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Burns and Scalds in the 1999 CHIRPP Database CHIRPP Surveillance Evaluation On The Web - Warnings & Advisories From Health Canada Canadian Injury Prevention and Control Curriculum (CIPCC) Injuries Associated with Sliding Glass Doors
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A hot topic!Burns and Scalds in the 1999 CHIRPP Database Tracey Selst Safe Kids Canada reports that 70% of parents do not know that the most common cause of burn injuries to children is scalds from hot liquids, not fire.1 In fact, hot liquids burn just like fire, and children's skin burns four times more quickly than that of adults.1 Scalds tend to be the most commonly treated type of burn injury and account for approximately 60% of all burn injuries.2 Burns are a serious injury problem. Analysis of data from Statistics Canada and the Canadian Institute for Health Information (CIHI) revealed that in 1998, 300 Canadians died and 3,493 more were hospitalized because of fire and burn-related injuries; the median length of hospital stay was 5 days.3
More than half (54.3%) of the CHIRPP patients with burns were children under the age of 5. The 1,909 burns that were treated at the 15 CHIRPP hospitals during 1999 were investigated in detail for this report. These burns represented 1.7% of all CHIRPP injuries in 1999. We explored the circumstances and injuries for the various types of burns. Generally, burns can be categorized as one of six types: scalds, contact, fire/flame, electrical, explosive or chemical. Age and Sex Distribution The youngest children are at highest risk for burns. More than half (54.3%) of the CHIRPP patients with burns were children under the age of 5 (see Table 1), and burns accounted for 1 in 20 of all CHIRPP records for infants and 1 year olds. The frequency was lower among older children and young adolescents but then increased somewhat after the age of 14 years. Overall, nearly 60% of burns were sustained by males.
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Burn injuries tended to be somewhat more serious, on average, than other CHIRPP injuries. More than twice as many patients required medical follow-up after initial treatment for burns, and the admission rate of 8.3% was slightly higher than the overall proportion of admissions for CHIRPP. Here again, infants and 1 year old children suffered a disproportionately high percentage of the serious burns. They accounted for 43.7% of all those admitted to hospital but only 31.0% of all burns in the data set. There were three deaths in this 1999 CHIRPP series of burns, all related to house fires. Although fatalities represented only 0.16% of the burn records, this is still more than five times higher than the death rate for all injuries in the CHIRPP database. It is important to note that CHIRPP underestimates fatal injuries of all types because it does not capture information on people who died before they could be taken to hospital or those who died after being admitted to hospital. Across Canada in 1998 there were 300 deaths due to fire and burns (Statistics Canada and CIHI data). Serious burns occurred in a variety of circumstances (see Table
2). A very high percentage, 20.8%, of patients burned by open flames were
admitted to hospital. These open flames involved clothing fires, campfires,
cigarettes, welding torches, and flames involving flammable liquids. People
burned by explosions, typically of containers holding flammable liquids or
fireworks, also had above average hospital admission rates (16.7%). On the
other hand, hospital admissions for contact burns were comparatively infrequent
(2.0%). Although only 5.4% of patients with electrical burns were admitted
to hospital, this relatively low percentage was offset by another 14.0% who
were held in the emergency department for observation. |
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Approximately one in five patients (22.5%) were at play or recreation at the time of injury, and the proportion of patients burned while playing was highest among young children. Among adults, most burns involved occupational situations (32.3%), household chores (18.0%), or maintenance activities (9.3%). Nearly three-quarters (72.2%) of adults with job-related burns were men, as were nearly all those (97.0%) performing maintenance; women were burned more often while performing household chores (60.9%).
More than three-quarters of burns for which the location of the incident was known occurred in or around the home. More than three-quarters of burns for which the location of the incident was known occurred in or around the home. It is not surprising that the kitchen was the room where burns occurred most frequently, accounting for 40.9% of burns that happened at home followed by 11.5% in the living room and 5.1% in the bathroom. Kitchen burns accounted for more than a third of burns among young children less than 5 years of age. Their frequency declined for older children and adolescents, ages at which outdoor and non-residential locations were more frequent, and then increased slightly for adults.
