- Email: [email protected]
Epidemiology of isolated adult lower limb burns over 15 years with a focus on preventable work-related injuries
JBUR 6009 No. of Pages 4
burns xxx (2019) xxx
xxx
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/burns
Epidemiology of isolated adult lower limb burns over 15 years with a focus on preventable work-related injuries Amal Sharaf * ,1 , Melissa Bautista, Lauren Taylor, Sharmila Jivan Department of Plastic Surgery and Burns, Pinderfields Hospital, Mid Yorkshire NHS Trust, United Kingdom
article info
abstract
Article history:
Our aim was to describe the epidemiology of isolated adult lower limb burns presenting to the
Accepted 22 December 2019
Pinderfields Regional Burns Centre, Wakefield, United Kingdom between 2003 and 2018. Data
Available online xxx
was obtained using our local records of the international Burn Injury Database (iBID). 6059 patients were treated in our department during this period. 18.7% presented with isolated
Keywords: Lower limb burns Preventable injuries Work-related burns
lower limb burns (n = 1133). 65.4% of patients were male (n = 741). Scald was the most common mechanism of injury. Work-related burns accounted for 23.4% of the injuries (n = 265). 36% of patients were admitted (n = 408), and 11.7% underwent surgical intervention (n = 133). Isolated lower limb burns are common in patients in the working age group. Work-related injuries are preventable. Targeted education to highlight the risks, reduce the incidence, and improve awareness of first aid measures are recommended. © 2019 Elsevier Ltd and ISBI. All rights reserved.
1.
Introduction
Burn injuries are a common acute presentation to emergency department. In 2004, the World Health Organisation (WHO) Global Burden of Disease report placed burn injury as the fourth most common substantial injury after road traffic accidents, falls and interpersonal violence [1]. In March 2008, the WHO described non-fatal burn injuries as a leading cause of morbidity, including prolonged hospitalization, disfigurement and disability [2]. Lower limb burns can be disabling and distressing. During the acute phase and until wound healing, lower limb burns can limit mobility. This can particularly affect productivity of patients in the working age group. Previous papers on trends and outcome of lower limb burn injuries have mainly focused
on isolated foot/feet burn injury in relation to paediatric and diabetic patient groups [3 8]. There is however a paucity of literature on the epidemiology of isolated lower limb burns including anatomical areas other than feet, in the healthy adult population. This study aims to provide epidemiological analysis of isolated lower limb burns in adult patients presenting to the Pinderfields Regional Burns Centre, Wakefield which serves a population of approximately 5 million, spread across 3000 square miles of Yorkshire and North Lincolnshire.
2.
Methods
Records of adult patients with isolated lower limb burn injuries, between 2003 and 2018, were obtained from our local
* Corresponding author at: Gate 29, Burns Unit, Pinderfields General Hospital, Aberford Road, Wakefiled, West Yorkshire, WF1 4DG, United Kingdom. E-mail addresses: [email protected], [email protected] (A. Sharaf). 1 Home Address: 2 Ashworth Square, Wakefield, West Yorkshire, WF1 4SN https://doi.org/10.1016/j.burns.2019.12.011 0305-4179/© 2019 Elsevier Ltd and ISBI. All rights reserved.
Please cite this article in press as: A. Sharaf, et al., Epidemiology of isolated adult lower limb burns over 15 years with a focus on preventable work-related injuries, Burns (2019), https://doi.org/10.1016/j.burns.2019.12.011
JBUR 6009 No. of Pages 4
2
burns xxx (2019) xxx
international Burn Injury Database (iBID). Data was categorized by age group and gender. Epidemiological analysis was performed on the mechanism of injury, total burn surface area (TBSA), depth and management including the need for admission and/or surgical intervention. A further subgroup analysis was conducted on workrelated injuries which represented approximately quarter of isolated lower limb burns.
3.
Results
3.1.
