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Original Article ORIGINAL ARTICLE BURN TRAUMA PATTERN IN HAMIDIA HOSPITAL IN 4 YEARS 2009 TO 2012 Arun Bhatnagar 1., Archana Shukla 2, Zeeshanuddin Ahmed 3, Narayan 4, Sunil Kuril 5, Vikram Watti 6, Vibhav Vikas 7, Arvind Maravi 8. 1. Associate, Professor, Department of Burn and Plastic Surgery, Gandhi Medical College, Bhopal Madhya Pradesh. 2. Assistant Professor, Department of Burn and Plastic Surgery, Gandhi Medical College, Bhopal Madhya Pradesh. 3. Resident, Department of Burn and Plastic Surgery, Gandhi Medical College, Bhopal Madhya Pradesh. 4. Resident, Department of Burn and Plastic Surgery, Gandhi Medical College, Bhopal Madhya Pradesh. 5. Resident, Department of Burn and Plastic Surgery, Gandhi Medical College, Bhopal Madhya Pradesh. 6. Resident, Department of Burn and Plastic Surgery, Gandhi Medical College, Bhopal Madhya Pradesh. 7. Resident, Department of Burn and Plastic Surgery, Gandhi Medical College, Bhopal Madhya Pradesh. 8. Resident, Department of Burn and Plastic Surgery, Gandhi Medical College, Bhopal Madhya Pradesh. CORRESPONDING AUTHOR: Dr. Archana Shukla, 148/2 doctors quarters, Hamidia hospital campus, Bhopal, Madhya Pradesh. Email - [email protected] HOW TO CITE THIS ARTICLE: Arun Bhatnagar, Archana Shukla, Zeeshanuddin Ahmed, Narayan, Sunil Kuril, Vikram Watti, Vibhav Vikas, Arvind Maravi. “Burn Trauma Pattern in Hamidia Hospital in 4 years 2009 to 2012”. Journal of Evolution of Medical and Dental Sciences 2013; Vol2, Issue 23, June 10; Page: 4046-4054. ABSTRACT : A high Incidence of burn death is estimated to occur in developing countries like India. This study investigated the incidence as well as pattern characteristic associated with hospitalized burn patient in Bhopal and surrounding area through 2009 -12. It was found that 1593 burn patients were hospitalized. Most burn occurred at home. 480 were suicidal 1072 accidental and 41 homicidal. Burn was higher in females in all groups. Young age was more affected. KEYWORDS: burns, injury pattern, developing countries. INTRODUCTION : Globally, burn present as major health problem contributing to high mortality and morbidity but the context and risk involved can vary substantially in different socio-economic group. In four years 1593 burn patents were admitted causing 977 deaths. Thus it was responsible for approximately 67.28 % of death. The impact of burn can induce further poverty in already dis-advantaged regions. Increasing knowledge of the burden of these deaths and injury countrywide is providing much needed impetus for global agenda of burn prevention. Thus this data is necessary to galvanize action at local level. In this regard many studies are published and accidental burn amongst women using kerosene was identified as most common form of death followed by, scalds, and electric burn. Journal of Evolution of Medical and Dental Sciences/ Volume 2/ Issue 23/ June 10, 2013 Page 4046 ORIGINAL ARTICLE MATERIAL AND METHOD: The burn and plastic department of Hamidia hospital and Gandhi medical college Bhopal was established in year 2001 to cater approximate population 1,805645 of Bhopal as per census 2011.It includes urban and rural area both, data was collected for 4 years that is from January 2009 to December 2012 in a pre-format including various headings of age, sex, marital status, education status socioeconomics, mode of injury and TBSA score. Resident doctors and trained nurses located in hospital received the patient and evaluated to start immediate management. Plan was carried out immediately as per protocol and later data was collected under heading mentioned. Injury surveillance forms were checked and data was approved and obtained. Analysis was conducted using obtained data to provide standard descriptive analysis .The 2011 census information was used to calculate population incidence rate. RESULTS AND STATSTICS: During a period of 48 months .1593 burn patients were admitted in Hamidia hospital accounting for overall incidence of approximately 7 % of total hospital admissions. Out of which 1072 were accidental burns 480 were suicidal burns and 41 were homicidal burns. As per age they were again grouped as a, b, and c. Group a] 12 to 30 years, Group b] 30 to 45 years and Group c] 45 years and above. In accidental burn group a] had 270 patient out of which 105 were male and 165 were female. Group b] had total 511out of which 213 male and 298 female group c] had 291, 119 male and 172 female. In 480 suicidal burn group a] had total 212, 45 male and 167 female, group b] had 156 in total, 52 male and 104 female group c] had 52 total, 23 male and 29 female. In homicidal burn total no of patients were 41 Group a] had ten patients 5male 5 female. Group b] had 16 patients male 7and 9 female and group c] had 15 patients 7 male and 9 female. Looking at the mechanism and causative factor out of 1593 burns 1354 were because of the flame 143 were due to electricity and 93 scald burns. Socioeconomically status was recorded as per knowing per capita from holding a bpl card or other facility card issued by govt. of M.P. to the public. Nearly 7600 patients were having these cards and facility. Out of total admissions there were977 deaths 306 discharges and 310 left against medical advice. The most common cause of death was septicemia and pseudomonas was the commonest organism. Next cause was inhalation injury to alveolar tree followed by thromboembolism. 