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ORIGINAL ARTICLE
Year : 2019  |  Volume : 22  |  Issue : 5  |  Page : 642-647

Comparison of clinical findings in adult and paediatric burn victims


1 Department of General Surgery, University of Health Science, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
2 Department of General Surgery, Medipol University, Faculty of Medicine, Istanbul, Turkey

Date of Acceptance30-Jan-2019
Date of Web Publication15-May-2019

Correspondence Address:
Dr. C Tiryaki
Department of Surgery, University of Health Science, Derince Education and Research Hospital, Kocaeli
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_359_18

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   Abstract 


Aim: We aimed to compare the epidemiological data, general characteristics, laboratory findings, and outcomes of burn patients with ≤18 and >18 years of age. By this way, we also aimed to determine the effective preventive measures appropriate for different age groups. Subjects and Methods: The data of 630 consecutive patients admitted to our hospital with 2nd or 3rd degree burn injuries were retrospectively investigated. The patients were grouped into two regarding their ages as ≤18 (group 1) and >18 (group 2) years. Data of age, gender, cause of injury, location of injury, total burn area, length of hospital stay, laboratory data, and outcome of treatment were recorded. Results: We determined that although burn injury is more common in males compared with the females, male predominance is more commonly determined in older age group than children. Extremities are most commonly affected areas in both groups. In children, the most common etiological agent was hot beverages while in older age group electrical burns, and work accidents were more common (P < 0.001). Among children, patients younger than 3 years of age were compromising 62.4% of all cases. In adult group, total burned body surface area %, operation or intensive care unit requirement, hospitalization period, blood transfusion, or fresh frozen plasma requirement and the number of patients expired were all significantly higher compared with the children. Regarding the admission laboratory data, renal and liver function tests were significantly worse in older age group. However, neutrophile percentage was significantly higher in older group which may be a sign of augmented inflammatory response. Conclusion: Especially clinicians and public health providers should be aware of the clinical findings and outcomes of burn victims in order to drive more effective preventive measures.

Keywords: Burn victim old age, burn victim young age, burn


How to cite this article:
Tiryaki C, Haksal M C. Comparison of clinical findings in adult and paediatric burn victims. Niger J Clin Pract 2019;22:642-7

How to cite this URL:
Tiryaki C, Haksal M C. Comparison of clinical findings in adult and paediatric burn victims. Niger J Clin Pract [serial online] 2019 [cited 2019 May 26];22:642-7. Available from: http://www.njcponline.com/text.asp?2019/22/5/642/258271




   Introduction Top


Unfortunately, burns are still an important cause of injury worldwide and mortality rates after burn injuries are still high.[1],[2],[3] On the other hand, the management and care of burn patients usually requires long-term follow-ups which is expensive and depresses the patients and their caregivers.[4] There are many interventions defined in developed countries to prevent the burn injuries; however, the preventive measures should be improved especially in developing or underdeveloped countries to decrease the number of burn victims.[5],[6]

There are some epidemiological studies in literature reporting the general characteristics of burn patients.[7],[8],[9] However, to the best of our knowledge, in literature directly comparing the childhood and adulthood patients with burn injury regarding the epidemiological and laboratory findings is not much.

The aim of this study was to compare the epidemiological data, general characteristics, laboratory findings, and outcomes of burn patients with ≤18 and >18 years of age. By this way, we also aimed to determine the effective preventive measures appropriate for different age groups.


   Subjects and Methods Top


This study was performed in our Hospital. The data of 630 consecutive patients admitted to our hospital with 2nd or 3rd degree burn injuries between January 2012 and December 2015 were retrospectively investigated. The data were obtained from patients' records and patients with incomplete data were excluded from the study. The study was approved by local ethics committee.

The patients were grouped into two regarding their ages as ≤18 (group 1-children) and >18 (group 2-adults) years. Data of age, gender, cause of injury, location of injury, total burn area, length of hospital stay, laboratory data, and outcome of treatment were recorded and analyzed.

