TY - JOUR
AU1 - MPH, Nicole E. Alden, RN,
AU2 - MS, Angela Rabbitts, RN,
AU3 - FACS, Roger W. Yurt, MD,
AB - Abstract Contact burns may result in severe burn injury due to prolonged transfer of heat from an object to the skin. Often, these burns occur with the use of household appliances and fixtures during routine activities of daily living. A retrospective review was performed. Data were obtained through a review of electronic medical records and the Burn Center's National Trauma Registry of the American College of Surgeons database. Patients admitted to the burn center between July 1999 and June 2004, who had sustained a contact burn, were identified and included in the study group. During the study period, 336 patients (55% male) were admitted for treatment of acute contact burns. The mean age of patients was 18 years, and the median age was 2.4 years. The mean burn size of the study group was 2.1% of the total body surface area. During the study period, four patients required mechanical ventilation for a mean of 13.2 days. Surgical closure of the burn wound was required by 36% of patients. Eighty-nine percent of patients were discharged to home; mortality rate was 1.0%. The majority of burns (92%) were non-occupational. The findings of this study support the premise that significant morbidity from contact with heated objects continues to occur. During the past 5 years, the incidence of contact burns has remained steady, resulting in 10% of all aucte burn injuries requiring hospitalization at this burn center. The incidence reported here is similar to those reported both nationally and internationally and supports the need for continued burn prevention education. Contact burns may result in severe burn injury as the result of a prolonged transfer of heat from an object to the skin. Often, these burns occur while using household appliances and fixtures during routine activities of daily living. Commonly reported sources of injury include oven doors, fireplace screens, and personal care items, such as clothing irons and beauty appliances.1,–8 Because of the ubiquitous sources of contact burns, anyone can be at risk of sustaining such an injury. Many burn-prevention education programs are available and have been successful in reducing overall incidence of burns.9,–11 Despite these efforts, current literature reports that contact burns continue to account for 7% to 9% of all reported burns and that children are especially at risk for these injuries.1,8 According to the National Safe Kids Coalition, contact burns account for 20% of all burn injuries requiring hospitalization among children ages 4 and younger.12 These findings prompted further investigation of the incidence of contact burns within the geographical region of this burn center. It is hypothesized that contact burns continue to cause significant morbidity among the population of patients admitted to the Burn Center. To assess frequency, severity, and root causes of such injury trends, a retrospective study of patients hospitalized for treatment of contact burns was performed. METHODS After HIPAA authorization and Institutional Review Board approval were granted by the Weill Medical College of Cornell University, data were obtained through a review of electronic medical records and the Burn Center's National Trauma Registry of the American College of Surgeons (NTRACS) database. Patients admitted to the burn center between July 1999 and June 2004 who sustained a contact burn were identified and included into the study group. Sex, age, race, burn size expressed as percentage of total body surface area (TBSA), etiology of injury, site/mechanism/circumstance of injury, number of patients requiring operative procedures, length of stay (LOS), ventilator utilization and discharge disposition were reviewed. Mean and standard error of the mean (SEM) values are presented where applicable. For the purposes of this study, the academic year of July to June was used to define annual periods (ie, July 2003–June 2004 is referred to as 2003). RESULTS Demographics During the 5-year study period, 336 patients (55% men) were admitted for treatment of acute contact burns at an annual rate ranging from 6.8 to 9.1 contact burns per 100 admissions (Figure 1). The mean age ± SEM of patients was 18.0 ± 1.4 years (range, 0.1–101.5) and the median age was 2.4 years. Patients younger than 5 years, between the ages of 5 and 14.9 years, 15.0 and 64.9 years, and older than 65 years of age accounted for 59%, 6%, 28%, and 6% of the study group, respectively. Thirty-two percent of