INTRODUCTION
Burns are skin lesions caused by heat, with different agents that can compromise muscle
tissue, tendons, bones and bring risks of loss of limbs, function or even death of
the patient. These are problems that can result in clinical, physical and psychological
damage. Treatments involve interruption of the burn, electrolyte replacement, rehydration,
pain management, debridement and grafts1.
Burns is a set of injuries that cause injury to organic tissue and are caused by an
external agent, resulting from the trauma of thermal, chemical, electrical, friction
or radiation, leading to the partial or total destruction of the skin and adjacent
tissues2.
This type of trauma can imply, in addition to psychological repercussions, damage
to the respiratory, immune, cardiovascular and renal systems, and the risk of infection
followed by sepsis, considered the main cause of mortality3.
According to the World Health Organization, burns are the fourth most common type
of trauma globally, second only to interpersonal violence, falls and traffic accidents2. However, despite being a traumatic entity quite present in all social groups, burns
have become one of the main causes of morbidity and mortality in low- and middle-income
countries, such as Brazil4.
In Brazil, it is estimated that one million individuals are burned each year, with
no restrictions on sex, age or race, with a strong economic impact, given the prolonged
treatment time5 and the burden inherent to the disease6.
Burns, therefore, is an important public health problem in Brazil, being costly to
the health system, and requiring long-term follow-up of the patient to deal with possible
psychological and physical consequences arising from the incident7,8.
OBJECTIVE
To evaluate the epidemiological profile of adult patients admitted to a burn treatment
center in the Recôncavo da Bahia, from June 2019 to June 2020.
METHODS
This is a retrospective descriptive study. For the present study, the medical records
of patients admitted to the Burn Treatment Unit of the Santo Antônio de Jesus Regional
Hospital were evaluated from June 2019 to June 2020. The following variables were
considered: gender; age; period of internment; procedures performed and the number
of procedures; existence or not of complications; burned body area; causal agent of
the burn; patient’s origin; burn date; date of admission; burned region; reason for
the burn (accidental, aggression or self-extermination); degree of burns; ICU indication;
comorbidities and deaths. The medical records of patients under 18 years of age or
who were not admitted to the Burn Treatment Unit were excluded from the present study,
In order to protect the physical and psychological integrity of those involved, assuring
them of ethical standards, respecting the Declaration of Helsinki (2000) and the National
Health Council - resolution 196/96, this project was submitted to the Ethics Committee
in Research (CEP) of the Health Sciences Center (CCS) of the Federal University of
Recôncavo da Bahia (UFRB) after the signature of a letter of consent by the Hospital
board and data collection was only started after approval by the CEP, under CAAE number
31216820.9.0000.0056.
During data analysis, information from the research participants was cross-referenced,
and the frequency and mean of the variables were calculated. Data such as age group4, body surface area burned (BBS)9 and length of stay10 were grouped according to the theoretical framework present in the literature.
RESULTS
In the 13 months analyzed at the Burn Treatment Unit, 102 adult patients were admitted,
whose epidemiological data were summarized in Table 1.
Table 1 - Epidemiological profile.
|
|
n |
% |
| Sex |
Masculine |
51 |
50.0 |
| Feminine |
51 |
50.0 |
| Comorbidities |
Present |
28 |
27.5 |
| Absent |
74 |
72.5 |
| Age group |
18-25 |
22 |
21.6 |
| 26-40 |
31 |
30.4 |
| 41-55 |
33 |
32.4 |
| 56-65 |
9 |
8.8 |
| 66+ |
7 |
6.9 |
| Burn degree |
2nd-degree
|
83 |
81.4 |
| 3rd-degree
|
17 |
16.7 |
| Not registered |
2 |
2.0 |
| BBS |
0-10% |
62 |
60.8 |
| 11-20% |
15 |
14.7 |
| 21-30% |
2 |
2.0 |
| >31% |
3 |
2.9 |
| Cause of burn |
Accident |
92 |
90.2 |
| Aggression |
6 |
5.9 |
| Self-extermination |
2 |
2.0 |
| Not registered |
2 |
2.0 |
Table 1 - Epidemiological profile.