245 Patients had 50% and below TBSA score. 289 had 50 to 70% TSBA and 1059 had 70% and above DISCUSSION : The epidemiological study showed that most of the admissions in Hamidia hospital affiliated to Gandhi medical college Bhopal were accidental in mode followed by Journal of Evolution of Medical and Dental Sciences/ Volume 2/ Issue 23/ June 10, 2013 Page 4047 ORIGINAL ARTICLE suicidal then homicidal. Females have significant higher number than males in total and all groups made age wise. Female patients specially had very high difference than male in accidental as well as suicidal age group. The number is directly proportional to the lower socio economic status as it was higher in this group, like many other developing countries. Factors which contributed to this difference was low literacy causing lack of knowledge to handle kerosene stove and other equipment like lanterns where kerosene is used as fuel. Domestic cooking gas mishandling also contributed to attain flame burn. These patients were not successfully trained to escape the hazard. The patents attaining electric burns were also having little awareness regarding the hazard and most of them were from domestic low tension wire .There were few cases of high voltage current and most of them were fatal Almost all the suicidal burns where subjected to psychiatric evaluations and were treated accordingly. It was also found in that few accidental burns were occurring closely just after a family conflict. Use of synthetic clothes in this group was very high and caused further quick progress of flames rendering the large body surface area involved. Most the distribution of burn area involved were face, neck anterior and posterior chest followed by upper limb and lower limbs. Out of 1593 patients 977 patients could not survive. 306 were discharged. Hospital stay ranged from 0 to 90 day the median stay was thus 6 days. Those discharged had significant disability and disfigurement which made impact on many aspects of quality of life. Effective intervention for burn prevention and management, especially in low socio economic area would benefit the population. Use of solar power in rural area should be strongly advocated. Development of burn prevention strategies to address the contributing factors, optimize treatment, rehabilitation, recovery and supportive program can enhance better result. REFERENCES: 1. Sanghavi P, Bhalla K, Das V. Fire-related deaths in India in 2001: a retrospective analysis data. Lancet 2009; 373: 1282–88. 2. Mahapatra P, Chalapati Rao PV. Cause of death reporting systems in India: a performance analysis. Natl Med J India 2001; 14: 154–62. 3. Mari Bhat PN. Completeness of India’s sample registration system: an assessment using the general growth balance method. Popul Stud2002; 56: 119–34. 4. Gajalakshmi V, Peto R. Suicide rates in rural Tamil Nadu, South India: verbal autopsy of 39 000 deaths in 1997–98. Int J Epidemiol 2007; 36: 203–07. 5. Jha P, Jacob B, Gajalakshmi V, et al. A nationally representative case-control study of smoking and death in India. N Engl J Med 2008; 6. The solar lantern provides high quality solutions to families living without electricity. Available from: http://www.dlightdesign.com/products_product_line_global.php [last cited on 2010 Mar 15] [last retrieved on 2010 May 14]. Journal of Evolution of Medical and Dental Sciences/ Volume 2/ Issue 23/ June 10, 2013 Page 4048 ORIGINAL ARTICLE 7. Ahuja RB, Bhattacharya S. Burns in the developing and burn disasters. Br Med J 2004; 329:447-9. 8. Bakshi AB. An NGO sounds the warning bell on infant mortality. Outlook 2010 May 10. 9. Atiyeh B, Masellis A, Conte F. Optimizing burn treatment in developing low and middle income countries with limited health care resources (part 3). Ann Burns Fire Disasters 2010; 23:1. 10. Keswani MH. The prevention of burn injury. Burns 1986; 12:533-9. 11. Mashreky SR, Rehman A, Chowdhury SM, Giashuddin S, Svanstrom L, Linnan M, et al. Epidemiology of childhood burn: Yield of largest community based injury survey in Bangladesh. Burns 2008; 34:856-62. 12. IFPMA Partnerships: Arogya Parivar Program - A Rural Health Initiative. Available from: http://www.ifpma.org/index.php?id=2142
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