Recent trends in burn epidemiology worldwide: A systematic review

doi:10.1016/j.burns.2016.08.013

Burns

Volume 43, Issue 2, March 2017, Pages 249-257

https://doi.org/10.1016/j.burns.2016.08.013 Get rights and content

Highlights

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A literature review was conducted regarding trends in burn epidemiology worldwide.
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There has been a downwards trend in burn incidence and injury severity.
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Length of hospital stay and burn mortality have also declined.
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There is a lack of data from low and middle income countries.
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Positive developments are due to advances in treatment and prevention of burns.

Abstract

Burns 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 and middle income 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.

Introduction

Burns are devastating injuries, often resulting in significant morbidity, impairment of emotional well-being, and experienced quality of life. In addition to the stressful immediate care, burns often benefit from long-term treatment with numerous outpatient visits (dressing changes etc.) and multiple reconstructive surgical procedures ± concomitant hospital stays. These health-related consequences of burns are often accompanied with additional socioeconomic burdens for burn victims and their families [1], [2], [3], [4], [5].

Socioeconomic development in different countries is a continuous process affecting basically every aspect of life. Its impact on human health is evident. According to the Human Development Reports 2015, the average mortality rate between high and low/middle income countries differ by a factor 3 (57:106 and 249:291 (women:men) per 1000 respectively), while the access to physicians per 10,000 inhabitants differ with about a factor 10 (27.9 and 2.9 physicians per 10,000 inhabitants, respectively) [6]. It is not surprising that burns are also more common in populations with lower socioeconomic status and delayed developmental growth [3], [7], [8], [9], e.g., a lack of basic safety education has been associated with increased risk for burns [10]. Furthermore, the majority of burns are preventable. Measures such as educational programs, introduction of smoke alarms/detectors, and controlled hot water in households have contributed significantly to decrease burn incidence rates and severity when applied [3], [10], [11].

In pace with the increasing worldwide socioeconomic development there should be a decreasing trend of burns. The aim of this literature review was to assess recent developments in burn epidemiology worldwide including changes in burn incidences, injury characteristics, length of hospital stay, and mortality. A similar study, previously published, regarding developments in severe burns only evaluated European populations [12]. This review intends to provide an overview of the burn epidemiology trends on a global level.

Section snippets

Material and methods

A systematic search was performed in PubMed (March 2nd–10th, 2016) to retrieve the included studies. The applied search strategy included the combination of the key words: “thermal”; “injury”; “trends”; “epidemiology”; “tbsa”; “size”; “depth”; and “mortality”. For additional studies; the references of the included articles have also been hand-searched. Only original articles; covering a period of at least 5 years; published from 2001 and onwards were included. The included studies were divided

Results

In total 46 studies were found fulfilling the inclusion criteria (Table 1). The absolute majority of studies were from VHI countries (69%, n = 32). Twenty two per cent were from HI countries (n = 10), only 4 (9%) studies from MI countries and no studies were available from LI countries (Fig. 1). There were 26 (57%) multicenter studies and 20 (43%) single-center studies. Fig. 2 gives an overview on observed trends; Fig. 3 depicts which years were covered by the studies. Fig. 4 is a political world

Discussion

In general there has been a decrease of burn incidence and burn severity as well as an overall reduction of mortality rates and LOS in recent years. A reduction of burn admissions and mortality has initially also been described by Peck in an extensive review [56]. The results of our literature research do not only correspond with these findings but also show that these trends have been continuing.

Various explanations for the decrease of burn admissions could be found: in Australia, Duke et al.

Conclusions

Globally there has been a decrease of burn incidence, burn severity, burn mortality and LOS, especially in VHI, HI and MI countries. In LI countries, due to the lack of data and publications, it is hard to give an exact trend. Hence, studies on burn epidemiology should be conducted especially in LI countries.

According to development status, countries face different tasks: while in very high developed countries tertiary care is well established, there seems to be a lack of specialized facilities

Conflict of interest

None.

Authors’ contributions

All authors made substantial contributions to the development or design of the work or to the acquisition, analysis, or interpretation of data for the work and the drafting of the work or revising the intellectual content. All authors have approved the final version of the article.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Acknowledgments

N/A.

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ReviewRecent trends in burn epidemiology worldwide: A systematic review

Highlights

Abstract

Introduction

Section snippets

Material and methods

Results

Discussion

Conclusions

Conflict of interest

Authors’ contributions

Funding

Acknowledgments

Burns J Int Soc Burn Inj

Burns J Int Soc Burn Inj

Burns J Int Soc Burn Inj

Burns J Int Soc Burn Inj

J Pediatr Surg

Burns J Int Soc Burn Inj

Burns J Int Soc Burn Inj

Burns J Int Soc Burn Inj

Burns J Int Soc Burn Inj

Burns J Int Soc Burn Inj

Burns J Int Soc Burn Inj

Burns J Int Soc Burn Inj

Burns J Int Soc Burn Inj

Burns J Int Soc Burn Inj

Burns J Int Soc Burn Inj

Burns J Int Soc Burn Inj

Burns J Int Soc Burn Inj

Burns

Burns J Int Soc Burn Inj

Burns J Int Soc Burn Inj

Injury

Burns J Int Soc Burn Inj

Burns J Int Soc Burn Inj

Burns J Int Soc Burn Inj

Burns J Int Soc Burn Inj

Burns J Int Soc Burn Inj

Burns J Int Soc Burn Inj

Burns J Int Soc Burn Inj

Burns J Int Soc Burn Inj

Review
Recent trends in burn epidemiology worldwide: A systematic review