patients were Hispanic, and 29% were African American (Figure 2). Seven patients were readmitted during the study period for further treatment of the initial injury for reasons including graft loss, scheduled or staged procedures, and intravenous treatment of cellulitis. Figure 1. View largeDownload slide Total number and incidence (number per 100 admissions) of patients admitted with contact burns by year from July to June of each year. Figure 1. View largeDownload slide Total number and incidence (number per 100 admissions) of patients admitted with contact burns by year from July to June of each year. Figure 2. View largeDownload slide The distribution of race/ethnicity of patients admitted with contact burns. Figure 2. View largeDownload slide The distribution of race/ethnicity of patients admitted with contact burns. Burn Injury and Resource Utilization The mean burn size of the study group was 2.1 ± 0.1 % (range, 0.5–23% TBSA). The most common areas burned were hands, arms, legs, and head (Figure 3). Four patients within the study group required mechanical ventilation for a mean of 31.0 ± 1.4 days (range, 1–87). Surgical closure of the burn wound was required by 36% of patients. The mean length of stay was 11.6 ± 0.6 days (range, 1–87). Eighty-nine percent of patients were discharged to home, whereas 4% required home care services after discharge; mortality was 1.0% (Figure 4). Figure 3. View largeDownload slide The anatomic distribution of contact burns in patients admitted to the Burn Center. Figure 3. View largeDownload slide The anatomic distribution of contact burns in patients admitted to the Burn Center. Figure 4. View largeDownload slide The discharge disposition of patients admitted with contact burns. Figure 4. View largeDownload slide The discharge disposition of patients admitted with contact burns. Mechanism, Circumstance, and Etiology of Injury The majority of injuries (92%) were nonoccupational in nature, 4% were occupational related, 2% were the result of other circumstances, and 2% of injuries occurred as a result of abuse or assault. Eighty percent of contact burns occurred within the domestic setting whereas 10% occurred in other sites, 9% occurred outdoors, and 1.5% occurred within industrial settings. Radiators, irons, and small household appliances were the most common sources of injury among the study group (Figure 5). Figure 5. View largeDownload slide The distribution of contact burn injuries by etiology is shown. Figure 5. View largeDownload slide The distribution of contact burn injuries by etiology is shown. CONCLUSION Although many burn-prevention programs are available and have demonstrated success in injury reduction and improvements in public awareness, contact burns continue to occur and disproportionately affect children younger than 5 years of age.1,–12 During the first 5 years of the study period, the total number of contact burns admitted to this burn center decreased until 2003, when the trend reversed. The incidence of contact burns per 100 admissions initially increased during the period of 2000 to 2002, declined in 2003 and again increased during the subsequent period. That racial minorities constitute approximately 75% of patients within the study group reflects the population demographics of the communities within the local, geographical catchment areas served by this burn center, thus differing significantly from the national population. The incidence and causes of injury reported here are similar to those reported both nationally and internationally.1,8 Although the average burn size was less than 3% TBSA, prolonged hospitalizations resulted from these injuries, as many were deep, affected critically functional areas and required ongoing wound care and physical therapy. Approximately 40% of patients required surgery for these injuries. Fortunately, few mortalities occurred within this study group, and an overwhelming majority of patients were able to return home. These data suggest that continued burn prevention is warranted. The finding that more than 80% of contact burns occurred within the home supports the need to focus on home safety and should include a specific focus on contact burn prevention. Educational guidelines for consumers should reinforce the need for safe use and storage of household items such as curling and clothing irons, home appliances, and barbeques. Strategies should also include reinforcing the burn-prevention information often included by the device manufacturers and promoting the use of appliances that are constructed with materials