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Iranian Red Crescent Medical Journal

SHORT COMMUNICATION

Epidemiology of Burn Injuries in West Azerbaijan

Province, Western Iran

N Aghakhani*1, N Rahbar1, A Feizi1

¹Department of Nursing, Urmia University of Medical Sciences, Urmia, Iran

Abstract

Background: Burn injuries are in many respects the most of all tragedies an individual can experience. So there
was an attempt to quantify the frequency of burn injuries, identify the risk and predisposing factors, determine the
health outcomes at Imam Khomeini Hospital in Urmia, westen Iran.

Methods: From March 2005 to March 2006, all demographic and epidemiological information of 639 patients
(48.36% female and 51.64% male) about the burns and the complications were provided from the records of
patients at Imam Khomeini Hospital in Urmia, Western Azarbaijan Province, westen Iran.

Results: The incidence rate of burn hospitalization was 21.6 per 100.000. Almost 31.8% of admissions were in
the 16-25 years age group. Pediatric (<5 years) and geriatric (>65 Years) burns were (21.6%) and (3.2%), re-
spectively. Burning with flame, the most common cause of burning, accounted for 36.4% of admissions in males
and for 43.6% in females. The mortality rate was 25.9%. The percentage of patients who had more than 40%
body surface area (BSA) burn was 30.9%. Patients with >40% BSA burn had a mortality of 76.7%. The mean
BSA burn was 33.8% in males and 25.2% in females. Admissions from Urmia were the most among the cities of
the province. The mean duration of hospitalization was 7.76 days. The most cases occurred from October 22 to
November 22; 10.95%) and from Jun 21 to July 21; 9.54%).

Conclusion: The results of this study help to guide health care efforts towards the prevention of burn injuries
and provide a valuable baseline for assessing future efforts directed toward the prevention of burn injuries.
Keywords: Burn injuries; Urmia; Iran

Introduction published studies about burn injuries in different re-

gions of Iran, the nature and extent of this problem is
Burns are a main cause of disability and mortality still unknown.3
throughout the world and have severe economic and This research was designed to study epidemiologi-
social consequences. They can also lead to pain, so- cal parameters over one year to assist in devising
matic and psychological complications too.1 Iran has strategies towards burn prevention and cost-effective
a very high incidence of burn injuries with a formida- management in developing regions like West Azer-
ble public health problem in terms of mortality, mor- baijan Province in west of Iran. The characteristics of
bidity and permanent disabilities. Variations in man- high-risk persons, together with risk factors in the
agement standards, available facilities and workload environment are identified too.
factors are so diverse in different parts of the country
that small epidemiological samples can not suffi-
ciently recommend on possible optimum therapeutic Materials and Methods
interventions in a developing country with limited
resources and a large population.2 Because of a few The province of West Azerbaijan is located in the
north-west of Iran. Its population is 3,015,361 living
*Correspondence: Nader Aghakhani, MSc, Department of Nursing, in 39487 Km2. There is only one burn center located
Urmia University of Medical Sciences, Urmia, Iran. Tel: +98-441-
2225522, Fax: +98-441-2237160, e-mail: nader1453@umsu.ac.ir in Imam Khomeini Hospital in Urmia and all
Received: May 27, 2008 Accepted: October 15, 2008 important burn cases in the province are referred to it.

IRCMJ 2009; 11(1):85-89 ©Iranian Red Crescent Medical Journal

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Archive of SID
Aghakhani et al.

