Burn Injuries in Eastern Province: An Analysis of Epidemiology, Treatment & Outcome : A Tertiary Care Hospital, Batticaloa. Pirasath S1, Jasotharan V2 , Jeepara P3 1,3 Teaching Hospital Batticaloa, Sri Lanka. 2Faculty of Health Care Sciences, Eastern University of Sri Lanka. Annual Academic Sessions 2012

Dr.P.JEEPARA MBBS,MS,FRCS By: Dr.Selladurai Pirasath, RHO/TH/Batticaloa. Mr.Velapoddy Jasotharan, Medical Student/FHCS/EUSL. Supervisor: Dr.P.JEEPARA MBBS,MS,FRCS Senior Consultant Surgeon, Teaching Hospital/Batticaloa. Annual Academic Sessions 2012

Introduction Incidence of Burn Injuries is increased in Batticaloa. Injuries due to Burns are fatal, even end up – Cosmetic disfigurement, Contractures & Death. Burn Injuries are preventable. Accidental & Suicidal Burn Injuries. A high number of self-burning injuries are noted in Batticaloa. Annual Academic Sessions 2012

Objectives To study the following selected aspects of victims with Burn Injuries admitting to surgical units, Tertiary Care hospital, Batticaloa. Primary Objective Epidemiology Secondary Objective Type of injuries Modalities of treatments Outcome of victims Annual Academic Sessions 2012

Materials & Methods Materials Methods Interviewed based predesigned questionnaires Methods Study design : Descriptive study Study population : All victims admitting to surgical units, Teaching hospital, Batticaloa. Study period : 1st August 2011 –31st March2012. Sampling method : Convenience sampling Sampling size : 63 Patients Ethical Clearance ERC/FHCS/EUSL Annual Academic Sessions 2012

RESULTS Annual Academic Sessions 2012

EPIDERMILOGICAL PROFILE Females [61.9%,Nos-39] are common than Males [38.1%,Nos-24] Age < 12 yrs - 9.52% 13-18 yrs - 3.17 % 19-40 yrs - 53.97 % 41-60 yrs - 28.57 % >60 yrs - 4.76 % Annual Academic Sessions 2012

PLACE Nos Urban areas Rural areas 24 (38.1%) 39 (61.9%) Marital status Married Single Race Tamil Muslim Sinhala 46 (73%) 17 (27%) 51 (80.9%) 9 (14.2%) 3(4.7%) SLIDE CONTENT / TEXT Annual Academic Sessions 2012

Accidental Burn Injuries 56% Suicidal Burn Injuries 41% Homicidal Burn Injuries 5% Annual Academic Sessions 2012

Personal characteristics on Suicidal Burns Suicidal Burn Injuries Nos Courtship failure 6(23.0%) Marital problems 14 (53.8%) Family problems 3(11.5%) Social problems 2(7.6) Economical problems 1(3.8) Annual Academic Sessions 2012

Accidental Burn Injuries Nos (%) Traditional lamp 18(51.4%) Arican lamp 7(20%) Gas cooker 1(2.8) Keresone iol cooker 9(25.7%) Risk factors Nos (%) Alcoholism 10(15.7%) Psychiatric disorders 4(6.35%) Epilepsy 2(3.17%) Annual Academic Sessions 2012

TYPE OF BURN INJURIES Thermal burn 56(88.9%) DEPTH OF BURN INJURIES % OF INJURIES SUPERFICIAL BURN INJURIES 17 (26.9%) DEPP BURN INJURIES 1.PARIAL THICKNESS 2.FULL THICKNESS 46(73.1%) 27(42.8%) 19(30.6%) TYPE OF BURN INJURIES Thermal burn 56(88.9%) Chemical burn (Acid/Alkali) 3(4.7%) Electrical burn 4(6.3%) TYPE OF BURN INJURIES Annual Academic Sessions 2012