Demographics
A total of 1133 adult patients with isolated lower limb burns were identified. The male to female ratio was 1.89: 1 (741: 392) and the average age was 43.1 years (range 16 98). 87.1% of injuries occurred in the working age group, 16 65 years old (n = 987) (Table 1)
3.2. Total burn surface area (TBSA), anatomical distribution and depth In 56% of cases (n = 635), TBSA ranged between 1 to 4%. 36% of patients presented with TBSA of <1% (n = 408). Two patients were admitted with more than 20% TBSA. Isolated foot burns accounted for 32.8% of presentations (n = 372). In 5.7% of patients, burns involved feet, legs and/or thighs (n = 65). 61.4% of patients had isolated lower limb burns without foot involvement (n = 696). Deep dermal and/or full thickness wounds were diagnosed in 28.2% of cases (n = 320). 71.8% of patients sustained superficial to mid-dermal burns (n = 813) (Table 1)
3.3.
Mechanism of injury and first aid measures
Scald was the commonest mechanism of injury, representing 44.4% of isolated lower limb burns (n = 503). 73.1% of scalds occurred accidently at home by hot water or hot oil. Second most common mechanism was chemical burns, which accounted for a total of 16.2% of injuries (n = 184). 64.1% of chemical burns were caused by alkaline substance (n = 118). 15.2% of patients gave history of acidic burn injury (n = 28), and 20.7% did not know the type of chemical (n = 38).
xxx
Work-related injuries were associated with 23.4% of the isolated lower limb burns (n = 265). 27.16% of these patients did not receive and first aid measures prior to presenting to our Burns Centre (n = 72). 54.7% of work-related injuries were chemical burns (n = 145). Second most common mechanism of work-related burns was scald (24.5%, n = 65). Flame or flash burns occurred in 10.5% (n = 28) and contact burns in 10.1% (n = 27). Work-related burns rates increased significantly between 2013 and 2018 (Table 2,Fig. 1). Cement burns was the commonest among work-related chemical burns to lower limb and accounted for 46.2% of this group and 25.2% of all work-related injuries (n = 67). Majority of work-related cement burns (89.5%) occurred in industrial place of work or construction area (Table 2).
3.4.
Management
36% of patients with isolated lower limb burns were admitted to the hospital (n = 408). This included three patients who were admitted to Burns ICU for fluid resuscitation and monitoring. Of the remaining 405 patients, 14 were admitted to the burns ward for intravenous antibiotics after they developed systemic infections. The average length of stay of all inpatients was 8.3 days (range 1 81 days). 11.7% of patients underwent surgical management (n = 133). Ten patients had more than one surgical procedrue. 10.7% received skin grafts (n = 122). Two patients presented with circumferential full thickness burns and underwent emergency lower limb escharotomy. One patient with selfinflected electrical burns had bilateral lower limb fasciotomies and eventually underwent an above knee amputation on one side. Four patients with full thickness wounds had exposed bone and/or tendon. Two of these developed osteomyelitis and received amputation of one or more of their toes. One patient had exposed metalwork andunderwent flap coverage. Hospital admissions included 21 patients with workrelated cement burns. These account for 5.1% of total admissions and 31.3% of all work-related cement burns. Fifteen patients with cement burns underwent surgical management and 11 of them had their wounds grafted. Injury to healing time in this group ranged between 7 and 46 days (average = 14.6 days). Indicative average cost of management was £847.1 per patient.
Table 1 – Demographics, mechanism, TBSA and depth of lower limb burns in adults presented to Pinderfields Regional Burn Centre over a 15-year period. Demographics
No. (%)
Age
104 126 215 194 205 143 66 80 741 392
Gender
16 19 20 24 25 34 35 44 45 54 55 64 65 74 >75 Male Female
(9.1%) (11.1%) (18.9%) (17.1%) (18%) (12.6%) (5.8%) (7%) (65.4%) (34.6%)
Mechanism
No. (%)
Scald Chemical Contact Flame Flash Radiation Cold Friction Electrical Missed information
503 184 148 143 46 26 11 6 1 65
(44.4%) (16.2%) (13%) (12.6%) (4%) (2.2%) (0.9%) (0.9%) (0.08%) (5.7%)
TBSA
No. (%)
<1% 1 4% 5 9% 10 14% 15 19% 20 29% 30 39% Burn Depth Deep dermal to Full Thickness Superficial to mid-dermal
408 635 74 10 4 1 1 No. (%) 320 813
(36%) (56%) (6.5%) (0.8%) (0.3%) (0.08%) (0.08%) (28.2%) (71.8%)
Please cite this article in press as: A. Sharaf, et al., Epidemiology of isolated adult lower limb burns over 15 years with a focus on preventable work-related injuries, Burns (2019), https://doi.org/10.1016/j.burns.2019.12.011
JBUR 6009 No. of Pages 4
burns xxx (2019) xxx
3
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Table 2 – Mechanism of work-related lower limb burns in adult patients presented to Pinderfields Regional Burn Centre over a 15-year period. Work-related burns (total = 265) Mechanism Scald Chemical Contact Flame Flash
Work-related chemical burns (total = 145)
No. (%) 65 145 27 21 7
Chemical (24.5%) (54.7%) (10.1%) (7.9%) (2.6%)
No. (%)
Cement Hydrofluoric acid Unspecified acid Unspecified alkali Unknown Chemical
67 2 19 31 26
(46.2%) (1.3%) (13.1%) (21.3%) (17.9%)
Safety standards. We however advise periodic refresher sessions, two or three times a year, undertaken either online or face to face paying attention to:
Fig. 1 – Increasing work-related lower limb burn rates between 2003 and 2018.
