- Email: [email protected]
Burns at school
burns 42 (2016) 1617–1622
Letter to the Editor Burns at school§ [1_TD$IF]Dear Sir, The burns in children are often distressing and can result from a wide range of circumstances. As a consequence, different mechanisms of burns require different preventative strategies. A school is considered a safe environment for children however accidental burns can still occur. We conducted this study to determine the patterns of burns sustained by children at school and school related activity and also to determine the areas where further initiatives could be taken to prevent burns in children. The study was conducted at the Welsh Centre for Burns and Plastic Surgery (WCBPS), Swansea United Kingdom. A retrospective review was conducted of the burns sustained by paediatric patients in a school environment or a school related activity from January 2010 to December 2014. The paediatric patients admitted or treated following burns was determined from our centre’s burn database that presented during this period (the burns database records both inpatient and outpatient, admission and attendance of all the burns treated at our unit. All the data recorded is maintained on an Excel sheet database). The patient demographics, mechanism of injury, provision of first aid, Total Body Surface Area (TBSA) of burn, depth of the burn and its management were recorded. All the data collected was extracted on a excel sheet and Microsoft Excel and Access were used for analysis. The study did not require a formal ethical review and appropriate letters of exemption were acquired from our National Health Service Trust’s Research Ethics Committee and Research & Development office. Ten (n = 10) patients sustained burns in a school environment or school related activity (Table 1). The average age was 10 years (range 4–15). 70% of the patients were male and 30% were female. In 50% (n = 5) the mechanism of burn was contact, 30% (n = 3) had scalds, 10% (n = 1) chemical and 10% (n = 1) sustained burns secondary to radiation (sun burn) (Fig. 1). The first aid was given in 90% (n = 9). The average TBSA of burn was 0.5% (range 0.15–1). In 7 patients the burns were partial thickness, two had mixed thickness and one patient
1621
had full thickness burn. One patient was admitted following failure of conservative treatment and hence, required a burn excision surgery and reconstruction with skin grafting for a full thickness burn (Fig. 2). 82% of the burns were sustained within the school environment through several mechanisms such as contact with bunsen burner in a chemistry lab, scalds following use of glue gun, contact and scald burns at school cooking class etc. and the remaining were sustained in school related activity such as at a school festival and a school trip. Burns are a significant cause of morbidity and mortality in the paediatric population [1–3]. The schools have been at the centre of successful community based burns prevention and education programs and are considered to be potentially a safe environment in regards to the incidence of burns [1]. There is a paucity of data reporting burns being sustained at schools in the developed world. In our study we report ten patients who sustained accidental burns in a school environment or school related activity. We found a higher incidence of burns in boys then girls (ratio 2:1), a statistic similar to the global incidence [4]. The majority of the paediatric burns are secondary to scalds which predominantly occur within the home environment. However, in older children flame is the leading cause of burns [4]. In our study, the mechanism of majority of the burns was contact followed by scalds. All the burns were accidental and were sustained in environments such as the laboratory, cooking class, using glue gun and school festivals/trips. Numerous complications can develop following paediatrics burns and include infection and septicaemia, hypertrophic and keloids scarring, contractures, amputation and disfigurement [4]. Fortunately, the cohort in our study did not have any complications as the average TBSA in our study was small and this was possibly because of the prompt first aid provided in 90% of the patients. Thought the study is limited by small numbers, it gives us an important insight into the patterns of burns in a school environment. These injuries are entirely avoidable. The key initiative to prevent such injuries at schools is to promote education on burns prevention and first aid training through outreach educational programs for parents, school staff and pupils. In addition, hot surfaces should be clearly marked in school and where, there is interaction with materials which can possibly cause chemical, scald and flame burns, the pupil should be closely supervised.
