduction: A "large burn" patient is defined as a patient who suffers a burn of such magnitude that it carries a major risk of life, defined by different parameters. Burns are a national and worldwide public health problem due to the morbidity and mortality they cause. The objective of this study is to describe the epidemiological and clinical characteristics of hospitalized patients with large burns.
Methods: A descriptive, retrospective and longitudinal study was carried out at the Plastic Surgery and Burn Service of the Celia Sánchez Manduley Surgical Hospital, Manzanillo - Granma, from January 2015 to December 2018, to understand the epidemiological characteristics of hospitalized large burn patients.
Results: The largest number of hospitalizations (45 patients [35.16%]) occurred in 2018. There was a predominance of females (74 patients [57.81%]). Accidents were the most frequent cause of burns (71 patients [55.47%]). Severe large burn patients were the most frequently treated (48 [37.50%]). The highest number of cases occurred in the municipalities of Bayamo (40 cases [31.25%]) and Manzanillo (21 cases [16.41%]).
Conclusion: The highest number of cases occurred in 2018, with a predominance of females between the age of 30-59 years. Accidents were the primary cause for burns, and the survival rate exceeded expectations. The municipalities with the most cases were Bayamo and Manzanillo.

Keywords: Burns; Epidemiology; Severity; Survival; Burn Unit.

RESUMO

Introdução: O paciente "grande queimado" é definido como um paciente que sofre uma queimadura de tal magnitude que carrega um importante risco vital, deFInido por diferentes parâmetros. As queimaduras são um problema de saúde pública mundial e nacional, devido à morbidade e mortalidade que produzem. O objetivo é descrever as características epidemiológicas e clínicas relacionadas ao paciente grande queimado hospitalizado.
Métodos: Estudo descritivo, retrospectivo e longitudinal realizado no Serviço de Cirurgia Plástica e Queimadura do Hospital Estadual Clínico Cirúrgico "Celia Sánchez Manduley", Manzanillo - Granma, no período de janeiro de 2015 a dezembro de 2018, a FIm de conhecer as características epidemiológicas do paciente grande queimado hospitalizado.
Resultados: O maior número de internações foi em 2018 com 45 pacientes (35,16%). Houve predomínio do sexo feminino com 74 pacientes (57,81%). Os acidentes como modo de produção de queimaduras foram os mais frequentes com 71 pacientes (55,47%). Grandes pacientes queimados relatados graves foram os mais frequentes com 48 (37,50%). O maior número de casos correspondeu aos municípios de Bayamo com 40 (31,25%) e Manzanillo 21 casos (16,41%).
Conclusão: O ano de 2018 foi o que apresentou maior número de casos, predominantemente o sexo feminino e entre eles os grupos de idade entre 30 e 59 anos. Os acidentes foram o principal modo de produção, a sobrevivência foi acima das expectativas. Os municípios com mais casos foram Bayamo e Manzanillo.

Palavras-chave: Queimaduras; Epidemiologia; Gravidade do paciente; Sobrevida; Unidades de queimados


INTRODUCTION

Burns are traumatic injuries that cause variable degree of tissue necrosis due to different physical, chemical, or biological agents that cause cell-mediated and humoral changes that can lead to death or leave debilitating or deforming sequelae1-3.

Injuries caused by burns constitute a health problem that globally affects all age groups, not only in terms of the frequency with which they occur but also their severity; burns can be incapacitating with a high mortality rate, and have an unfavorable nationwide economic impact4.

Extensive burns involve hospitalization and are usually associated with social, aesthetic, and economic losses5,6. A “large burn” patient is defined as a patient who suffers a burn that poses an important risk to life defined by different parameters. Burns are a national and global public health problem due to the morbidity and mortality they entail. According to the World Health Organization, an estimated 265,000 deaths worldwide are annually associated with burns7.

Globally, the morbidity and mortality rates associated with burns have decreased, with 90% of deaths occurring in low- and middle-income countries, where prevention programs are scarce; when they occur in high-income countries, they mainly affect the socially marginalized classes8.

The incidence of burns in Germany is 10,000–15,000 hospitalizations per year and 700,000–800,000 new cases in India9. In the United States, burns represent a mean 1,230 visits per day at the emergency services. Although many of these lesions heal spontaneously, almost 1 in 10 is severe enough to require hospitalization or transfer to a burn unit10. In Brazil, an estimated 1 million burn accidents occur per year; among them, 100,000 patients seek treatment at a hospital, while approximately 2,500 die directly or indirectly due to the injuries11.

