Original Research Published on December 30, 2023

 

Importance of a Dedicated Burns Unit: A Comparative Study on The Clinical Outcome  of Burns Patients with and without a Burns Unit

Premlal A Pa, Minu Catherine Abrahamb, Anu Anto Kallereyc
Roshjo Roshan Attokarenc

a. Department of Plastic and Reconstructive Surgery, Government Medical College, Trivandrum;
b. Resident in Internal Medicine, Bronx Healthcare System, NY, USA;
c. Department of Plastic and Reconstructive Surgery, Government Medical College, Kozhikode*


ABSTRACT

Background: Burns is an endemic health hazard in a country like India rough estimate of the total number of burn admission in India with a population of over 1 billion, is 7,00,000 to 8,00,000 annually. This high incidence makes it an endemic health hazard. Burns speciality units are being established for dedicated burns care.

Objectives: this study was to done to compare the outcomes between patients admitted to a dedicated burns unit and a general care unit.

Methods: Record based cross sectional study was conducted analysing the clinical outcome of patients admitted with burns from June 2014 to December 2016. The study compared the morbidity and mortality rates of patients admitted with burns in Govt. Medical College, Thiruvananthapuram before and following the introduction of an exclusive Burns ICU care facility. Data was entered in Excel sheets and analysed using SPSS software.

Results: ICU admissions were most common among females (56.4% ie 128 patients). The commonest age group was between 20-40 years. Majority of the burns victims suffered from accidental burns with 65% requiring ICU care and 62.4% admitted to the wards. The most common cause of burns was fire accounting for 70 – 80%. In patients with 40 - 60 % burns there was a significant difference in outcome with better mortality when treated in a dedicated burns ICU in comparison to the patients treated in a non-burns speciality unit, with chi square test giving a P value of 0.0306.

Conclusion: A burns unit with Dedicated ICU care improves the morbidity and mortality among burns patients. In the ICU with minimal facilities itself, Patients sustaining burns of 40 - 60 % TBSA, significant improvement in survival is noted. An upgraded ICU with good intensive care will surely improve the survival rate of burn victims

Keywords:  Burns care, Burns ICU, Burns mortality

 

Introduction

Burn injuries are a serious problem to developing countries like India.1 Important demographic factors that make such injuries common are the high population density, poverty and to an extent, illiteracy.2 A rough estimate of the total number of burn admission in India with a population of over 1 billion, is 7,00,000 to 8,00,000 annually.3 This high incidence makes it an endemic health hazard.2 Various social, economic, and cultural factors further complicate the management, reporting, and prevention of burns.4

The goal in management of an acute burn is to limit the extent of the systemic insult.5 Intensive care management should not be seen as rescue for failed initial treatment but as a preventive measure in patients at high risk of organ failure.5 Intensive care units have the resources for improved monitoring and expertise in managing acute physiological change.5

Thermal injury induced lesions in the adult population that ideally require at least three days of intensive care treatment post injury are classified as major injury.6 There are studies that suggest survival rates up to 50% in young adults who have suffered total body surface area burns of 80% without inhalational injury.7,8 Multiple organ failure was a common entity in patients who died 3 days post injury9 and hence it becomes of utmost importance to increase the efficiency of the initial chain of medical care for these patients.

Since the 1950s there has been an increasing interest to ascertain the type of facilities required to treat major burn victims. Evaluation of mortality after burns  and hospitalization time crucial to attaining inpatient treatment are the two most important criteria to roughly predict the number of beds a burns unit would require. 

The disaster management ability of the health system is an indicator of its efficiency. An article on “Clinical profile of a firework disaster in Kerala: lessons learnt” based on a firecracker accident in Kerala in India also aided in the realisation of the importance of a burns care facility.9

The following study was undertaken to analyse the outcomes of burns victims before and after commissioning of the burns ICU at a tertiary care medical centre. The clinical outcome of patients admitted at a tertiary care centre before and after the establishment of a burns care unit categorized based on the percentage of burns was assessed.

Methodology

We conducted a record-based  cross-sectional study analysing the clinical outcome of patients admitted with burns  from June 2014 to December 2016. This study compared the morbidity and mortality rates of patients admitted with burns in Govt. Medical College,  Thiruvananthapuram before and following the introduction of an exclusive Burns ICU care facility.

