Demographic features of pediatric patients with burn injuries referred to the emergency department of Sina hospital in Tabriz , Iran , in 2014

Epidemiology Abstract Introduction: The aim of this study was to evaluate the demographic status of children with burn injuries who were referred to the emergency department of the Sina hospital in Tabriz, Iran, in 2014. Methods: Total of 220 pediatric patients with burn injuries, who referred to the emergency department of Sina hospital, were enrolled in this prospective descriptive study. Data such as age, gender, type of injury, location of injury, and severity of burns was collected, and analyzed using SPSS statistical software. Results: Most patients were the first children of their families (61.8%). Two-year-old children had a higher incidence of burn injuries (33.2%). Most of the burns (94.5%) occurred at home. The most common cause of injury was hot liquids (74.5%). The position of the burn injuries in most patients was the upper extremities (47.3%) and second-degree burn severity was more frequent (70.5%). There were no significant statistical differences between the two genders regarding cause, severity, percentage, and anatomical area of the burn. Conclusion: It is necessary to design effective strategies to reduce the incidence of burn injuries in pediatric patients, so that steps can be taken to reduce burn injuries and their complications.


Introduction
Burn injuries are among the most important vulnerabilities in children that can cause severe functional, social, and psychological disabilities. 1,2Pediatric burn injuries can be more severe than those in adults.However, children and their parents are often unaware of the results of the burn injuries.In fact, many of them are unaware of the possibility of death due to such injuries.While in some cases, a burn injury may not be life-threatening, the scars impose severe impact on an individual's physical and mental performance. 3Most cases that occur in the first two decades of life are accidental and can be prevented.
Burns are the most common cause of death due to injury in this age group. 3,4tudies on the epidemiology and risk factors for burns in many advanced countries like the United States play an important role in the primary and secondary prevention of burns.6][7] Epidemiological information on burn injuries can contribute to design effective strategies to reduce the incidence of burn injuries and to determine appropriate management methods of treatment.Programmes that lead to domestic disaster reduction can reduce deaths from pediatric burns. 5,7Peleg et al. found that the hospitalization of neonates and toddlers were reduced significantly in areas where such programs have been implemented. 8he present research focused on the causes and location of burn damage in pediatric patients who were referred to the emergency department of Sina hospital of the Tabriz University of Medical Sciences, Tabriz, Iran, in 2014.The results can provide the appropriate strategy to prevent and reduce the incidence, morbidity, mortality, and the costs of burn injuries within the health system.

Methods
This cross-sectional study was conducted in the Sina hospital of the Tabriz University of Medical Sciences during a period of one year in 2014.The Sina Medical Center is a burn referral center 9 and about 500 patients with burn injuries are referred to the emergency ward of this hospital each year.
A sample size of 220 patients was determined using the Morgan table, a confidence level of 95%, and an α of 0.05.The inclusion criteria were children under 12 years who had burn injuries and were referred to the emergency ward of the Sina Medical Center.The exclusion criteria were those who not consent to participate in the research and those who were older than 12 years.
The parents of patients have been assured that the patient information will remain confidential and their participation in the study will not interfere with the treatment.All conditions of the study were explained to the patients' parents and their consent was obtained.Later, after obtaining informed consent from the parents of the patient, the parents were interviewed and information was collected.The variables included age, sex, birth order, parental education, injury location and its reason, percentage, anatomical location and severity of the burn, and disposition status of patients (discharge or admission).
The collected data was entered into SPSS software (version 17, SPSS Inc., Chicago, IL, USA).The descriptive tests of mean ± standard deviation (SD) and frequency (percentage) were used to describe the data.To search for the normal distribution of data, the Kolmogorov-Smirnov test was used.An independent sample t-test was used to compare quantitative data between the groups.A chi-square test was used to compare qualitative data.A P-value < 0.05 was considered significant.

Results
In this study, 220 patients with burn injuries were studied.Among the patients, 117 were boys (53.2%) and 103 were girls (46.8%).The mean age (± SD) of patients was 1.46 ± 0.5 years (median = 1 year).Table 1 shows the demographic status of patients' family between the two genders.Table 2 shows the status of patients' burn injuries between the two genders.

Discussion
Our findings showed that of the 220 visited children with burn injuries, the male to female ratio was 1.13:1.1][12] So, it seems that boys are more susceptible to burn injuries because they are more likely to do dangerous things compared to girls. 10he mean age of the children was 3.5 years, and 61.8% (136 patients) of the children with burn injuries were the first child in their families.In a study conducted in Brazil on patients who were under 12 years of age, about 50% of the victims were younger than three years. 13nother study was conducted on children less than seven years with burn injuries in Ankara, where most children were under three years.Children in this age group are more exposed to the risk and therefore, parents should train and supervise the activities of the children.Any ignorance from parents may result in such damage. 14n this study, the majority of burn cases (94.5%) occurred at home.Torrati et al. conducted a study on children under 12 years of age in Brazil, where 86.0% of injuries took place at home, 13 which is consistent with the finding of our study.Most burn injuries were caused by hot liquids in this study (74.5%).In Ankara, more than 605 cases of burn injuries in children were due to boiling water. 14saac et al. also concluded that boiling water was the main cause of burns in children in South Africa. 15Also, in the study by Arslan et al., 16 boiling water was the most important cause of burn injuries.Most deaths were due to burns from fire.They suggested that changes in the living habits of parents have reduced this injury. 16Shams et al. have concluded that in a population under 20 years, burn injuries in the lower limbs and due to boiling water were more common at home. 17n this study, 90.9% (200 patients) of mothers of patients were housewives and 40.4% had a diploma (their education level).This can be a sign of their low knowledge about protecting children from hazardous factors at home.Thus, proper training is important for mothers to prevent burns.
The majority of fathers of children with burns were self-employed (82.7%), and most of them (41.8%)hold a diploma.In the study conducted by Samimi et al., mothers and fathers who had diplomas were 92% and 96%, respectively.The majority of fathers (42.0%) were self-employed. 10n this study, most cases of burns (47.2%) were in the upper limbs.Research findings suggested that the upper limbs were more susceptible to burn injuries due to children's curiosity; 3,18,19 therefore, it is recommended to train parents on how to ensure safety at home.In this study, the highest frequency (22.7%) of the burn size was 2.0% and about 91.9% of children had second-degree burns.According to a study by Mercier and blond, the majority of children with burn injuries had blisters. 20Of all children with burns, 162 (73.6%) were discharged and others were admitted in the pediatric burn unit.One of the limitations of our study was sample collection in a limited time per day (8 am-4 pm).Another limitation of our study is that we did not follow up on the admitted patients.

Conclusion
This research will be useful for implementing prevention programs of burn injuries and reducing their effects.The development and implementation of appropriate strategies will be beneficial to train parents on how to use heating devices such as samovars, heaters, stoves, etc., and observe safety rules at home.They can be trained to identify risk factors at home and at the workplace as it will reduce the physical, mental, and economic effects of burns in pediatric patients.

Table 1 .
Demographic status of patients' family according to patient's gender

Table 2 .
Status of patients' burn in terms of gender SD: Standard deviation