Prevalence of Acute Pediatric Burns in a Tertiary Care Hospital

ABSTRACT Introduction: Burn injury is an important cause of mortality and morbidity in children worldwide. Mortality is higher in developing countries than in developed ones. Most of them occur in predictable domestic settings and can be prevented. The objective of this study was to find out the prevalence of acute pediatric burns in a hospital setting. Methods: A descriptive cross-sectional study was conducted by reviewing the secondary data of burn cases admitted during the years 2016 AD to 2018 AD in a tertiary care hospital after taking ethical clearance from the Institutional Review Committee (IRC No. 016-2019). The sample size was calculated and systematic random sampling was done. Data analysis was done using Statistical Package for the Social Sciences, version 23. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: The prevalence of acute pediatric burns at the hospital was found to be 101 (29.71%) (24.85-34.57 at 95% Confidence Interval). The majority of them were males 54 (53.47%) and toddlers 39 (38.61%). Scalding 54 (53.47%) was the main etiology. Most of the burn injuries occurred inside the house 76 (75.25%) and on November 11 (10.9%). The mortality rate was 11 (10.89%). Conclusions: The prevalence of acute pediatric burns in a hospital setting was lower than most other countries but mortality was higher. The majority of the burn injuries occurred inside the house. Therefore, special focus should be done on prevention at the household level. Adequate medical services for emergency management of childhood burns should be available in different parts of the country.


INTRODUCTION
Pediatrics are individuals less than 18 years of age. 1 Burn injury in the pediatric population is a global health problem. 2 It is an important cause of significant mortality and morbidity in this age group. 3 Children have unique biological responses to burn injuries. This demands a different approach to resuscitation and management. 4 The risk of mortality in children from burns is higher than that in adults. 5 The pediatric burn is a huge challenge for developing countries where there is a higher risk of burns and treatment difficulties. 3 Mortality associated with burn injuries is higher in developing countries than developed ones. 5 Childhood burns mostly occur in predictable domestic settings and most of them can be prevented. 3,6 So, it is important to conduct programs at the national level for the prevention and management of burn injuries specific tothe pediatric population.
JNMA I VOL 58 I ISSUE 231 I NOVEMBER 2020 The main objective of this study was to find out the prevalence of acute pediatric burns among admitted burn cases at Kirtipur Hospital, Kathmandu over three years (2016 to 2018 AD).

METHODS
A descriptive cross-sectional study was conducted by reviewing the secondary data of burn cases admitted during the years 2016 AD to 2018 AD in Kirtipur Hospital, Kathmandu. Ethical approval was taken from the Institutional Review Committee (IRC No. 016-2019), phect-NEPAL. Secondary data were collected from hospital records which included all the acute burn cases admitted in the Plastic Surgery ward of Kirtipur Hospital, Kathmandu from the years 2016 to 2018 AD. Admitted burn cases with inadequate information and burn cases managed in the emergency room only and as an outpatient basis was excluded from the study. Systematic random sampling was done.
The sample size was calculated as follows; where, n= required sample size Z= 1.96 at 95% Confidence Interval (CI) p= prevalence taken, 50% e= margin of error, 6% The minimum required sample size was 264. But 304 patient cases were taken into the study.
Data analysis was done in Statistical Package for the Social Sciences, version-23. Period prevalence at a 95% confidence interval was calculated.

RESULTS
The prevalence of acute pediatric burns at Kirtipur Hospital, Kathmandu from 2016 AD to 2018 AD was found to be 101 (29.71%) (24.85-34.57 at 95% CI).

DISCUSSION
There are several studies on pediatric burns all around the world. According to our study, the prevalence of acute pediatric burns in a hospital setting is 29.71%. This is comparable to the prevalence (28.6%) in a burn unit in Jinzhou, China. 7 Another study in Nepal 8 showed the prevalence of burns in the 0-15 years age group to be 25.6% which is similar to ours. Similarly, our finding corresponds to the finding in Nigeria where the proportion of childhood burns is 33.3%. 9 But this is contrary to the findings in Western Regional Hospital of Nepal where the prevalence in 0-15 years children is 61%. 10 Similarly, studies in hospitals of Europe show that burns in children account for half of all burn injuries. 11 Pediatric burns alone cover 40% of all admissions every year at three burn centers in Netherland. 12 Approximately, 50% of the burn cases in the United States are younger than five years of age. 13 In our study, mortality due to pediatric burns is 10.89% which is higher than that in Shanghai, China, 14 and Saudi Arabia. 15 Majority of the pediatric cases in our study are males and the burn injury occurred inside the house which is similar in South Central China. 16 The major cause of pediatric burns in our study is scalds followed by flame burns. This is in line with the findings in Israel 2 and the United States of America (USA). 13 Our study depicts that pediatric burns are maximal among toddlers (38.61%). This is supported by studies in South Central China. 16 But, in Iran 6 and Israel, 2 it is maximum among preschool-age children and infants respectively. In Hong Kong, out of total hospital admissions for burns, 42.7% belonged to toddlers of age less than two years. 17 In the same way, in Israel, 51% of all burn admissions comprised of children (0-14 years) with infants (0-1 year) having the highest prevalence (45%). 2 There are some limitations to our study that need to be mentioned. First, it is conducted in a hospital setting only which cannot be generalized for the whole country. Next, secondary data of only three year period is taken and the burn cases managed in the emergency room and as an out-patient basis were excluded.

CONCLUSIONS
The prevalence of acute pediatric burns in a hospital setting was found to be lower than most other countries. The majority of the cases were male toddlers with scalds being the major etiology. Most of the burn injuries occurred inside the house in the month of November. Mortality was higher than in other countries. So, special focus should be given on the prevention of pediatric burns at the household level. Besides it, there should be the provision of adequate medical services for emergency management of childhood burn injuries in different parts of the country.