There was a balance between male and female and, of the 102 hospitalized patients,
most did not have comorbidities.
When analyzing the reason for the burn, whether of an accidental nature, aggression
or self-extermination, it can be observed that the majority had burns of an accidental
nature.
In addition, several causal agents of burns were observed. Scalding by hot liquids,
including milk, coffee and oil at high temperatures, was the main agent, with 68 cases
(66.7%). The second cause was direct contact with a flame, corresponding to 18 cases
(17.6%). Four patients (3.9%) were victims of electrical burns. Four patients with
unspecified burns were registered, representing 3.9% of the sample.
When looking at the time elapsed between the accident and admission to the burn center,
it can be seen that 55 patients (53.9%) took up to 5 days to seek care, while 3 (2.9%)
delayed up to 16 days or most.
As for the depth of the injuries, 83 (81.4%) were victims of 2nd-degree burns, 17
(16.7%) of 3rd-degree and 2 (2%) with wound depth not specified in the records. The
records of the affected body regions were present in 100 medical records, with the
lower limbs being the most affected, with 24.5% of the cases; followed by the upper
limbs, with 19.6%; head and neck, with 16.7%; and multiple lesions, with 15.7%.
The most prevalent BBS was up to 10%, found in 62 patients (60.8%). Twenty patients
had their BBS missing from the medical records.
As for the procedures performed, all patients in the sample underwent surgical debridement,
68 patients underwent debridement only (66.7%), 32 underwent debridement and grafting
(31.4%), and 2 patients (2%) underwent grafting and retail.
Regarding the length of stay, 30 patients stayed 16 days or more in the hospital (29.4%),
and 29 patients stayed up to 5 days.
Regarding the outcome, 96 (94.1%) were discharged from the hospital, 3 (2.9%) died,
and 3 (2.9%) were transferred to another service. Regarding the ICU indication, 4
(3.9%) patients had an established indication, while 98 (96.1%) were treated in common
ward beds.
When analyzing the overall mortality of patients, the result is 3 deaths (2.9%). Of
all hospitalized patients, 12 (11.8%) had complications in their treatment, and 87
(85.3%) did not.
When comparing comorbidities with deaths (Table 2), it is observed that, of the three deaths that occurred, 66% had no comorbidities.
Table 2 - Deaths due to the presence of comorbidities.
|
Deaths |
| Yes |
No |
| Presence of comorbidities |
Yes |
1 |
27 |
| No |
2 |
72 |
| TOTAL |
3 |
99 |
Table 2 - Deaths due to the presence of comorbidities.
When comparing deaths with complications (Table 3), it can be seen that most patients had no complications and did not die.
Table 3 - Deaths due to the presence of complications.
|
Deaths |
| Yes |
No |
| Presence of complications |
Yes |
3 |
10 |
| No |
0 |
89 |
| TOTAL |
3 |
99 |
Table 3 - Deaths due to the presence of complications.
It can be seen that, when comparing BBS with the length of hospital stay (Table 4), there was a certain balance in the period spent in the hospital environment.
Table 4 - Length of hospital stay by burnt body surface indices.
|
|
length of stay |
|
|
Up to 5 days |
Between 6 and 10 days |
Between 11 and 15 days |
16 days or more |
| BBS |
Up to 20% |
20 |
11 |
17 |
14 |
| From 11 to 20% |
1 |
0 |
4 |
10 |
| From 21 to 30% |
1 |
0 |
0 |
1 |
| More than 30% |
2 |
1 |
0 |
0 |
| TOTAL |
24 |
12 |
21 |
25 |
Table 4 - Length of hospital stay by burnt body surface indices.
DISCUSSION
According to the Ministry of Health, there were 966 hospitalizations of adults for
burns and corrosion in Bahia from November 2018 to November 2019. When comparing this
same period and this same age group to the Northeast Region, this number increases
to 4081 admissions. In the entire national territory, in the same period and age group,
there were a total of 16,231 hospitalizations11.
The epidemiological data of patients admitted to the burn treatment unit are of paramount
importance as it is a way of knowing the main factors related to burns and developing
preventive measures that reduce the incidence of such events12.
