Clinical and epidemiological profile of burn victims, a retrospective study
Perfil clínico e epidemiológico de pacientes vítimas de queimaduras, um estudo retrospectivo

INTRODUCTION

In Brazil, burns are an important public health problem, affecting around one million people per year, of which 100,000 seek hospital care and 2,500 die¹.

Several factors influence the prognosis of these patients, such as age, nutritional status, presence of complications, immunological status, type of agent that caused the burn, degree, location of injury, infection, therapeutic structure of the care service, and performance of the healthcare team².

In several epidemiological studies, it is found that children (mainly males) are the most affected by burns due to curiosity and inability, this being the second accidental cause of death in this age group³. Children and adolescents have a great emotional impact as they are undergoing psychological development, which leads to difficulty in dealing with stressful situations caused by pain, discomfort, and hospital admission, in addition to physical changes generated by the burn, causing low self-esteem, social isolation, interfering with the patient’s quality of life⁴.

In addition to the impact on these people’s lives, there is also the impact on public financial resources. This occurs not only due to the care and treatment of these patients in the health care network (Sistema Único de Saúde) but also due to compensation costs for disabilities caused by the burn. Regarding the latter, according to the World Health Organization, in 2016, 10 million people were considered incapacitated in the world (80% of which are located in lowand middle-income countries)⁵.

Burn treatment is extremely difficult in the medical field due to the patient’s severity upon admission, as well as the long follow-up caused by complications. Furthermore, few professionals are dedicated to providing care and studying the topic³.

Epidemiological studies are extremely important to guide better health promotion practices (such as prevention campaigns and improvements in the cost-effectiveness of burn care). For this reason, it was necessary to carry out this work, outlining the profile of burn victims in the Plastic Surgery and Burns Service of Santa Casa da Misericórdia de Santos⁶.

OBJECTIVE

To outline the clinical and epidemiological profile of burn victims treated at the Plastic Surgery and Burns Service of Santa Casa da Misericórdia de Santos (SCPSCS) from January 2016 to December 2019 to prevent such an event.

METHOD

RESULTS

Between 2016 and 2019, 398 burn patients were admitted to the SCPSCS, with the sample for this study being 393 patients.

Regarding the origin of the patients, the majority came from the Metropolitan Region of Baixada Santista, with 109 (27.74%) from Santos, 81 (20.61%) from São Vicente, 54 (13.74%) from Praia Grande, 46 (11.70%) from Guarujá, 25 (6.36%) from Itanhaém, 22 (5.60%) from Cubatão, 15 (3.82%) from Peruíbe, 13 (3.31%) from Bertioga, 10 (2.54%) from Mongaguá and 18 from other cities, mainly coming from São Paulo, with 6 (1.53%) people, as shown in Table 1.

Table 1 - Epidemiological data.

Among the causes of the accident, 300 (76.34%) were domestic accidents, 46 (11.70%) work accidents, 14 (3.56%) attempted homicides, 13 (3.31%) attempted suicides, and 1 (0.25%) car accidents. Nineteen people (4.83%) did not inform the cause.

Regarding the time elapsed from the accident to the first care at SCPSCS, 260 (66.16%) patients were seen in less than 24 hours (h), 60 (15.27%) in the period from 24h to 48h, 48 (12 .21%) from 2 to 7 days and 13 (3.31%) after 7 days of the accident. A total of 12 (3.05%) patients did not have this data recorded in the medical record.

Of the complications caused in the postoperative period of burn patients, partial necrosis of the graft, as well as surgical wound infection, were reported in 11 cases (2.80%) each, followed by scar retraction, with 3 (0.76%) cases, and flap dehiscence, with 1 case (0.25%). The majority, 367 (93.38%), had no reported postoperative complications.

Regarding the classification of burns, Table 2 shows the following data:

Table 2 - Classification related to burns.

Table 3 presents information regarding hospitalization and discharge conditions.

Table 3 - Hospitalization data.

Finally, data regarding the treatment of these patients are presented in Table 4:

Table 4 - Burn treatment.

DISCUSSION

According to Coutinho et al.⁷, there is a prevalence of adults suffering from burns, with 54.86% of the patients in their research being over 16 years old, which is in line with this study, which shows that individuals aged 18 to 59 years old are more affected by burns compared to others. However, other studies point to children as the most affected. This was found in the research by Santos Junior et al.⁸, in which, in a sample of 952 patients, 51.15% were children aged 0 to 12.