Statistical analyses

The data were analyzed with Statistical Package for Social Sciences (SPSS) version 21.0. Categorical variables are presented in number and percentage (%), and continuous variables are presented as mean ± SD or median. Normality of data was tested by Kolmogorov–Smirnov test. Categorical variables were compared using Chi-squared test; or nonparametric methods. A P value of < 0.05 was considered statistically significant.


   Results Top


We compared the demographic data, general clinical characteristics, laboratory data, and clinical outcomes of patients with ≤18 (children) or >18 (adult) years of age. In both groups, males were more common than females but in adult group male patients were significantly more common compared with the younger age group (79.2% vs 53.9%) [Table 1] and [Figure 1]. General clinical characteristics of study participants are summarized in [Table 2]. There was not any statistically significant difference between groups regarding the mostly burned part of the body and in both groups; extremities were the most affected part. However, the mean total burned body surface area (TBSA %) was significantly higher in adult group [Figure 2]. Similarly, the ratio of 3rd degree burns, operation requirement, intensive care unit (ICU) requirement, hospitalization days, blood transfusion, or fresh frozen plasma (FFP) requirement and the number of patients expired were all significantly higher in adult group (P < 0.001). The etiology of the burns was also significantly different between two groups (P < 0.001) [Table 3], [Figure 3]. In children, the most common etiology was the hot water or beverages, while in adult group electrical burns, work accidents, and fire burns were more common. All electrical burns were high voltage since most of them were work accident and remaining were associated with illegal electricity.
Table 1: Demographic data of study participants

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Figure 1: Distribution of age among two groups

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Table 2: General clinical characteristics of study participants

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Figure 2: TBSA distribution between two groups

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Table 3: Distribution of burn etiology in both groups

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Figure 3: Distribution of burn etiology in both groups

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The distribution of patients having TBSA more than 20% was analyzed regarding the etiological agent [Table 4]. There was not any significant difference between groups regarding the distribution of patients having TBSA more than 20% in all subgroups with different etiological factors.
Table 4: Number of patients having TBSA more than 20% in all subgroups with different etiological factors

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During hospitalization, most of the patients were nourished orally [Figure 4]. There was not any significant difference between two groups regarding the way of nourishment (P: 0.65).
Figure 4: Nutrition status of patients in both groups

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The laboratory data at admission were also compared between two groups [Table 5]. Renal function tests and liver function tests were significantly worse in adult group of patients. Electrolyte levels were similar between two groups. Although hematocrit level and white blood cell count were not significantly different between two groups; platelet count was significantly lower and neutrophiles percentage was significantly higher in adult group.
Table 5: Comparison of laboratory data at admission between 2 groups

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   Discussion Top


In this study, we analyzed the general characteristics and outcomes of burn patients, regarding their age and we determined that children were having better outcomes with less number of expired patients, shorter hospitalization periods, less requirement of ICU, and less number of transfusion requirements compared with adults.

There are some studies investigating the epidemiologic findings of burn patients in previous literature. In a population based study on 620 people who were hospitalized with burn injuries, 60% were men, the average age was 27.4 years, and the average hospitalization time was 11.3 days. In that study, it was reported that, approximately 30% of the patients were younger than 3 years of age.[10] Li et al.[11] analyzed the epidemiological characteristics of 1407 hospitalized children, under 14 years of age, for burn and reported that; the male to female was 1.6 : 1.0 and 68.3% of patients were between 1 and 3 years of age. In that study the most common etiological agent was hot fluids while the most commonly involved anatomic site was the trunk. In our study, similarly the overall male/female ratio was 2.35. However, there was a significant difference between two groups regarding the gender and in childhood group the male/female ratio was 1.17, while it was 3.80 in adulthood group; the older the patients, the more common the male predominance. This may be due to the increased work accidents in adults and male patients may be working in more risky jobs regarding the burn injuries. In that aspect, the workers of risky jobs should be advised for the preventive measures of burn injuries. In our study 141 of the patients (22.4%) were ≤3 years of age but the most common injury site was extremities in childhood group. For that reason, especially caregivers of children under 3 years of age should be cautious about the burn injuries.

We did not determine any significant difference between adults or children regarding the percentage of patients having TBSA more than 20% in all subgroups with different etiological factors. We can suggest that although the most common etiological factors are significantly different between children and adults; the etiological agents were affecting adults and children with a similar degree.