In the period studied, from June 2019 to June 2020, 102 medical records were analyzed,
in which females and males were equally affected by burns, a prevalence that differs
from other studies2,4,5. This finding can be explained by the risk of accidents offered by the residence
for the occurrence of burns13.
Regarding the age group, the patients most affected by burns belonged to the 41 to
55 group. In the literature, 20 to 24 years old, followed by 35 to 39 years old, were
the most prevalent, which differs from the results of this research4.
The reason for the burn is following the literature, in which most burns are accidental
in nature14. The most common causal agents were hot liquids and flame, corroborating the literature3.
According to the literature, the most affected regions were lower limbs and upper
limbs, which shows the limbs as the most affected; however, the present study differs
from the others in terms of this involvement15. Concerning the depth of the injuries, second-degree burns were the most prevalent
in this study. Similar results were found in other studies2,16.
Surgical debridement was the most performed procedure in patients, a result also obtained
in the literature4, in which debridement was responsible for 58.74% of procedures performed in burn
patients in Indonesia.
The length of hospital stay in this research, which averaged 11 to 15 days, agrees
with the literature, which shows an average of 13.3 days3, which the reduced specialized team can justify, and not available on all days of
the week, postponing some procedures in the area, and extending the length of stay.
Complications were found in 11.8% of the patients, a value that differs from that
found in the literature8, which resulted in complications in 63.1% of the patients, which can again be explained
by the level of complexity of the referred burn center. The smaller sample size can
also explain this difference in this research (102).
In this study, there was a prevalence of hospital discharge, and only 2.9% had death
as an outcome, a result also found in the literature16, with 97.1% of patients being discharged and 2.7% dying. Despite converging with
results from other studies, these data can be justified by the proposal of the burn
center studied, that is, because it is a care unit for small and medium burns, these
numbers become biased, since large burns, the main responsible for the mortality rates
of this condition, are promptly transferred to other institutions.
In this context, epidemiological studies are valuable because they create information
for carrying out preventive public health policies17, thus showing the importance of carrying out this work, aiming at improving public
assistance to burn victims with greater efficiency and effectiveness.
However, this work is limited by the absence of some variables in the patients’ charts
or incomplete information. In addition, this research brings specific data from a
region in the interior of Bahia, which may not be compatible with other regions.
CONCLUSION
In this study, in the epidemiological profile of the patients, there was an equality
in prevalence between the sexes, aged between 41 and 55 years and without comorbidities.
The main causal agent was scalding, followed by direct contact with flame. There was
a prevalence of second-degree burns, and the main reason that led to the burn was
accidental.
Burning is an avoidable evil, so epidemiological data are tools that contribute to
the development of care and prevention aimed at this group to reduce burns accidents.
This study may serve to plan public health policies to care for and prevent burns.
REFERENCES
1. Nascimento SB, Soares LSS, Areda CA, Saavedra PAE, Leal JVO, Adorno J, et al. Perfil
dos pacientes hospitalizados na unidade de queimados de um hospital de referência
de Brasília. Rev Bras Queimaduras. 2015;14(3):211-7.
2. Arruda FCF, Castro BCO, Medeiros JF, Valadão WJ, Reis GMD. Análise epidemiológica
de 2 anos na Unidade de Queimados do Hospital de Urgências Governador Otávio Lage
de Siqueira, Goiânia, Brasil. Rev Bras Cir Plást. 2018;33(3):389-94.
3. Mola R, Fernandes FECV, Melo FBS, Oliveira LR, Lopes JBSM, Alves RPCN. Características
e complicações associadas às queimaduras de pacientes em unidade de queimados. Rev
Bras Queimaduras. 2018;17(1):8-13.
4. Wardhana A, Basuki A, Prameswara ADH, Rizkita DN, Andarei AA, Canintika AF. The epidemiology
of burns in Indonesia’s national referral burn center from 2013 to 2015. Burns Open.
2017;1(2):67-73.