Face was involved in majority of the cases: (Nos-37, 59%). The median extent of burn was >40% of total body surface area (TBSA) in majority of patients (Nos-38, 60%), with the top of the body (Anterior surface of Chest and upper & Lower limbs) mainly affected. Face was involved in majority of the cases: (Nos-37, 59%). Annual Academic Sessions 2012

TREATMENT MODALITIES & OUTCOME Annual Academic Sessions 2012

MODALITIES OF TREATMENT Management %Nos Medical Mx Analgesics 100.00% [63] Antibiotics Surgical Mx Dressing under anaethesia 16.98% [18] Skin graft 39.8% [24] Contracture release 4.76% [03] Annual Academic Sessions 2012

Outcome of victims depend on co morbid disease, . Outcome of victims depend on co morbid disease, mechanism and the type of injuries. Wound infections (Nos-52,82%) are the commonest encountered problem among them. The survivors(Nos-30,44%) had long hospital stays nearly more than two weeks. Mortality was higher during 2nd week of hospital stay due to infections (7 out of 10). The cosmetic disfigurement and contractures are encountered among the survivors. Contractures esp in neck and limbs were also reported in follow up patients. Annual Academic Sessions 2011

All data were analyzed using SPSS analytical package. Statistical analysis All data were analyzed using SPSS analytical package. Annual Academic Sessions 2012

Marital problems was significantly contributed to suicidal burn injuries. (P<0.05) Traditional lamps was significantly contributed to accidentalburninjuries. (P<0.05) Fire burn injuries are a very significant method of suicidal and accidental burn injuries. (P<0.05) Mortality and morbidity were significantly associated with infections rather than total surface area of burn injuries. (P<0.05) Annual Academic Sessions 2012

CONCLUSIONS Commonest victims of Burn Injuries Female, Married, Tamils, Hindus, Young adults, from Rural areas. Major contributors for Burn Injuries Accidental common than Suicidal. Accidental Burn Injuries: Traditional lamps & Kerosene oil cookers Suicidal Burn Injuries: Failures Marital and Romantic relationship Risk Factors: Alcoholism, Epilepsy, Psychiatric diseases Annual Academic Sessions 2012

Greatest challenge – Mortality of Victims Commonest injuries Deep Burn Injuries & Fire Burn Injuries Impact of Burn injuries Cosmetic disfigurement & Contractures Ultimate Burn injuries Secondary Bacterial Infections Death Infections Greatest challenge – Mortality of Victims Annual Academic Sessions 2012

Get the “Recommendations” from research; Precautions should be taken to prevent the incidence of accidental burn injuries Problem-solving ability has to be promoted to reduce the rates of suicidal burn injuries among young females in Batticaloa district. Intensive Care Burn Unit is necessary to reduce the mortality of the victims in Batticaloa. Annual Academic Sessions 2012

BURN INJURIES HAVE TO BE PREVENTABLE Annual Academic Sessions 2012

References Annual Health Bulletin 2000. Department of Health Services, Sri Lanka. Total Burn Care, 3rd Edition, Edited by David Herndon, Saunders, 2007. Cameron DR, Pegg SP, Muller M. Self-inflicted burns. Burns 1997;23:519–21. Somasundaram D, Rajadurai S. War and suicide in northern Sri Lanka. Acta Psychiatr Scand 1995;91:1–4. Annual Academic Sessions 2012

Acknowledgement Supervisor & Co-Author Committee of BMA Sincere thanks to Supervisor & Co-Author Committee of BMA Victims & relatives of Burn Injuries Staffs, TH, Batticaloa. Annual Academic Sessions 2012

THIS RESEARCH PAPER IS TO BE PUBLISHED AS “FULL PAPER” IN INTERNATIONAL JOURNAL OF SURGERY,EDINBERG SOON. Annual Academic Sessions 2012

Thank you Annual Academic Sessions 2012

QUESTIONS Annual Academic Sessions 2012