Table 1 – Demographical data, mechanism and the environment in which the burn was sustained. Serial number 1 2 3 4 5 6 7 8 9 10
§
Age
Sex
Mechanism
Environment
TBSA
9 12 4 6 15 13 11 12 7 11
F F F M M M M M M M
Scald Contact Scald Contact Contact Chemical Radiation Contact Scald Contact
Glue gun dripped onto child’s finger while at school Burnt hand on hot tray in cookery class in school Pulled a cup of hot water over herself at school fete Contact burn to right thigh at school breakfast club’s radiator Burnt his hand whilst using hot glue gun in school Put hand in pool of glue at school Sun burn sustained on a school trip Touched a hot handle of pan while cooking in cheese cake in school Sustained hot oil burn at the school club Touched bunsen burner at school
0.25 0.25 0.5 1 0.5 0.25 0.25 0.25 0.5 1
The study has been presented at the annual European Burns Association Meeting, Hannover, 2015.
1622
burns 42 (2016) 1617–1622
[(Fig._1)TD$IG]
Fig. 1 – The mechanism of burns in the study.
[(Fig._2)TD$IG] references
[1] Turner C, Spinks A, McClure R, Nixon J. Communitybased interventions for the prevention of burns and scalds in children. Cochrane Database Syst Rev 2004;(3):CD004335. [2] Koompirochana V, Javed M, Hemington Gorse S, Dickson W. Ten-year epidemiology and cost analysis of paediatric burns undergoing fluid resuscitation and treatment at the welsh centre for burns and plastic surgery. In: Annals of burns and fire disasters, vol. XXVIII – Supplement EBA; 2015. [3] Coles C, Javed M, Hemington Gorse S, Nguyen D. Paediatric burns secondary to nail glue: a case series. Burns Trauma 2016. http://dx.doi.org/10.1186/s41038-016-0048-6 [in press]. [4] Rayner R, Prentice J. Paediatric burns: a brief global review. Wound Pract Res: J Aust Wound Manage Assoc 2011;19(1):39–46.
Fig. 2 – Full thickness contact burn to thigh sustained at school.
Funding
Muhammad Umair Javed* Wajeeha Khan Sarah Hemington Gorse Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK *
None declared.
Conflict of interest None declared.
Corresponding author E-mail address: [email protected] (M.U. Javed) Accepted 5 May 2016 [(49)TD.ENIM] http://dx.doi.org/10.1016/j.burns.2016.05.004 0305-4179/# 2016 Elsevier Ltd and ISBI. All rights reserved.
Letter to the Editor Burns at school§ [1_TD$IF]Dear Sir, The burns in children are often distressing and can result from a wide range of circumstances. As a consequence, different mechanisms of burns require different preventative strategies. A school is considered a safe environment for children however accidental burns can still occur. We conducted this study to determine the patterns of burns sustained by children at school and school related activity and also to determine the areas where further initiatives could be taken to prevent burns in children. The study was conducted at the Welsh Centre for Burns and Plastic Surgery (WCBPS), Swansea United Kingdom. A retrospective review was conducted of the burns sustained by paediatric patients in a school environment or a school related activity from January 2010 to December 2014. The paediatric patients admitted or treated following burns was determined from our centre’s burn database that presented during this period (the burns database records both inpatient and outpatient, admission and attendance of all the burns treated at our unit. All the data recorded is maintained on an Excel sheet database). The patient demographics, mechanism of injury, provision of first aid, Total Body Surface Area (TBSA) of burn, depth of the burn and its management were recorded. All the data collected was extracted on a excel sheet and Microsoft Excel and Access were used for analysis. The study did not require a formal ethical review and appropriate letters of exemption were acquired from our National Health Service Trust’s Research Ethics Committee and Research & Development office. Ten (n = 10) patients sustained burns in a school environment or school related activity (Table 1). The average age was 10 years (range 4–15). 70% of the patients were male and 30% were female. In 50% (n = 5) the mechanism of burn was contact, 30% (n = 3) had scalds, 10% (n = 1) chemical and 10% (n = 1) sustained burns secondary to radiation (sun burn) (Fig. 1). The first aid was given in 90% (n = 9). The average TBSA of burn was 0.5% (range 0.15–1). In 7 patients the burns were partial thickness, two had mixed thickness and one patient
1621