A retrospective study was done and the data were in males and for 43.6% in females. The mortality rate
collected by analyzing medical records of 639 was 25.9%. The percentage of patients who had more
patients hospitalized in the burn ward from the 1st of than 40% BSA burn was 30.9%. Patients with >40%
March 2005 to the 1st of March 2006. Age, gender, BSA burn had a mortality of 76.7%. The mean BSA
duration of hospitalization, the percentage of body burn was 33.8% in males and 25.2% in females.
surface area (BSA) burned, cause and type of Admissions from Urmia were the most among the
burning, and outcome of the therapies were studied. cities of the province. Mean duration of
The reading of the records was authorized by the hospitalization was 7.76 days. Most cases of burn
hospital manager. Differences among various groups occurred from October 22 to November 20 (10.95%)
were evaluated, using Student’s t-test or the Chi- and from Jun 21 to July 21 (9.54%). Fifty percent of
Square test. The level of significance was set at 0.05. burn cases were from Urmia district. In males, the
Statistical analysis was performed, using software most common cause of burn was flame (36.4%),
SPSS (version 11.5, Chicago, IL, USA). Pearson followed by hot fluids (32.4%), and chemical
statistic test was used to determine correlation. materials (15.1%), whereas in females, the most
common cause was flame (43.6%) followed by hot
fluids (31.6%), and electricity (15.9%) (Table 1).
Results The mean age for all burn patients was 23.6 years
with a range from under 1 to 83 years old. The male
In this study, 639 patients (48.36% female and to female ratio was 1.05:1. The majority of the burns
51.64% male) with burn injuries admitted to our unit (31.7%) occurred in 16-25 year age group followed
were enrolled. The incidence rate of burn by 0-5 year age group (20.6%) and 26-35 year age
hospitalization was 21.2 per 100.000 during this group (14.2%). Table 2 shows the distribution of the
period. Almost 31.8% of the admissions were in the number of burns in different age groups in males and
16-25 year age group. Pediatric (<5 years) and females.
geriatric (>65 years) burns were 21.6% and 3.2%, The range of the percentage of TBSA burn varied
respectively. Burning with flame, the most common from 1% to 100% with a mean of 32.3%±1.84% (Ta-
cause of burning, accounted for 36.4% of admissions ble 3). The mean length of stay of patients was 7.76

Table 1: Distribution of patients by gender and type of burning

Gender Cause of burn Total
No. (%) No. (%)
Age group Hot Electricity Flame Hot Chemical
(year) fluids surfaces materials
0-5 35 (67.3) 0 (0.0) 6 (11.5) 6 (11.5) 5 (9.6) 52 (100)
6-15 12 (30.7) 4 (10.3) 44 (51.3) 14 (5.1) 25 (2.6) 39 (100)
16-25 22 (19.4) 8 (7) 44 (39) 14 (12.9) 25 (22.1) 113 (100)
26-35 12 (27) 4 (8.6) 18 (39) 4 (8.6) 8 (17.3) 46 (100)
Male 36-45 10 (24) 2 (4.5) 22 (52.3) 2 (4.5) 6 (14.3) 42 (100)
46-55 10 (47.6) 1 (4.7) 4 (19) 3 (14.2) 3 (14.2) 21 (100)
56-65 3 (42.8) 0 (0) 2 (28.5) 2 (14.2) 1 (14.2) 8 (100)
>65 3 (30) 0 (0) 4 (40) 2 (20) 1 (10) 10 (100)
Total (%) 107 (32.4) 19 (5.7) 120 (36.4) 34 (10.3) 50 (15.1) 330 (100)
0-5 60 (71.4) 0 (0) 16 (19.4) 2 (2.3) 6 (7.2) 84 (100)
6-15 5 (13.5) 2 (5.4) 19 (51.3) 3 (8.1) 8 (21.3) 37 (100)
16-25 10 (11.1) 4 (4.4) 60 (66.6) 4 (4.4) 12 (13.3) 90 (100)
26-35 6 (13.3) 1 (2.2) 23 (51.1) 1 (2.2) 14 (31.1) 45 (100)
Female 36-45 4 (18.1) 1 (4.5) 9 (41) 3 (13.6) 5 (22.7) 22 (100)
46-55 3 (25) 0 (0) 4 (33.3) 3 (25) 2 (16.7) 12 (100)
56-65 5 (45.5) 0 (0) 2 (18.8) 3 (27.2) 1 (9) 11 (100)
>65 (%) 3 (37.5) 0 (0) 2 (25) 2 (25) 1 (12.5) 8 (100)
Total (%) 96 (31.6) 8 (2.6) 135 (43.6) 21 (6.8) 49 (15.9) 309 (100)