that decrease risk of burn injury.13,14 Finally, the installation and use of safety devices that limit exposure to heat sources (ie, radiator and heating pipes covers, fireplace enclosures) should be encouraged and have proven to be effective at reducing other types of burn injuries.15 Given that most patients in this and other studies are pediatric, educational efforts highlighting the need for constant supervision by parents and/or caregivers and age appropriate teaching also should be pursued. Although this article serves to describe the problem of contact burns among patients treated at this burn center, it also highlights the need for further research into this continuing problem. Further research into burn safety practices of individuals and families may provide insight into specific circumstances which contribute to contact burns and highlight new avenues for prevention education. Additionally, as suggested by Basset and Arild,13 future research into materials technology and development with the intention of creating burn safe appliances is also warranted. REFERENCES 1. Pegg SP. Burn epidemiology in the Brisbane and Queensland Area. Burns [serial online]. 2005 [cited 2005 Jan 22];31;S27–31. Available at: http://www.sciencedirect.com/science/journal/03054179; Internet; accessed May 8, 2006. 2. Dunst CM, Scott EC, Kraatz JJ, Anderson PM, Twomey JA, Peltier GL Contact palm burns in toddlers from glass enclosed fireplaces. J Burn Care Rehabil  2004; 25: 67– 70. Google Scholar CrossRef Search ADS PubMed  3. Qazi K, Gerson LW, Christopher NC, Kessler E, Ida N Curling iron-related injuries presenting to U.S. emergency departments. Acad Emerg Med  2006; 8: 395– 7. Google Scholar CrossRef Search ADS   4. Yen KL, Bank DE, O'Neill AM, Yurt RW Household oven doors: a burn hazard in children. Arch Pediatr Adolesc Med  2001; 155: 84– 6. Google Scholar CrossRef Search ADS PubMed  5. Wibbenmeyer LA, Amelon MJ, Torner JC, et al.   Population-based assessment of burn injury in southern Iowa: identification of children and young-adult at-risk groups and behaviors. J Burn Care Rehabil  2003; 24: 192– 202. Google Scholar CrossRef Search ADS PubMed  6. Barret JP, Desai MH, Herndon DN The isolated burned palm in children: epidemiology and long-term sequelae. Plast Reconstr Surg  2000; 105: 949– 52. Google Scholar CrossRef Search ADS PubMed  7. Fukunishi K, Takahashi H, Kitagishi H, et al.   Epidemiology of childhood burns in the critical care medical center of Kinki University Hospital in Osaka, Japan. Burns  2000; 26: 465– 9. Google Scholar CrossRef Search ADS PubMed  8. National Safe Kids Campaign. Burn Injury: Burn Facts. Available at: http://www.safekids.org/tier3_cd.cfm?folder_id=540&content_item_id=1011; Internet; accessed May 8, 2006. 9. Tan J, Banez C, Cheung Y, et al. Effectiveness of a burn prevention campaign for older adults. J Burn Care Rehabil [serial online]. 2004 [cited 2005 Jan 22];25;445–51. Available at: http://gateway.ut.ovid.com/gw2/ovidweb.cgi; Internet; accessed May 8, 2006. 10. Macauthur C. Evaluation of Safe Kids Week 2001: prevention of scald and burn injuries in young children. Inj Prev [serial online]. 2003 [cited 2005 Jan 22]. Available at: http://ip.bmjjournals.com/; Internet; accessed May 8, 2006. 11. Redlick F. Cooke A, Gomez M, Banfield J, Cartotto RC, Fish JS. A survey of risk factors for burns in the elderly and prevention strategies. J Burn Care Rehabil [serial online]. 2002 [cited 2005 Jan 22];23;351–6. Available at: http://gateway.ut.ovid.com/gw2/ovidweb.cgi; Internet; accessed May 8, 2006. 12. National Safe Kids Campaign. Toddler: why kids are at risk. Available at: www.usa.safekids.org/tier3_cd.cfm?content_item_id=3098folder_id=168; Internet; accessed May 8, 2006. 13. Bassett M, Arild AH Hot surface temperatures of domestic appliances. Inj Control Saf Promot  2002; 9: 161– 7. Google Scholar CrossRef Search ADS PubMed  14. Becker L, Cartotto R The gas fireplace: a new burn hazard in the home. J Burn Care Rehabil  1999; 20: 86– 9. Google Scholar CrossRef Search ADS PubMed  15. Fallat ME, Rengers SJ The effect of education and safety devices on scald burn prevention. J Trauma  1993; 34: 560– 3. Google Scholar CrossRef Search ADS PubMed  Copyright © 2006 by the American Burn Association
TI - Contact Burns: Is Further Prevention Necessary?
JF - Journal of Burn Care & Research
DO - 10.1097/01.BCR.0000226102.43343.0A
DA - 2006-07-01
UR - https://www.deepdyve.com/lp/oxford-university-press/contact-burns-is-further-prevention-necessary-adTB54nLgo
SP - 472
EP - 475
VL - 27
IS - 4
DP - DeepDyve
ER -