had full thickness burn. One patient was admitted following failure of conservative treatment and hence, required a burn excision surgery and reconstruction with skin grafting for a full thickness burn (Fig. 2). 82% of the burns were sustained within the school environment through several mechanisms such as contact with bunsen burner in a chemistry lab, scalds following use of glue gun, contact and scald burns at school cooking class etc. and the remaining were sustained in school related activity such as at a school festival and a school trip. Burns are a significant cause of morbidity and mortality in the paediatric population [1–3]. The schools have been at the centre of successful community based burns prevention and education programs and are considered to be potentially a safe environment in regards to the incidence of burns [1]. There is a paucity of data reporting burns being sustained at schools in the developed world. In our study we report ten patients who sustained accidental burns in a school environment or school related activity. We found a higher incidence of burns in boys then girls (ratio 2:1), a statistic similar to the global incidence [4]. The majority of the paediatric burns are secondary to scalds which predominantly occur within the home environment. However, in older children flame is the leading cause of burns [4]. In our study, the mechanism of majority of the burns was contact followed by scalds. All the burns were accidental and were sustained in environments such as the laboratory, cooking class, using glue gun and school festivals/trips. Numerous complications can develop following paediatrics burns and include infection and septicaemia, hypertrophic and keloids scarring, contractures, amputation and disfigurement [4]. Fortunately, the cohort in our study did not have any complications as the average TBSA in our study was small and this was possibly because of the prompt first aid provided in 90% of the patients. Thought the study is limited by small numbers, it gives us an important insight into the patterns of burns in a school environment. These injuries are entirely avoidable. The key initiative to prevent such injuries at schools is to promote education on burns prevention and first aid training through outreach educational programs for parents, school staff and pupils. In addition, hot surfaces should be clearly marked in school and where, there is interaction with materials which can possibly cause chemical, scald and flame burns, the pupil should be closely supervised.
Table 1 – Demographical data, mechanism and the environment in which the burn was sustained. Serial number 1 2 3 4 5 6 7 8 9 10
§
Age
Sex
Mechanism
Environment
TBSA
9 12 4 6 15 13 11 12 7 11
F F F M M M M M M M
Scald Contact Scald Contact Contact Chemical Radiation Contact Scald Contact
Glue gun dripped onto child’s finger while at school Burnt hand on hot tray in cookery class in school Pulled a cup of hot water over herself at school fete Contact burn to right thigh at school breakfast club’s radiator Burnt his hand whilst using hot glue gun in school Put hand in pool of glue at school Sun burn sustained on a school trip Touched a hot handle of pan while cooking in cheese cake in school Sustained hot oil burn at the school club Touched bunsen burner at school
0.25 0.25 0.5 1 0.5 0.25 0.25 0.25 0.5 1
The study has been presented at the annual European Burns Association Meeting, Hannover, 2015.
1622
burns 42 (2016) 1617–1622
[(Fig._1)TD$IG]
Fig. 1 – The mechanism of burns in the study.
[(Fig._2)TD$IG] references
[1] Turner C, Spinks A, McClure R, Nixon J. Communitybased interventions for the prevention of burns and scalds in children. Cochrane Database Syst Rev 2004;(3):CD004335. [2] Koompirochana V, Javed M, Hemington Gorse S, Dickson W. Ten-year epidemiology and cost analysis of paediatric burns undergoing fluid resuscitation and treatment at the welsh centre for burns and plastic surgery. In: Annals of burns and fire disasters, vol. XXVIII – Supplement EBA; 2015. [3] Coles C, Javed M, Hemington Gorse S, Nguyen D. Paediatric burns secondary to nail glue: a case series. Burns Trauma 2016. http://dx.doi.org/10.1186/s41038-016-0048-6 [in press]. [4] Rayner R, Prentice J. Paediatric burns: a brief global review. Wound Pract Res: J Aust Wound Manage Assoc 2011;19(1):39–46.
Fig. 2 – Full thickness contact burn to thigh sustained at school.
Funding
Muhammad Umair Javed* Wajeeha Khan Sarah Hemington Gorse Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK *
None declared.
Conflict of interest None declared.
Corresponding author E-mail address: [email protected] (M.U. Javed) Accepted 5 May 2016 [(49)TD.ENIM] http://dx.doi.org/10.1016/j.burns.2016.05.004 0305-4179/# 2016 Elsevier Ltd and ISBI. All rights reserved.