In Cuba, according to the 2013 Statistical Health Yearbook, burns were the seventh leading cause of accidental death with an estimated mortality rate of 0.4 per 100,000 inhabitants12,13.

Due to economic constraints, different countries display differences in access to health care; therefore, access to specialized care units for burn patients varies widely14,15.

OBJECTIVE

The objective of this study is to understand the epidemiological characteristics of large burns and to develop preventive measures against these injuries.

METHODS

This descriptive, retrospective, and longitudinal study was performed at the Plastic Surgery and Burns Service of the Celia Sánchez Manduley Surgical Hospital, Manzanillo – Granma between January 2015 and December 2018 and aimed to understand the epidemiological characteristics of large burn patients who required hospitalization. The total sample was composed of all hospitalized patients with extensive large burns.

The following variables were determined: year of burn, age (age groups, with 15 year intervals), sex (female and male), cause of the burn injury (accident, attempted suicide, attempted murder), life expectancy (in accordance with the Cuban classification: severe, very severe, extremely critical), survival, and municipality of origin.

A patient’s life prognosis was determined by the burn severity index:1 mild, 0.1 to 1.49; less severe, 1.5 to 4.99; severe, 5 to 9.99; very severe, 10 to 19.99; critical, 20 to 39.99; and extreme critical, 40 or more.

To calculate the severity index, the total percentage of burns by depth was multiplied by a constant K and then added. This result was indicated as the severity index: for dermal A, the constant is 0.34; for dermal AB, 0.5; and for hypodermic B, 1. In the end, we added these results and obtained the severity index1.

A form was prepared for data collection after review of the medical records of all patients hospitalized for major burns.

This study data were analyzed on a computer using descriptive statistics in Microsoft Excel 2007, and absolute numbers, percentages, and rates were expressed in tables created for this purpose.

RESULTS

There were a total of 128 hospitalized large burned patients (Table 1), an incidence that has increased since 2017, with the highest number occurring in 2018.

Table 1 - Distribution of hospitalized large burn patients by year.
Year No. %
2015 26 20.31
2016 22 17.19
2017 35 27.34
2018 45 35.16
Total 128 100
Table 1 - Distribution of hospitalized large burn patients by year.

Analysis of the hospitalized large burn patients by age and sex (Table 2) revealed a predominance of females (74 [57.81%]); most patients were 45–59 years of age (15.63%), followed by 30–44 years of age (12.50%).

Table 2 - Distribution of large burn patients according to age and sex.
Age range Sex
Female Male Total
No. % No. % No. %
Less than 15 years 5 3.90 12 9.38 17 13.28
15-29 years 15 11.72 13 10.16 28 21.88
30-44 years 16 12.50 7 5.47 23 17.97
45-59 years 20 15.63 14 10.94 34 26.57
60-74 years 15 11.72 4 3.12 19 14.84
75 years and above 3 2.34 4 3.12 7 5.46
Total 74 57.81 54 42.19 128 100
Table 2 - Distribution of large burn patients according to age and sex.

Accidents were the most frequent cause of burns (Table 3; 55.47%), followed by suicide attempts(40.63%).

Table 3 - Distribution of hospitalized large burn patients in accordance with the cause of burns.
Burn cause No. %
Accidents 71 55.47
Suicide attempt 52 40.63
Homicide attempt 5 3.90
Total 128 100
Table 3 - Distribution of hospitalized large burn patients in accordance with the cause of burns.

A severe large burn (Table 4) was the most frequent (48 cases [37.50%]), followed by extreme critical (36 [28.12%]). Regarding threat to life, the survival rate after severe burn was 100%, that after a very severe burn was 92.30%, after critical burn was 77.78%, and after extreme critical burn was 13.89%.

Table 4 - Distribution of hospitalized large burn patients by life expectancy and survival.
Life expectancy Hospitalized Alive (N = 128)
No. % No. %
Severe 48 37.50 48 100.00
Very severe 26 20.32 24 92.30
Critical 18 14.06 14 77.78
 Extreme critical 36 28.12 5 13.89
Total 128 100 91 71.09
Table 4 - Distribution of hospitalized large burn patients by life expectancy and survival.

The majority of patients with large burns (40 cases [31.25%]) were injured in Bayamo, followed by Manzanillo (21 cases [16.41%]) and Bartolomé Masó (11 [8.59%]) (Table 5); however, with regard to the incidence per 10,000 people, most were from the municipality of Buey Arriba with 2.20, followed by Bartolomé Masó and Media Luna at 2.19 and 2.07, respectively.