4.
Discussion
Burn injuries are noted by WHO to be one of the leading causes of preventable injuries [2]. In our population, scalds were the most common mechanism of isolated lower limb burns. Chemical burns were the second most common with the majority of injuries occurring at work. We found that isolated lower limb burns predominantly affect active working sector of society which has a significant socioeconomic impact. A large number of these patients did not receive first aid until they presented to the emergency departments or our burns centre. Kneeling on concrete is the most common cause of workrelated of lower limb burns. Majority of these patients were unable to predict the duration of contact with the burning agent (cement) and estimated it as more than two hours. The construction industry statistics report released by the Office of National Statistics in October 2019, shows that between 2010 and 2018, the United Kingdom sustained year-on-year growth in the volume of construction industry with the highest growth since 2015 at 10.2% [9]. This may in part explain the increase in incidence of cement burn treated between 2013 and 2018. We propose a better education system to highlight the risks, reduce the incidence, and improve awareness of first aid measures in burn injuries, especially in work-related accidents. Those at higher risk of occupational injuries such as people working with flammables, chemicals and cement products receive mandatory training as part of Health and
Personal Protective Equipment (PPE) including fire and/or chemical resistant materials, proper gloves, footwear and eye protection. Thorough understanding of chemical they work with, safe handling, storage and management in case of exposure. For people who use cement/concrete, we recommend inspection of skin at the end of the shift. Functioning fire-extinguishing equipment, first aid kits and eyewash stations must be visible and easily accessible. Training sessions can be augmented by external education of local burns department. The suggestions we have made are largely based on the principles of mandatory training that NHS employees are expected to undertake and the pre and post procedural safety checks that are carried out to prevent any incidents.
5.
Conclusion
Our figures draw attention to areas where possible better education and preventive measures can be implemented. The outcome of this epidemiological analysis may not be applicable to other areas of the United Kingdom. We advise this study should be replicated in all burns centres in the country to provide a clearer picture and to help plan national prevention strategies.
Declaration The outcome of this study was presented in British Burns Association (BBA) annual scientific meeting 2019 and won the National Burn Care Poster Prize.
Funding None.
Conflict of interest None.
Please cite this article in press as: A. Sharaf, et al., Epidemiology of isolated adult lower limb burns over 15 years with a focus on preventable work-related injuries, Burns (2019), https://doi.org/10.1016/j.burns.2019.12.011
JBUR 6009 No. of Pages 4
4
burns xxx (2019) xxx
REFERENCES
[1] The World Health Organisation Global Burden of Disease Report: 2004 Update. World Health Organization Website https://www.who.int/healthinfo/global_burden_disease/2004_ report_update/en/ Published 2004, updated 2008, part 3, page 28, table 5 (Accessed December 28, 2019). [2] The World Health Organisation. Newsroom/Fact sheets/Detail/ Burns. World Health Organization Website https://www.who. int/news-room/fact-sheets/detail/burns/ Published March 2018 (Accessed December 28, 2019). [3] Hemington-Gorse S, Pellard S, Wilson-Jones N, Potokar T. Foot burns: epidemiology and management. Burns 2007;33(8):1041 5. [4] Shah BR. Burns of the feet. Clin Paediatr Med Surg 2002;19 (1):109 14.