A total of 446 patients were studied of which 214 were treated in wards 15 months before the commissioning of the ICU and 232 in Burns ICU Patients admitted 15 months after its establishment were included and data was compared.

Data collection was using data from case records of patients included in study. Quantitative variables were expressed as mean standard deviation and qualitative variables as proportion. Data was analysed using SPSS software. Chi Square test was used as a test for significance of data.

Results

ICU admissions were most common among females (56.4% ie 128 patients). The commonest age group was between 20-40 years. On comparing both genders it was seen that burns among the female population (147 patients ie 69%) required more ICU admissions as compared to their male counterparts (66 patients ie 31%).

Of the total burns patients admitted,  80% (357) belonged to the BPL category with the majority being unemployed (40% ie 203 patients) or manual labourers (30% ie 151 patients). Less than 10% of the burns population were college-educated. It was also noted that less than 20% of the burns population were under the influence of alcohol at the time of admission. No significant differences were seen in the number of burn victims admitted in the wards and the ICU in the above-mentioned aspects.

Figure 1. Comparison of aetiology of burn based on ICU admission

Majority of the burns victims suffered from accidental burns with 65% ie (152) requiring ICU care and 62.4% ie 133 admitted to the wards. This was followed by suicidal burns with 32.1 % (75 patients) in the ICU and 36.2% ie 77 patients  in the ward. Homicidal burns barely accounted for 2-3% of the burns victims requiring admission (Figure 1).

The most common cause of burns was fire accounting for 70 – 80%. Upper limbs, head and neck and face where the most commonly involved site involved whereas genitalia, posterior trunk and posterior abdominal wall were the least commonly involved sites (Table 1).

It was seen that in patients with 40 - 60 % burns there was a significant difference in outcome with better mortality when treated in a dedicated burns ICU in comparison to the patients treated in a non-burns speciality unit, with chi square test giving a P value of 0.0306.  Providing of proper ICU care to major burn victims will result in improved survival rate and reduced mortality (Table 4).

Discussion

According to a study by Sulunke.et.al, on the survival of burns patients in a tertiary care centre in India, females suffer burns more frequently than males.1 in our study 54.7% patients were females and of the patients requiring ICU admission 69% were females. the common age group was between 20 - 40 years which is corresponding to other studies on burns management.

According to an Epidemiological study of burn injuries by  Shankar G.et.al 41% patients came under the extremely poor socioeconomic category.10 In our study, 80 % of patients belonged to the BPL category.

The overall mortality in this study was found to be 59.4% ie 251 patients. In a study by C J Ede.et.al on “a comparative study of outcomes of burns across multiple levels of care” there was no significant difference in mortality rates between burns speciality and non-burn speciality centres.11 But our study assessed the difference in outcome between Burns ICU care and non-Burns ICU care and found that in 40 - 60 % Total burns surface area (TBSA) burns the survival showed significance with a P value of <0.05. Whereas in other category burns there was no significance found between speciality burns care and non-dedicated burns unit management (Table 2 & 3).

Limitations of study

The type of burns referred to before the establishment of a dedicated burns unit may have been different from the time after which a dedicated unit was established as more severe cases may be referred after the commissioning of the burns dedicated unit

Conclusion

A burns unit with Dedicated ICU care improves the morbidity and mortality among burns patients. In the ICU with minimal facilities itself, Patients sustaining burns of 40 - 60 % TBSA, significant improvement in survival is noted. An upgraded ICU with good intensive care will surely improve the survival rate of burn victims

End Note

Author Information

  1. Dr Premlal A P, Professor
    Department of Plastic and Reconstructive Surgery, Government Medical College,  Trivandrum
  2. Dr Minu Catherine Abraham
    Resident in Internal Medicine,
    Bronx Healthcare System, NY, USA
  3. Dr Anu Anto Kallerey
    Assistant Professor, Department of Plastic and
    Reconstructive Surgery, Government Medical College, Kozhikode 
  4. Dr Roshjo Roshan Attokaren
    Senior Resident, Department of Plastic and
    Reconstructive Surgery,   Government Medical College, Kozhikode 

Conflict of Interest: None declared

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