5. Zafani RT, Perrone RP, Vilaça DT, Faro SF, Moraes CM, Souza GCVF. Análise da evolução
dos pacientes queimados de acordo com seu perfil epidemiológico na Santa Casa de Misericórdia
de Santos, Brasil. Rev Bras Cir Plást. 2018;33(3):395-8.
6. Silva TBL, Oliveira CM, Felisberto D, Nigro MVAS, Kusano LDC, Mialski JR. Caracterização
epidemiológica de pacientes queimados atendidos no Serviço de Queimados do Hospital
Universitário Evangélico Mackenzie de Curitiba no Ano de 2017. Rev Bras Cir Plást.
2019;34(Suppl 1):70-2.
7. Marinho LP, Andrade MC, Goes Junior AMO. Perfil epidemiológico de vítimas de queimadura
internadas em hospital de trauma na região Norte do Brasil. Rev Bras Queimaduras.
2018;17(1):28-33.
8. Silva JAC, Vendramin FS, Martins MM, Lima AVM, Cunha LM, Borborema CLP. Epidemiologia,
principais complicações e mortalidade dos pacientes atendidos em um Centro de Tratamento
de Queimados na Amazônia. Rev Bras Cir Plást. 2018;33(1):104-9.
9. Dutra JPS, Custódio SR, Piccolo N, Daher RP. Estudo clínico-epidemiológico de pacientes
queimados internados em uma unidade de terapia intensiva em Goiás. Rev Bras Queimaduras.
2017;16(2):87-93.
10. Giuli AE, Itakussu EY, Valenciano PJ, Fujisawa DS, Trelha CS. Caracterização de idosos
vítimas de queimaduras internados em um centro de tratamento de queimados. Rev Bras
Queimaduras. 2015;14(4):253-6.
11. Brasil. Ministério da Saúde. DATASUS. Informações de Saúde. Epidemiológicas e morbidade
[acesso 2020 Fev 2]. Disponível em: http://www2.datasus.gov.br/DATASUS/index.php?area=0203&id=6926
12. Soares LR, Barbosa FS, Santos LA, Mattos VCR, De-Paula CA, Leal PML, et al. Estudo
epidemiológico de vítimas de queimaduras internadas em um hospital de urgência da
Bahia. Rev Bras Queimaduras. 2016;15(3):148-52.
13. Gawryszewski VP, Bernal RTI, Silva NN, Morais Neto OL, Silva MMA, Mascarenhas MDM,
et al. Atendimentos decorrentes de queimaduras em serviços públicos de emergência
no Brasil, 2009. Cad Saúde Pública. 2012;28(4):629-40.
14. Hernández CMC, Núñez VP, Banqueris RF, Gil SRL, Suárez FAP, García MS. Caracterização
epidemiológica de 4 anos dos pacientes grandes queimados no Hospital “Celia Sánchez
Manduley”, 2015 - 2018. Rev Bras Cir Plást. 2020;35(1):78-82.
15. Pereira NCS, Paixão GM. Características de pacientes internados no centro de tratamento
de queimados no estado do Pará. Rev Bras Queimaduras. 2017;16(2):106-10.
16. Soares ALS, Saraiva ABC, Rêgo ALC, Lima GM, Nicolau-da-Costa LR. Características clínico-epidemiológicas
de pacientes internados em um hospital de referência em queimaduras na Amazônia brasileira.
Rev Bras Queimaduras. 2019;18(2):102-6.
17. Lacerda LA, Carneiro AC, Oliveira AF, Gragnani A, Ferreira LM. Estudo epidemiológico
da Unidade de Tratamento de Queimaduras da Universidade Federal de São Paulo. Rev
Bras Queimaduras. 2010;9(3):82-8.
1. Federal University of Recôncavo da Bahia, Cruz das Almas, BA, Brazil.
Corresponding author: Paulo Plessim de Almeida Filho, Alameda Salerno, 113, Apartment 1801A, Pituba, Salvador, BA, Brazil, Zip Code 41830-500,
E-mail: pauloplessim@ufrb.edu.br
Article received: March 24, 2021.
Article accepted: April 19, 2021.
Conflicts of interest: none.