xxx
[5] Barret JP, Herndon DN. Plantar burns in children: epidemiology and sequelae. Ann Plast Surg 2004;53(5):462 4. [6] Kılıç T, Krijnen P, Tuinebreijer WE, Breederveld RS. Epidemiology of foot burns in a Dutch burn centre. Burns Trauma 2015;3:5. [7] Lawrence E, Li F. Foot burns and diabetes: a retrospective study. Burns Trauma 2015;3:24. [8] Momeni M, Jafarian AA, Maroufi SS, Ranjpour F, Karimi H. Diabetes and foot burns. Ann Burns Fire Disasters 2018;31 (3):181 4. [9] Office of National Statistics, UK. Construction statistics, Great Britain: 2018 Report. Office of National Statistics Website https://www.ons.gov.uk/businessindustryandtrade/ constructionindustry/articles/constructionstatistics/2018/ Published October 2019; International comparisons; Figure 20 (Accessed December 28, 2019).
Please cite this article in press as: A. Sharaf, et al., Epidemiology of isolated adult lower limb burns over 15 years with a focus on preventable work-related injuries, Burns (2019), https://doi.org/10.1016/j.burns.2019.12.011
burns xxx (2019) xxx
xxx
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/burns
Epidemiology of isolated adult lower limb burns over 15 years with a focus on preventable work-related injuries Amal Sharaf * ,1 , Melissa Bautista, Lauren Taylor, Sharmila Jivan Department of Plastic Surgery and Burns, Pinderfields Hospital, Mid Yorkshire NHS Trust, United Kingdom
article info
abstract
Article history:
Our aim was to describe the epidemiology of isolated adult lower limb burns presenting to the
Accepted 22 December 2019
Pinderfields Regional Burns Centre, Wakefield, United Kingdom between 2003 and 2018. Data
Available online xxx
was obtained using our local records of the international Burn Injury Database (iBID). 6059 patients were treated in our department during this period. 18.7% presented with isolated
Keywords: Lower limb burns Preventable injuries Work-related burns
lower limb burns (n = 1133). 65.4% of patients were male (n = 741). Scald was the most common mechanism of injury. Work-related burns accounted for 23.4% of the injuries (n = 265). 36% of patients were admitted (n = 408), and 11.7% underwent surgical intervention (n = 133). Isolated lower limb burns are common in patients in the working age group. Work-related injuries are preventable. Targeted education to highlight the risks, reduce the incidence, and improve awareness of first aid measures are recommended. © 2019 Elsevier Ltd and ISBI. All rights reserved.
1.
Introduction
Burn injuries are a common acute presentation to emergency department. In 2004, the World Health Organisation (WHO) Global Burden of Disease report placed burn injury as the fourth most common substantial injury after road traffic accidents, falls and interpersonal violence [1]. In March 2008, the WHO described non-fatal burn injuries as a leading cause of morbidity, including prolonged hospitalization, disfigurement and disability [2]. Lower limb burns can be disabling and distressing. During the acute phase and until wound healing, lower limb burns can limit mobility. This can particularly affect productivity of patients in the working age group. Previous papers on trends and outcome of lower limb burn injuries have mainly focused
on isolated foot/feet burn injury in relation to paediatric and diabetic patient groups [3 8]. There is however a paucity of literature on the epidemiology of isolated lower limb burns including anatomical areas other than feet, in the healthy adult population. This study aims to provide epidemiological analysis of isolated lower limb burns in adult patients presenting to the Pinderfields Regional Burns Centre, Wakefield which serves a population of approximately 5 million, spread across 3000 square miles of Yorkshire and North Lincolnshire.
2.
Methods
Records of adult patients with isolated lower limb burn injuries, between 2003 and 2018, were obtained from our local
* Corresponding author at: Gate 29, Burns Unit, Pinderfields General Hospital, Aberford Road, Wakefiled, West Yorkshire, WF1 4DG, United Kingdom. E-mail addresses: [email protected], [email protected] (A. Sharaf). 1 Home Address: 2 Ashworth Square, Wakefield, West Yorkshire, WF1 4SN https://doi.org/10.1016/j.burns.2019.12.011 0305-4179/© 2019 Elsevier Ltd and ISBI. All rights reserved.