Tabela 5 - Distribuição dos pacientes grandes queimados hospitalizados segundo seu município de origem.
Municipality of origin No. % Population Incidence per
10,000
population
Manzanillo 21 16.41 130 262 1.61
Niquero 2 1.57 42 870 0.46
Pilón 6 4.69 29 927 2
Media Luna 7 5.47 33 698 2.07
Campechuela 4 3.12 44 568 0.89
Yara 10 7.81 56 880 1.75
Bartolomé Masó 11 8.59 50 110 2.19
Bayamo 40 31.25 238 118 1.67
Rio Cauto 4 3.12 47 381 0.84
Buey Arriba 7 5.47 31 863 2.20
Cauto Cristo 2 1.57 20 664 0.97
Jiguaní 9 7.03 60 751 1.48
Guisa 5 3.90 47 777 1.04
Total 128 100 834 869 1.53
Tabela 5 - Distribuição dos pacientes grandes queimados hospitalizados segundo seu município de origem.

DISCUSSION

Burns represent one of the most devastating forms of trauma globally16, being an important public health problem in terms of morbidity and long-term consequences, especially in developing countries11.

Here we found that the incidence of extensive burns has increased in recent years. Exposure to and the use of combustible liquids in adulthood, especially by women, make it more likely for young women to suffer burns that require hospitalization. This was reflected in our study data and coincides with other authors who obtaine d similar results17; other studies reported a higher frequency of burn injuries in male patients11,18, and described differences in the exposure of individuals of either sex to the possible cause of burn injuries.

Accidents were the main cause of burns, although many suicide attempts were reported, and these two causes represent almost all patients hospitalized with extensive burns. The accidents were related to occurrences in the household as reported by other studies performed in developing countries19,20.

In our study we observed that severe burn patients had a higher survival than expected based on the Cuban life prediction classification1. This is due to medical advances, the individual dedication of doctors and nurses who care for these patients, and their high level of professionalism, which enables the survival of patients with extensive burns and a high mortality risk. Other studies7 also reported higher rates of survival when applying other measures for for mortality, such as the Garcés index, in agreement with our results.

The majority of extensive burns occurred in the municipalities of Bayamo and Manzanillo, but when the incidence rate per population was determined, higher values occurred in the municipalities of Buey Arriba, Bartolomé Masó, and Media Luna, mainly in rural areas. These results may be related to sociocultural differences among different population groups and the possible causes of burns as reported by some authors9.

CONCLUSION

In 2018, a significant increase in the number of large burn patients was noted with a predominance of patients of female sex, aged 30–59 years. Accidents were the primary cause, and severe and critical burns were the most frequent in the reports describing survival prognosis and a higher than expected survival rate. The greatest number of cases occurred in the Bayamo and Manzanillo municipalities. As a recommendation we suggest improve the interrelationship between primary care and secondary care, determining the behavior of large burn patients is important to contribute to health promotion and burn prevention actions.

COLLABORATIONS

CMCH

Analysis and/or data interpretation, Conception and design study, Conceptualization, Data Curation, Final manuscript approval, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing - Original Draft Preparation, Writing - Review & Editing

VPN

Analysis and/or data interpretation, Conception and design study, Final manuscript approval, Investigation, Project Administration, Supervision, Visualization, Writing - Original Draft Preparation, Writing - Review & Editing

RFB

Analysis and/or data interpretation, Data Curation

SRLG

Analysis and/or data interpretation, Data Curation

FAPS

Analysis and/or data interpretation, Data Curation

MSG

Analysis and/or data interpretation, Data Curation

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1. Hospital Estadual Clínico Cirurgico “Celia Sánchez Manduley”, Manzanillo, Granma, Cuba.
2. Hospital Estadual Psiquiátrico Manuel Fajardo Rivero, Manzanillo, Granma, Cuba.

Institution: Hospital Provincial Clínico Cirúrgico “Celia Sánchez Manduley”, Manzanillo, Granma, Cuba.

Corresponding author: Carlos Manuel Collado Hernández Circunvalación, Manzanillo, Cuba. Zip Code: 87510. E-mail: vivicollado2013@gmail.com

Article received: September 5, 2019.
Article accepted: October 21, 2019.

Conflicts of interest: none.



 

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