Scalds and contact burns were especially frequent in children younger than 2. Burns that happened in the kitchen and bathroom tended to be scalds (64.5% and 62.9% respectively), whereas burns that happened in other locations were more often due to contact with hot objects or open flames. Analysis by Type of Burn The most common type of burn was scalds, burns caused by hot liquids or steam. Scalds accounted for 43.5% of cases in this series of 1999 CHIRPP burns. Contact with hot objects was responsible for 30.7% and open fires, flashes or flames for 12.5%. The remainder were associated with electrical sources (6.8%), chemicals (4.0%), explosions (0.9%), or other sources (see Table 3 and Figure 1). The frequency of these types of burns varied with age. Scalds and contact burns were especially frequent in children younger than 2. Chemical burns and those associated with flash and flame occurred most frequently among adults.
All three fatalities in this series of 1999 CHIRPP burns involved children less than 5 years old who died in house fires. |
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Figure 1. Burn Type Distribution, 1999
CHIRPP Database, All Ages * This category includes burns due to laser light in the eyes, candle wax and hot glue.
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Scalds were the most frequent type of burn injury. They often resulted from spilled tea or coffee, 34.7% of scalds being due to hot beverages and 28.0% due to hot food. Young children were the most vulnerable – those less than 5 years of age suffering 72.2% of hot beverage scalds. Young children were also scalded by hot food, but older children, adolescents and adults sustained a greater proportion, 49.6%, of scalds due to hot food than to hot beverages. Scalds related to cooking made up 15.5% of all scalds and were most often caused by pots of boiling water spilling on stove tops, or spilling in transit between the stove and the sink. Twenty-nine children less than 5 years old were scalded when they pulled either a pot or a kettle or boiling water onto themselves from a counter or stove top. Hot tap water was responsible for 7.1% of the scalds, and children less than 5 years sustained three-quarters of hot tap water scalds. Scalds tended to involve the full range of body regions. Although the greatest proportion affected the upper extremity (38.3%), scalds to the lower extremities (leg, foot and toes) and trunk were more frequent than for other types of burns. One-quarter of the scalds affected the lower extremities, and one in five affected the trunk. 2. Flash/Flame Burns Adults sustained one-third (34.7%) of burns associated with flash and flame, and two-thirds (69.2%) involved males. In contrast, young children less than 5 years of age received only 6.3% of burns of this type. The three most common sources of flashes or flames were flammable liquids (22.2%), welding flashes (20.5%), and campfires (19.2%). Older children and young adults less than 15 tended to suffer flame burns caused by combustion of flammable liquids (32.8%), clothing fires (22.4%), and campfires (14.9%). Campfire burns usually involved the hand and arms (63.0%) or feet and legs (23.9%) and were often caused by walking through the hot ashes, stepping on hot coals, or falling into the fire. Flash and flame burns to older adolescents and adults, 15 years and older, were most often due to welding flashes (40.7%) or combustion of flammable materials (22.9%). There were 49 patients who sustained burns while welding, all older adolescents and adults. Almost all welding burns were work-related (38.8%) or happened at home in a maintenance situation (44.9%). Ninety percent of welders' flashes affected the face or eyes. All three fatalities in this series of 1999 CHIRPP burns involved children less than 5 years old who died in house fires. 3. Contact Burns Over a third of all contact burns happened in the kitchen, and 25.7% involved some part of the cooking range (stove or oven). In half of the range burns there was contact with stove-top elements, and the remainder were due to contact with some other part of the stove, including the heating elements inside the oven, the oven door and the top surface of the stove. Other contact burns in the kitchen were due to contact with objects such as hot pots, pans, and baking trays. Contact burns were most common in young children less than 5 years of age. Seventy-one percent of contact burns involved the hands. Fireplaces and wood burning stoves, combined, accounted for 16.5% of all the contact burns. Infants and toddlers were very vulnerable and represented two-thirds of burns from hot fireplaces and wood stoves. Almost all of these infants (95.4%) were treated for burns to their hands. Overall, fireplaces were the second most common source of burns to infants less than 1 year of age and were exceeded only by hot beverage scalds. Nearly three-quarters of patients with burns due to contact with fireplaces or wood-stoves required follow-up medical treatment after being sent home from the emergency department.
