The past 25 years of pediatric burn treatment in Graz and important lessons been learned. An overview☆
Introduction
Burns are as old as a fire; they have always existed and they will always persist, because there is no life without “fire”. However the questions asked are: how can we prevent the undesirable effects of “fire”, how can we reduce the number of burn victims and how can we minimize the severity of burns.
To develop proper prevention measures it is necessary to analyze the causes of injuries first; then to draw the right conclusions and finally eliminate those causes. In this respect the etiological and epidemiological studies play a crucial role. Etiology refers to the study why things occur, or even the reasons behind the way that things act. Epidemiology is concerned with the distribution and determinants of health and diseases, morbidity, injuries, disability, and mortality in populations; epidemiology examines the distribution and determinants of disease occurrence among population groups and focuses attention on asking why certain diseases concentrate among particular population groups [1].
According to the “World report on child injury prevention 2008” by WHO in 2004, 310,000 people died as a result of fire related burns, of whom 30% were under the age of 20 years. Children are at high risk for death from burns, with a global rate of 3.9% deaths per 100,000 population. Among all people globally, infants have the highest death rates from burns [2]. Burns can also result in significant long-term consequences which can leave children physically and physiologically impaired for the rest of their lives. The most common problems include hypertrophic scaring, extensive contractures, and the formation of keloids. The most vulnerable groups in all countries for burns are children and the elderly. Lack of supervision of children, frailty and co-morbid illnesses of the elderly, clothing made of flammable materials, parental illiteracy, congested housing, pre-existing impairment of a child, and low socioeconomic status are important risk factors for burns. Infants and toddlers up to the age of four years make up almost one-third of all burns [3], [4] in high income countries (HIC) the number of burn children is reported to be decreasing; whereas in low-income (LIC) and middle-income countries (MIC) the number of burn victims has stayed consistent or even shows an upwards tendency [2].
In 2012 Austria had a population of 8.43 million; the percentage of the population under the age of 20 years was 20.2%. At the same time Styria had a population of 1,209,466 people, of which 231,242 (19%) were under 20 years. The provincial capital of Graz had a population of 404,093 [5]. In 2012 Austria's GDP (gross domestic product) was 307 milliard Euro [6]. Health care expenditure as a percentage of the GDP amounted to 11.1% in 2012. The human develop index (HDI) was 0.895. This ranked Austria in 2012 at number 18 in terms of most developed countries [7].
In mid-1987, the Children's Burns Unit at the Department of Pediatrics in Graz was established. Prior to that, burnt children were treated at the Department of Pediatrics as well, but depending on their age they were scattered throughout the baby, toddler or schoolchildren wards. The victims with the most severe thermal injuries were admitted to the pediatric intensive care unit. Since 1988 all pediatric patients with burns have been concentrated at the burns unit and in 1989 an additional outpatient clinic opened.
With the analysis of our data over a period of 25 years we investigate aspects mentioned and examine the change of burn admissions to our Burns Unit at the Department of Pediatrics and Adolescent Medicine, Graz, Austria. We are convinced that our study is representative in many respects for HIC and we will discuss our findings regarding socioeconomic factors in Austria.
Section snippets
Patients
This retrospective study took place at the Children's Burns Unit at the Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Austria and was approved by the ethical commission of the Medical University of Graz, Austria (#26-269 ex13/14). We studied pediatric and adolescent patients who were admitted for treatment of acute burns or their sequelas at our unit between January 1st 1988 and December 31st 2012. Our catchment area includes South-East Austria (Styria and
Burn admissions
In the studied 25 year period, 1586 pediatric burn patients were admitted to the Burns Unit Graz. 1451 patients were “acute” admissions and 64 “secondary” admissions; 71 patients did not fulfill the criterion of an acute in-patient because they did not spend a minimum of one full day at the burns unit. Of these 1451 patients, 930 (64%) were male and 521 (36%) female (ratio 1 male to 0.56 females); the male predominance occurred in all age groups. Fig. 1 shows the 1451 in-patients over a period
Discussion
The Children's Burns Unit in Graz, Austria was opened in July 1987. Collection of the demographics, injury characteristics and outcome from acute burns began at that time. Unfortunately the database used initially did not survive the millennium changeover and was replaced in 2000. However the collected data provides a good opportunity to review changes over a long period of time.
There are several reviews of burns demographics, prevention and care but most are either focused on a select patient
Conflicts of interest
None declared.
Author's contribution
Towards the organization of this work, Marija Trop contributed conception and design of the study and preparation of manuscript. Sereina A. Herzog made statistical data analysis and interpretation, figures, tables and drafted the article. Klaus Pfurtscheller and Angelika M. Hoebenreich are made data acquisition. Michael V. Schintler performed literature research. Andrea Stockenhuber performed data acquisition and literature research. Lars-Peter Kamolz helped preparation of the manuscript.
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Data presented in this study has been used to some extent for the final year project at the Medical University Graz with the title “Epidemiologische Studie über thermisch verletzte Kinder und Jugendliche in den Jahren 1988–2011”, written by Angelika M. Hoebenreich in 2013.