Recent trends in burn epidemiology worldwide: A systematic review

Abstract

Burn injuries have been more prevalent among low socioeconomic populations and in less developed regions. Incredible advances in burn care and social development over the recent decades, however, should have placed the incidence and severity of burns in a downwards trend. The aim of this review was to give an overview on current trends in burn epidemiology across the world. Also the socioeconomic development in countries that have published epidemiological data used in this study has been taken into account when comparing the results. There was a worldwide downwards trend of burn incidence, burn severity, length of hospital stay, and mortality rate. These findings were particularly pronounced in very highly developed countries. Data from highly and medium developed countries were more heterogeneous. No studies could be obtained from low developed countries. Comparisons between the different studies were compromised by the fact that studies emerged from specialized facilities on one hand and general hospitals on the other. Analyzed studies were also frequently focusing on limited patient populations such as “children” or “elderly”. Our findings indicate the need for an international burn database with a minimal data-set in order to obtain objective and comparable results in respect of burn epidemiology.

Outcome of burn care : the mortality perspective

“…In elderly people (>65 years), the risk of death increases linearly with age, and no cut-off age has been shown to be associated with increased mortality. 105 However, despite the global decrease in burn-related mortality, 33 there is no sign of this trend among the elderly, for whom the LD50 burn size has remained at 25% TBSA for the last 20 years. 25,48,105 The prognosis among elderly people seems to be worse than among younger patients, even when the TBSA% is lower and inhalation injuries fewer.…”

“…Globally, adult men are more likely to present with burns than women, 22 whereas differences among children are controversial. 16, 108 109 Men´s health seem to be more likely to be affected by "risky" behaviour such as smoking or drinking alcohol, 83,110,111 whereas women´s health is influenced by more structural and psychosocial factors.…”

“…The absence of severe pre-existing conditions, particularly in the youngest age groups, made it difficult to evaluate the whole range of issues that have an impact on mortality. However, patients with burns admitted to our centre comprise all patients with burns without exclusion for age, sex, severity of burn, or cause of injury, and some global similarities such as the decreases in the incidence of burns; the severity of injury; mortality; and the duration of stay, 33 give value to our results.…”

“…1 The incidence and severity of burns, the duration of stay in hospital, and the mortality after burns are all decreasing, particularly in countries where high to middle incomes predominate, while the scarcity of data from the poorer countries makes it difficult to provide a complete overview of global trends. 22 The World Health Organization has recently estimated that most of the 265 000 annual deaths from burns occur in poorer countries. 23 However, the in-hospital mortality after burns in the richer countries has decreased dramatically, 24,25 and there are many reasons for this improved survival including, for example, the advances in intensive care (fluid resuscitation, nutritional support, and treatment with antibiotics) as well as the introduction of early excision of burn wounds.…”

“…32,33 The time of injury is known, the estimate of the damage (expressed as TBSA%) is measurable, and it is a strong indicator of the severity of the illness. 5 The medical care is relatively standardised and allows daily monitoring of medical interventions and the nursing care given.…”