Common scenarios leading to chemical burns were children playing with chemicals, tasting or ingesting them, or pulling bleach or other substances down on top of themselves. Other hot objects frequently implicated in contact burns were irons (9.7%), curling irons (6.8%), radiators (4.8%), light bulbs (4.4%), and barbecues (2.6%). 4. Electrical, Chemical, and Explosive Burns The majority of electrical burns, 55.0%, involved contact with outlets that happened when the patients had been touching an outlet or plugging in an appliance, or when children stuck objects into the socket. Half of these patients were young children less than 5 years old. Other situations resulting in electrical burns included simultaneous contact with two appliances and children cutting live wires with scissors. The majority of electrical incidents, 75.3%, involved burns on the hands. There were 76 patients in this series who were treated for chemical burns; 40% were young children less than 5 years of age. Common scenarios leading to chemical burns were children playing with chemicals, tasting or ingesting them, or pulling bleach or other substances down on top of themselves. A third of the burns involved oven cleaner. Adults accounted for 34.2% of the chemical burns, and among these 57.8% were work related. Burns associated with explosions were the smallest category, involving only 18 cases or 1% of all burn injuries. The majority of explosive burns, 72.2%, were suffered by patients over 10 years of age, and 83.8% of patients were male. Explosive burns that involved children (younger than 20) were mainly caused by fireworks (80.0%) or involved children playing with containers filled with gas (i.e. butane or propane reservoirs) that exploded.
Interventions Scalds, many caused by hot tea or coffee, were by far the most common type of burn. Examination of the circumstances leading to scalds, especially scalds to young children, suggests several preventive measures that might be taken:
A recent study reports that adults rarely or never use lids on their hot beverages when at home or around children.1 These are all simple precautions that can protect young children from scalds. Over one-third of burns suffered by young children (< 5 years) happened in the kitchen. Sadly, 30% of Canadians surveyed reported taking no precautions to ensure that children are either kept out of the kitchen or kept at the table when meals are being prepared.1 Separation of young children from areas of hot food preparation protects them from another potentially hazardous situation. The habit of always turning pot handles away from the front of the stove is a simple safety practice that minimizes the risk of hot spills for all ages.
Parents, and all of us, can reduce the risks at home and elsewhere by being aware of the hazards and implementing simple measures. Safe Kids Canada reported that three-quarters of Canadians surveyed did not know the temperature of their hot water1 and that 75% could not name the recommended temperature setting to help prevent scalds from hot water (49°C, 120°F).1 As well, 40% of parents who had access to hot water heaters had not turned down the tem-perature to guard against scalds.1 Four per-cent of the burns suffered by patients less than 20 years of age in this series could be directly attributed to hot tap water.4 Simply turning down hot water heaters to the recommended 49°C (120°F) could prevent many scalds. CHIRPP data showed that an even greater number of children were burned by contact with wood stoves or fireplaces than by hot tap water. It should be noted that since CHIRPP hospitals are primarily urban, and rural homes are more likely to heat with wood burning stoves/fireplaces, the proportion of burns due to these heating devices may actually be higher in the general population. In homes heated by wood stoves, infants and toddlers should be separated from stoves by physical barriers such as gates on doorways and alcoves. Measures to prevent other types of contact burns include keeping the cords of irons, kettles, and curling irons out of reach. Different types of interventions are needed to prevent chemical and electrical burns. Locking caustic materials away from children's reach and using safety outlet covers are both simple and effective. This study indicated that other safety concerns need to be addressed for adolescents and adults. The improper use of flammable materials accounted for nearly one-quarter of all flash/flame burns. Burns associated with welding flashes can be prevented or minimized by the use of protective equip-ment, including gloves and goggles or face shields. Burns account for a significant number of emergency room visits each year. The causes of burns vary with age, but young children are at greatest risk. Burns are a very preventable type of injury. Parents, and all of us, can reduce the risks at home and elsewhere by being aware of the hazards and implementing simple measures. References
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Last Updated: 2002-11-13 |  |
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