Mortality rates and associated factors after burn injuries were studied before in many studies. In a 2-year period, the mortality rate of burn injuries was reported as 7.1% on 748 patients.[12] Tang et al.[13] investigated the epidemiological characteristics of hospitalized burn victims and reported that the majority of patients included were male as in our study. They also reported that in elderly patients, the risk of adverse outcomes was higher although the length of hospital stay was shorter and the proportion of surgical treatments was lower. In a large study on 23,073 hospitalized burn patients, age was defined as one of the important factors that influence the burn area lethal to 50% of patients.[14] Recently, in a population based study, Yen et al.[15] also reported that older age was a significant predictor of mortality in burn patients. After burn injuries, increased mortality rates were defined for the patients older than 65 years of age.[16] Costa Santos et al.[17] reported the mortality rate as 24.6% in burned patients over 65 years of age. In our study, the overall mortality rate was 17.4% in patients >18 years of age which was more common than the childhood group. In subgroup analysis, 39 patients were older than 65 years of age and among those patients the mortality rate was 35.8% (14/39).

On the other hand, Dhopte et al.[18] analyzed the risk factors for mortality in 475 pediatric burn patients and reported that the overall mortality was 31.3%. In that study, TBSA, female gender, deeper burns, positive wound cultures, and inhalation injury were defined as the risk factors for mortality. Moreover, age >11 years was also defined as a risk factor in that group. In another recent retrospective study on 2478 children with burns, most of the patients (58%) were male and 855 of the patients were under 5 years old. They reported that in pediatric age group limbs were the most common burn sites. The mortality rate was as low as 0.24% in that study.[19] In our study, the mortality rate was 4.9% in pediatric age group. Among those 11 expired patients, the mean TBSA% was 43.83 ± 13.82 which was significantly higher than that of the discharged pediatric patients (16.81 ± 4.92, P: 0.001); and the mean age of the expired and discharged patients were also significantly different (10.67 ± 4.33 vs 4.73 ± 2.12, respectively, p: 0.007). However, only two of the expired patients were female and there was not any significant difference between discharged or expired patients regarding gender (P: 0.18). For that reason, in pediatric age group, clinicians should be aware of increased mortality rates in patients with higher TBSA % and in older patients. In our study, although the mean TBSA was not very high in both groups; the mean TBSA of expired patients was significantly higher than the discharged patients in children and adults.

Very recently, Farinas et al.[20] reported that cytokines are differentially regulated in response to burn injury by young versus aged burn victims. Similarly, Frankel et al.[21] also reported that older patients have an increased risk for death after burn injury and there were many alterations on serum markers of inflammatory response such as interleukin 1 receptor antagonist, interleukin 2, 4, and 6 and granulocyte colony-stimulating factor which may be associated with mortality. This may also be associated with different outcomes of burn victims at different age groups. We determined an increased neutrophile percentage in older age group compared with the children, which may also be regarded as the sign of an augmented immune response.

There are some limitations of this study that should be mentioned. We determined that older age was associated with worse outcomes in patients with burn injury. However, the preexisting illnesses, malnutrition or immune deficiencies may also be responsible from the poorer outcome after burns which may affect the results but were not recorded or analyzed in this study. On the other hand, one of the important factors in mortality rates of burn patients is the infections but in this study the presence of infections or the results of microbiological cultures are not recorded.

In conclusion, we determined that although burn injury is more common in males compared with the females, male predominance is more commonly determined in older age group than children. Extremities are most commonly affected areas in both groups. In children, the most common etiological agent was hot beverages, while in older age group electrical burns and work accidents were more common. Among children, patients younger than 3 years of age were compromising 62.4% of all cases. In adult group, TBSA%, operation, or ICU requirement, hospitalization period, blood transfusion, or FFP requirement and the number of patients expired were all significantly higher compared with the pediatric patients. Regarding the admission laboratory data, renal and liver function tests were significantly worse in older age group which may also be associated with preexisting diseases. All those findings are important in defining preventive measures. Especially, clinicians and public health providers should be aware of the clinical findings and outcomes of burn victims in order to drive more effective preventive measures.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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