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Table 1: Distribution of Patients by Age and Gender

Number of patients
Total
Age (years) No. (%)
No. (%)
Male Female
0-5 54 (16.4) 84 (27) 138 (21.6)
6-15 37 (11.3) 38 (12.4) 75 (11.8)
16-25 112 (34) 90 (29) 202 (31.8)
26-35 46 (14) 44 (14.2) 90 (14.1)
36-45 41 (12.5) 22 (7) 63 (9.8)
46-55 21 (6.4) 11 (3.6) 32 (5)
56-65 8 (2.4) 10 (3.2) 18 (2.8)
>65 10 (3) 11 (3.6) 21 (3.2)
Total 329 (100) 310 (100) 639 (100)

Table 3: Distribution of patients by Gender, age group and TBSA burned

Gen- Total body surface area
der No. (%)
Age group 0-10 11-20 21-40 41-60 61-80 81-100 Total
(Year)
Male 0-5 (%) 26 (50) 16 (30.8) 5 (9.6) 4 (7.7) 0 (0) 1 (1.9) 52 (100)
6-15 (%) 8 (20.5) 13 (33.3) 6 (15.4) 5 (12.8) 0 (0) 7 (17.9) 39 (100)
16-25 (%) 14 (12.4) 16 (14.2) 27 (23.9) 11 (9.7) 14 (12.4) 31 (27.4) 113 (100)
26-35 (%) 9 (19.6) 8 (17.4) 8 (17.4) 10 (21.7) 6 (13) 5 (10.9) 46 (100)
36-45 (%) 10 (23.8) 10 (23.8) 9 (21.4) 8 (19) 2 (4.8) 3 (7.1) 42 (100)
46-55 (%) 5 (23.8) 6 (28.6) 2 (9.5) 2 (9.5) 3 (14.3) 3 (14.3) 21 (100)
56-65 (%) 1 (14.3) 3 (42.9) 1 (14.3) 0 (.0) 1 (14.3) 1 (14.3) 7 (100)
>65 (%) 3 (30) 1 (10) 2 (20) 1 (10) 1 (10) 2 (20) 10 (100)
Total 76 (23) 73 (22.1) 60 (18.2) 41 (12.4) 27 (8.2) 53 (16.1) 330 (100)
Female 0-5 (%) 36 (42.9) 30 (35.7) 12 (14.3) 4 (4.8) 1 (1.2) 1 (1.2) 84 (100)
6-15 (%) 15 (40.5) 8 (21.6) 4 (10.8) 5 (13.5) 4 (10.8) 1 (2.7) 37 (100)
16-25 (%) 27 (30) 18 (20) 13 (14.4) 8 (8.9) 13 (14.4) 11 (12.2) 90 (100)
26-35 (%) 18 (40) 10 (22.2) 5 (11.1) 3 (6.7) 3 (6.7) 6 (13.3) 45 (100)
36-45 (%) 7 (31.8) 3 (13.6) 5 (22.7) 2 (9.1) 1 (4.5) 4 (18.2) 22 (100)
46-55 (%) 5 (41.7) 3 (25) 1 (8.3) 1 (8.3) 2 (16.7) 0 (0) 12 (100)
56-65 (%) 5 (55.6) 0 (.0) 2 (22.2) 1 (11.1) 1 (11.1) 0 (0) 9 (100)
>65 (%) 4 (40) 4 (40) 1 (10) 0 (0) 1 (10) 0 (0) 10 (100)
Total 117 (37.9) 76 (24.6) 43 (13.9) 24 (7.8) 26 (8.4) 23 (7.4) 309 (100)

