Burn patients accounted for a large proportion of hospitalized injury patients worldwide. They suffered from great physical and psychological burden because of the associated morbidity, rehabilitation, mortality and requirement of high cost medical services. Therefore, investigations on epidemiological parameters related to burns and treatment outcomes could assist with the adoption of effective interventions and individualized prevention approaches in southwest China. In particular, this study focused on the clinical characteristics and treatment outcomes of different age groups of burn patients. The primary result we found was that the annual number of burn injuries has kept decreasing since the year of 2014, which was consistent with the global trends [17, 18]. This change might be partially attributed to the increased awareness and education of burn prevention and the improved burn-preventative environment. Another notable finding was that the gender difference and age difference should be considered when making individualized interventions and rehabilitative treatments. The etiology, the frequently burn sites, the occurrence rate of inhalation injury, the LOS, the cost and the mortality rates were significantly different between male patients and female patients, and among patients of different age groups. However, the burn severity showed by the indicators of TBSA, ABSI and BI, and the economic burden indicated by the medical cost were still in a high level, which suggested that the current prevention and care of burns remained inadequate, demonstrating that more effective interventions should be introduced in the future.
Same as the results from other studies [19–21], scalding and flame were identified as the two most common causes of burning in the southwest of China. Furthermore, the age difference and gender difference on etiology should be noticed. Firstly, considering the age difference, the scalding was in the first cause to burn injuries among pediatric patients, comprising of 74.24% of all cases under the age of 18 years old. Scald burns were primarily caused by hot steam, hot water, hot soup and hot oil. This suggested that hot steam and hot fluid should be cautioned among children population. In contrast, flame burns were the leading etiology in adult patients. The patients between the age of 18 and 40 years suffered most from flame burning, accounting for 62.07% of all the cases in this age group. Flame injuries were mainly generated by gas and bomb explosion, short circuit of electricity and fireworks. Secondly, considering the gender difference, the incidence of burns caused by flames was significantly larger than those caused by scalding among male patients; while the burns caused by scalding was significantly larger than those caused by flames among female patients. Electricity was the third most common cause of burns in the pediatric population and the adult patients under the age of 60 years old; while chemical burns was the third cause in the elderly population above the age of 60 years old. It was worthwhile to note that although the flame and scald were the first two etiologies of burn injuries, the electrical burn was the one that costed the highest medical expense (Table 5). According to the previous studies, this was likely because that 10 ~ 68% [22] of the electrical burns resulted in amputation, which increased the medical cost. The above findings indicated that burn education was necessary for the population of all ages, and particularly preventive strategies should be individualized by age, gender, and burn causes. For example, children were curious about their surroundings but they were too young to be aware of burn-related dangers. Therefore, it was their parents or guardians as the main target of education about providing safe environment and eliminating possible burn dangers to their children, such as putting the hot water or oil away from children and protecting the electrical plugs in case of electricity burns.
Our findings demonstrated that the adult patients aged between 18 and 60 years old were the main victims of burn injuries, accounting for 53.8% of the total cases. The first cause to burns in this population was the flame, followed by scald, and then the electricity. This may relate to the potential burn-related hazards in work place.[15] In particular, the number of male patients at this age was significantly larger than that of female patients, with the ratio of three to one (Table 1). Moreover, almost half of those patients were self-funded on the medical expense; and the male patients spent significantly more money on treatment compared to the cost among female patients. Furthermore, the sites of head/face/neck, trunk and limbs were the most significantly parts of body that burn occurred. During the process of post-burn recovery and rehabilitation, the scar was a notable problem. The scar on head/face/neck will influence the facial appearance, and the scar on limbs will affect the physical functions. All of these results suggested that the adult patients especially the male patients should become the major prevention target in the future considering their responsibilities to the family and society. Additionally, the early rehabilitation on physical abilities should be emphasized.
When great awareness and focus has been placed on the elderly and young children, the population of females should be also considered as a vulnerable group of burn injuries and worthy of increased attention. It was interesting to find out that the percentage of female burn patients increased annually despite of the decreased number of the overall adult patients (Fig. 1D). It suggested that the risk for Chinese females to suffer from burn injuries kept increasing. After further analysis of the etiology, we found that scalding was the priority cause to burns in females, accounting for over 60 percent of the total female patients (Table 1). Surprisingly, in another developing country India, similar finding has been reported before that Indian population of young females between the ages of 16 and 35 years were high-risk of burning. The reason lied in that females cooked over open flames at floor level, often with faulty equipment and loose clothing susceptible to catching fire. Based on years of clinical experience on burn center, our research team has discussed the reasons for the high risk of burning in Chinese females. Considering the priority etiology of scalding, we assumed the first reason was that women still took the main responsibility of cooking for the family, so they were more likely exposure to hot water/oil and cooking flames compared to men. Secondly, more and more women were involved in the workforce. The results showed that the labor force participation rate in Chinese females reached 70% [23]. And the chance of exposure to burn risks was increasing if the precautions were not sufficient in the workplace. The third reason we considered may be due to the culture factor of gender inequality in developing countries. Women in those countries such as India and China were mainly work in the areas with relatively high risk of burn injuries such as housemaid and catering services.
Building on the previous findings [18] of that the burn size determining major complications and survival rates, this study also identified that the burn size contributed to the total cost of burn patients according to burn index (BI). BI was an indicator of burn severity calculated on the basis of TBSA. In Dr. Jeschke and Prof. Herndon’s study of an sample of 952 severely burned pediatric patients, they confirmed that burn size of 62% TBSA was a crucial threshold for post-burn morbidity and mortality [24]; and the cost of burn treatment was increasing accordingly. Besides the TBSA, ABSI, and BI, there were other indicators developed to predict burn outcomes such as the modified Baux score [25] and the Pediatric Risk of Mortality (PRISM) score [26]. Most of these indices were formula developed by calculating risk factors for post-burn morbidity and mortality. For example, the Baux score was calculated in consideration of age, burn size and the presence of inhalation injury. Further analysis and comparisons were needed to figure out which of the above indicators would be more accurate and effective in predicting mortality and hospital length of stay among patients with burns.
Some limitations should be noted when interpreting these findings. First, due to system default, we could not access to the data of other poor outcomes such as infection and sepsis. Therefore, we failed to find out the risk factors contributed to these poor outcomes. However, our research team is now conducting a longitudinal study trying to investigate risk factors for these poor outcomes in Chinese burn patients. Another limitation was that our data only partially reflected the epidemiology of burn injuries in southwest of China, and the patients in this study mainly originated from Chongqing, Sichuan, Yunnan and Guizhou Province. Due to unequal economic development between the south cities and the east cities in China, the findings cannot represent the status in the eastern cities of China. Therefore, more studies with large sample sizes and multiple centers are still needed. Thirdly, since our center is in a tertiary hospital, so some of the severe burn patients have received treatments from other hospitals before they were transferred into our center. Therefore, the burn severity observed in our study might be higher than average.