| Objective:To analyze the epidemiological characteristics of hospitalized patients with severe burns in China and provide evidence for promoting burn prevention and treatment.Methods:Medical records of patients with severe burns hospitalized in multi-burn centers in China from January 2012 to December 2015 were collected.The analysis items including: demographic characteristics,etiology and environment of burns,burn severity,pre-hospital and hospital care and outcome.Results:1.Epidemiological characteristics of children with severe burns(1)The majority were male(61.4%),aged ≤6 years(86.6%),and rural patients(74.5%).No differences in gender and residence were observed in pediatric severe burns with different age groups.Most of the hospitalized children(63.8%)cost by their own expense.The younger the children were the higher proportion paid by their own.(2)The most common etiology of pediatric severe burn was scalding(80.9%).The majority occurred at private house(90.9%)and in summer(29.5%).With the increase of ages,scalding decreased gradually whereas flame and electric burns increased;meanwhile,private home as a place of injury decreased gradually whereas public place as a place of injury increased.Scalds accounted for 86.0% of all burn accidents occurred at private home.Flame burns accounted for 40.0% of all burn accidents occurred at public places.(3)Most of children(80.9%)sustained burns with 11% to 40% TBSA.There were positive correlations between children‘s ages and TBSA,incidence of third degree burn and third degree burn area.The common burn sites were trunk(81.1%),lower limbs(78.6%)and upper limbs(67.8%).With the increase of ages,the incidences of upper limbs,lower limbs,hands and feet burn were gradually increased.27 patients(6.1%)had inhalation injury,most of which were moderate or severe.Children‘s ages positively correlated with the incidence of inhalation injury.(4)Delayed resuscitations were observed in 11.4% of all victims,which was correlated to total TBSA of burns.The common complications in pediatric patients during hospitalization were hypoproteinemia(60.5%),wound infection(21.1%)and shock(10.5%),which were correlated with TBSA of burns,third degree burns,inhalation injury and surgical operations.The common organ complications in those patients were hepatic dysfunction(2.7%),pulmonary infection(2.3%),and heart dysfunction(1.6%).(6)The average length of stay(LOS)in hospital was 28.6 ± 35.1 days.A total of 347 cases(79.4%)were survived.Twelve cases(2.7%)had bad final outcomes,with 6 dead and 6 deteriorated at discharge.The common causes of death in pediatric severe burns were septic shock,sepsis and MODS.Inhalation injury,shock,sepsis and ARDS were the independent risk factors for children with severe burns.2.Epidemiological characteristics of adults and elderly severe burns(1)The majority of adult or elderly severe burns were male and rural populations.Most of adults(61.6%)had secondary education,and most of elderly(43.9%)had primary education.(2)Flame burn was the most common etiology in both adults and elderly patients.However,it occurred more frequently in elderly(85.4%)than in adults(57.2%).Working place(47.8%)was the most common place of burn injury in adults while private place(72.0%)the most common place of burn injury in elderly.Summer(35.9%)was the peak season of burn accident in adults while winter(36.6%)was the peak season of burn accident in elderly.(3)The incidence of pre-injury comorbidities in elderly was much higher than those in adults(61.0% vs.13.2%).CNS,respiratory and cardiovascular comorbidities were observed in 28.0%,12.2%,and 40.2% of all cases respectively,the incidence of which was 12.9,11.2 and 9.4-folds of that in adults.(4)The median TBSA of burns in elderly was lower than those in adults(40.0% vs.48.9%).However,both the incidence and area of third degree burns in elderly were higher than those in adults(incidence of third degree burns: 90.2% vs.82.0%;area of third degree burns: 23.4% vs.19.8%).The common burn sites in both adults and elderly were trunk,upper limbs and lower limbs.Inhalation injury was similar in both patients.(5)The proportion of delayed resuscitation in elderly was higher than that in adults(8.7% vs.4.7%).Elderly had much lower rates of excision and skin grafting operation than adults(35.4% vs.72.0%),but 3.4,3.3,5.7 and 10.8-folds higher incidence in ARDS,liver dysfunction,acute renal dysfunction,and cardiac dysfunction than adults.(6)The average LOS in hospital was 63.0 ± 76.7 days in adults,but 22.8 ± 29.8 days in elderly.Recovery rate in elderly was 24.4%(20 cases),which was quite lower than that in adults(77.2%,475 cases).The rate of bad outcomes(deterioration and death)in elderly was about 5-fold of that in adults(37.8% vs.7.5%).Elderly had a rate of medical abandon as high as 57.3%,while it was only 7.8% in adults.The common causes of death were MOF,sepsis and cardiac arrest in adults,and cardiac arrest,MOF and septic shock in elderly.Analysis showed that shock was an independent risk factor for elderly patients with adverse outcomes.Conclusions1.Epidemiological characteristics of children with severe burns(1)Children are the major population accounting for 38.7% of all severe burns in China.Aged ≤6 years,rural and male were the high-risk population,and scalding,private home and summer were the risk factors of pediatric severe burns.It is therefore the key point to take more care of the young children in their daily life by the supervisors in order to prevent pediatric severe burns.(2)Characteristics of pediatric severe burns are changed with the increase of ages,such as more flame and electric burns,more occurred at public place,increased burn severity,and higher incidence of extremity or neck/face burns.It indicates that targeted strategy towards children at different development stages should be especial for the prevention of pediatric severe burns.(3)The common complications in pediatric patients were hypoproteinemia,wound infection and shock,which were correlated with inhalation injury,TBSA of burns,third degree burns and surgical operations.These findings indicate that measures of airway management,nutritional support,wound operations and administration during preoperative period should be helpful for further improvement of pediatric severe burns.2.Epidemiological characteristics of adults and elderly severe burns(1)Rural and male were the high-risk population of either adults or elderly.Separately,flame burn,private place,summer,low educational level,and CNS comorbidities were the high-risk factors of elderly severe burns.It is therefore suggested that it should be helpful to decrease elderly severe burns by enhancing the awareness on fire disaster prevention particularly for rural family in winter and the care for older people with CNS diseases.(2)Pre-injury comorbidities in elderly was about 4-fold higher than those in adults.Elderly also had higher incidence and larger area of third degree burns when compared t o adults.These results indicate that elderly not only had bad general conditions,but also suffered a more serious burn injury,as compared to adults.(3)Elderly suffered more delayed resuscitation,had lower rates of excision and skin grafting operation,2.9-10.8-folds higher incidences of ARDS,liver dysfunction,acute renal dysfunction,and cardiac dysfunction than adults.These results suggest that it may be a way to improve elderly severe burns by the early and effective resuscitation,surgical operation,and organs protection and support.(4)The rates of recovery,bad outcomes and medical abandon in elderly were 29%,5-fold and 7.3-fold of those in adults,indicating that elderly severe burns are not only a big challenge of medicine,but also involves complicated social and financial problems. |
