Epidemiological trends and risk factors in major burns patients in South Korea: A 10-year experience

Highlights

• During 2003–2012, 4481 major burns patients were treated in our burns center.

• Mortality rate decreased during the study period, but nevertheless remained high.

• Flames and scalds caused most burns in those aged ≥21 and ≤20 years, respectively.

• Age, sex, burn size and full-thickness and inhalation injuries predicted mortality.

• ABSI was useful to predict mortality but overestimated mortality in older patients.

Abstract

Purpose

To determine epidemiological trends among burns patients admitted to our burns center during 2003–2012, and the usefulness of the Abbreviated Burns Severity Index (ABSI) for predicting burns-related mortality.

Methods

We retrospectively reviewed the data of 4481 burns patients. We analyzed the epidemiological trends and ABSI scores using Student t-test and one-way analysis of variance (continuous variables), chi-square test (categorical variables) and stepwise logistic-regression analysis (predictors of mortality).

Results

The mean age and male-to-female ratio were 39.9 ± 19.7 years and 2.88, respectively. ABSI scores decreased from 7.7 ± 3.0 in 2003 to 6.9 ± 3.0 in 2012. Mortality rate improved from 24.5% in 2003 to 15.8% in 2012. Burns were caused by flames (67.3%), scalding (22.0%) and electrical (7.5%), chemical (1.6%) and contact (1.5%) injuries. Scalding and flames were the most common causes in patients aged ≤20 years and ≥21 years, respectively. Female sex, inhalation injury, full-thickness burns, large total body surface area (TBSA) burned and old age predicted mortality. ABSI scores <4 and >14 were associated with 0.7% and >90% mortality, respectively.

Conclusions

The mortality of major burns has decreased but remains high. ABSI scores predict burns-related mortality.

Introduction

Burns are life-threatening and have varying morbidity and mortality rates in different countries. In 2000, an estimated 238,000 people worldwide died of burns. Over 95% of lethal burn victims are from low- and middle-income countries [1]. In South Korea, annual fire accidents increased from 31,372 in 2003 to 49,631 in 2008, and decreased to 47,318 and 41,868 in 2012 and 2013, respectively. The mortality rates of burns have decreased with advancements in antibiotics, nutritional support, critical care and skin substitutes in the last few decades, but are nevertheless high [2]. Burns constitute a national health problem because of the associated morbidity, rehabilitation, mortality and requirement of high cost medical services. Prevention is generally the best method of reducing the incidence and mortality rates of burns. The first step in burn prevention is the identification of the various epidemiological parameters related to burns and treatment outcomes. Although many severity scoring models have been proposed for the prediction of the mortality of thermal injuries, only eight have been constructed using appropriate methodological standards [3]. One such model is the Abbreviated Burn Severity Index (ABSI), which consists of five variables: gender, age, presence of inhalation injury, presence of full-thickness burns and percentage of total body surface area (TBSA) burned [4]. The aims of our study are to analyze the epidemiological characteristics, trends and risk factors of major burns and to confirm the efficacy of the ABSI as a scoring system for predicting the outcomes of burns patients.