Regarding the sex of the patients, this study shows that 64.12% of the patients are men, corroborating the majority of literature, which points to the male sex as the most affected by burns, as can be seen in the research by Santos Junior et al. .8, Francisconi et al.⁹ and Bessa et al.¹⁰, which show 63.02%, 69.4%, and 63.8% respectively, of men affected by the condition.

It was found that 95.42% of patients come from the Metropolitan Region of Baixada Santista, which is demonstrated in the study by Padua et al.¹¹, in which the majority of burns treated at SCPSCS from 2010 to 2015 were from this location, with Santos standing out with 39.1%, as in the present study, which found 27.74% of Santos residents.

Lacerda et al.¹² showed that 51.5% of burn victims suffered a domestic accident, the cause being unintentional, which is similar to the study in focus, which showed that 76.34% were domestic accidents. Lacerda et al.¹² also highlight that the percentage of suicide attempts is low and reaches 4.95%, bringing it even closer to this study, which found 3.31% of those burned due to attempted self-extermination.

This study shows that the most common causal agent of burns was heated liquids (45.04%), followed by direct contact with the flame (37.15%), similar to the study by Bessa et al.¹⁰, which points out the main cause of burns is contact with heated liquids (water and coffee, which together account for 39.9%), followed by contact with the flame (38%), just as Takino et al.⁶ point to scalding as the main causal agent of burns with 53%, followed by flame with 30%, however, this latest study focuses on patients aged 0 to 17 years, who are more susceptible to scald burns.

In studies by Santos Junior et al.⁸ and Santana¹³, 79.41% and 56% of patients suffered only second-degree burns, just as this study indicates a prevalence of 82.95% of patients affected by the same depth of injury in previous studies.

In the research by Lacerda et al.¹², 60.4% of those burned had less than 10% of BSB, of which 65.35% of patients were considered low severity. This goes against the results of this research, which indicate that 39.44% of patients have major burns, considered to be more serious patients and susceptible to complications or death. Cruz et al.¹⁴, in their literature review, show that the average BSB in adults is 14.6%, with first-degree burns being isolated or first and second-degree corroborating the first study cited.

Most patients at SCPSCS were hospitalized for 8 to 14 days (30.03%). This data corroborates the study by Fonseca Filho et al.¹⁵, which found that 62.43% of patients with an average hospitalization of 13.37 days. Padua et al. ¹¹ confirm what previous research shows, in which the length of stay was up to 14 days for 61% of patients. Of those hospitalized in this research, 71.76% went to the infirmary and 28.24% to the Intensive Care Unit, similar to studies by Takino et al.⁶, which showed that 23% of burn victims required admission to the Intensive Care Unit.

Most patients had a good outcome, receiving an improved discharge (89.57%), while 4.07% of patients died, following what was presented by Takino et al.⁶, who showed 94% of patients were discharged from the hospital, and only 6% died.

Santana13 shows that 71.3% of burn victims did not have any complications, and of those who presented complications, 15.3% were due to wound infection. The research in focus shows the absence of complications in 93.38% of patients. Of those who had complications, surgical wound infection corresponded to only 11 (2.80%) cases.

The study showed that the main treatments performed were debridement and partial thickness skin grafting (79.90% and 16.54%, respectively), similar to what Lacerda et al.¹² present, with debridement (35.45 %) and grafting (33.64%) being the main procedures performed.

CONCLUSION

The majority of people affected by the condition are men, in the adult age group, from the Baixada Santista Metropolitan Region, and who were burned due to a domestic accident.

Although the majority of injuries are severe second-degree burns, caused mainly by heated liquids and flame, many are treated solely with debridement of the injuries and daily dressings, presenting positive outcomes with discharge after clinical improvement, which shows the importance of qualified professionals to serve this type of patient in a targeted manner.

It is worth highlighting that these predominant profiles of burn victims are mostly hospitalized for one to two weeks in the hospital, negatively interfering with work relations and the country’s economy, as they are, in most cases, active workers who help provide for their families.

Public burn prevention policies (such as education, communication, and advertising, among others) are fundamental for the prevention of this condition in order not to increase hospital costs for the short and long-term care and treatment of these patients, as well as reduce the impact economic and social of the country.