days (range=1- 60 days) and 21.7% of them stayed respectively. There was also a significant and direct
more than 10 days in hospital. The mean BSA in pa- correlation between the level of literacy (low to high)
tients with third-degree burns was significantly higher and mean BSA (P=0.05), although this correlation
than that in second-degree burns (P<0.001). There was not uniformly linear. No statistically significant
was a significant correlation between the mean BSA, correlation was found between the level of literacy
burn depth and the burn type (P=0.005). That is, the and cause of burn (P=0.5).
increase of burn surface causes more depth. Twenty
six percent of patients (male and female) died because
of their burns. Female mortality was 20.4% and male Discussion
mortality was 31.3%. Case fatality rate for patients
with <40% of TBSA burn and ≥ 40% TBSA burn The first purpose of this study was to report the epi-
were 4.9% and 76.7%, respectively. The highest pro- demiology of burn injuries and their etiologic factors.
portion of monthly variation occurred in November The overall death and hospitalization due to burn in-
(11%), followed by July (9.6%) and March (9.3%), juries in West Azerbaijan province were 5.5 and 21.6

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Aghakhani et al.

per 100.000, respectively. In Kordestan Province, most frequent agent of burn injuries in our study
these rates were 4.5 and 13.5 and in Fars Province 4.6 (59.7), unlike reports from Japan23 and Nigeria.24 In
and 13.4 per 100.000 person-years.4,5 our study, scalds mostly affected >5 year age group
Mortality rate in our study in male and female pa- (66%) and flame affected adults but scald is the most
tients with TBSA≥70% was 89.6% and 85.7%, re- common cause of burn in countries like Denmark and
spectively. This result is consistent with other stud- Singapore.25,26
ies.6,7 The most incidence rate of burns was observed In summary, the highest incidence rate of burn was
in 16-25 year age group, because of insufficiencies of in 16-25 age groups. It is necessary to implement pro-
security preparations in workplaces and houses. grams for health education relating to prevention of
Females were burned nearly as frequently as males burn injuries by means of broadcast flashes on mass
(1:1.05). Some studies have reported different re- media like television or radio, showing risk situations
sults. 8,9 However, there are other studies that are con- and teaching self-care methods in workplaces and
sistent with our findings.9-12 In industrialized countries, homes together with epidemiological data about burn
the sex distribution of burn cases differs, where males accident and sentences to call attention to prevent burn
generally have a significantly higher risk. This might accidents. The implementation of an educational pro-
be explained by the higher incidence of industrial and gram for burn prevention and first aids has been
recreational burns among males in such countries. 13,14 proven to be useful in stopping the burning process,
In our review, flame was the most common cause reducing post burn hyperthermia and pain and morbid-
of burns in adults, being followed by scald. This ity. Policy makers should evaluate the need for a spe-
agrees with what is found in several studies.4,11,13,14 cific burn unit. Burn prevention programs in Urmia
This may be explained by the fact that kerosene and should be reassessed to determine their efficacy and if
gas are the most frequent fuels in houses and work- they target the high risk populations. Culturally appro-
places in Iran. On the other hand, scalds were the priate burn prevention programs should target each
main type of burn among children that agrees with population group accordingly. Parents of infants
other studies.13,15,16 It may be related to densely popu- should be exposed to prevention programs in an effort
lated families, physical environment of houses, child to reduce scald injuries. Prevention programs for the
neglect, and child’s inclination for touching things. population are implemented before the winter months.
Ahuja et al. reported that almost 80% of admis-
sions were in the 16-65 year age group and proportion
of pediatric and geriatrics burns was 17.1% and Acknowledgment
3.1%.17 Our study showed that 64.5% of patients lo-
cated in 15-65 year age group and proportions of pe- We would especially like to express our sincere grati-
diatrics and geriatrics were 33.3% and 3.2%, respec- tude to Urmia University of Medical Sciences for fi-
tively. Our study revealed that low incidence of burn nancial support of this project. We would like to ex-
in >65 years age group has also been reported in other press our thanks to students for their kind cooperation
studies conducted in India, 18 Pakistan, 19 Zimbabwe.8 in this study.
Iran,20 Kuwait,21 and Egypt.22
In spite of this finding, flame was found to be the Conflict of interest: None declared.

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