Please cite this article in press as: A. Sharaf, et al., Epidemiology of isolated adult lower limb burns over 15 years with a focus on preventable work-related injuries, Burns (2019), https://doi.org/10.1016/j.burns.2019.12.011
JBUR 6009 No. of Pages 4
2
burns xxx (2019) xxx
international Burn Injury Database (iBID). Data was categorized by age group and gender. Epidemiological analysis was performed on the mechanism of injury, total burn surface area (TBSA), depth and management including the need for admission and/or surgical intervention. A further subgroup analysis was conducted on workrelated injuries which represented approximately quarter of isolated lower limb burns.
3.
Results
3.1.
Demographics
A total of 1133 adult patients with isolated lower limb burns were identified. The male to female ratio was 1.89: 1 (741: 392) and the average age was 43.1 years (range 16 98). 87.1% of injuries occurred in the working age group, 16 65 years old (n = 987) (Table 1)
3.2. Total burn surface area (TBSA), anatomical distribution and depth In 56% of cases (n = 635), TBSA ranged between 1 to 4%. 36% of patients presented with TBSA of <1% (n = 408). Two patients were admitted with more than 20% TBSA. Isolated foot burns accounted for 32.8% of presentations (n = 372). In 5.7% of patients, burns involved feet, legs and/or thighs (n = 65). 61.4% of patients had isolated lower limb burns without foot involvement (n = 696). Deep dermal and/or full thickness wounds were diagnosed in 28.2% of cases (n = 320). 71.8% of patients sustained superficial to mid-dermal burns (n = 813) (Table 1)
3.3.
Mechanism of injury and first aid measures
Scald was the commonest mechanism of injury, representing 44.4% of isolated lower limb burns (n = 503). 73.1% of scalds occurred accidently at home by hot water or hot oil. Second most common mechanism was chemical burns, which accounted for a total of 16.2% of injuries (n = 184). 64.1% of chemical burns were caused by alkaline substance (n = 118). 15.2% of patients gave history of acidic burn injury (n = 28), and 20.7% did not know the type of chemical (n = 38).
xxx
Work-related injuries were associated with 23.4% of the isolated lower limb burns (n = 265). 27.16% of these patients did not receive and first aid measures prior to presenting to our Burns Centre (n = 72). 54.7% of work-related injuries were chemical burns (n = 145). Second most common mechanism of work-related burns was scald (24.5%, n = 65). Flame or flash burns occurred in 10.5% (n = 28) and contact burns in 10.1% (n = 27). Work-related burns rates increased significantly between 2013 and 2018 (Table 2,Fig. 1). Cement burns was the commonest among work-related chemical burns to lower limb and accounted for 46.2% of this group and 25.2% of all work-related injuries (n = 67). Majority of work-related cement burns (89.5%) occurred in industrial place of work or construction area (Table 2).
3.4.
Management
36% of patients with isolated lower limb burns were admitted to the hospital (n = 408). This included three patients who were admitted to Burns ICU for fluid resuscitation and monitoring. Of the remaining 405 patients, 14 were admitted to the burns ward for intravenous antibiotics after they developed systemic infections. The average length of stay of all inpatients was 8.3 days (range 1 81 days). 11.7% of patients underwent surgical management (n = 133). Ten patients had more than one surgical procedrue. 10.7% received skin grafts (n = 122). Two patients presented with circumferential full thickness burns and underwent emergency lower limb escharotomy. One patient with selfinflected electrical burns had bilateral lower limb fasciotomies and eventually underwent an above knee amputation on one side. Four patients with full thickness wounds had exposed bone and/or tendon. Two of these developed osteomyelitis and received amputation of one or more of their toes. One patient had exposed metalwork andunderwent flap coverage. Hospital admissions included 21 patients with workrelated cement burns. These account for 5.1% of total admissions and 31.3% of all work-related cement burns. Fifteen patients with cement burns underwent surgical management and 11 of them had their wounds grafted. Injury to healing time in this group ranged between 7 and 46 days (average = 14.6 days). Indicative average cost of management was £847.1 per patient.
Table 1 – Demographics, mechanism, TBSA and depth of lower limb burns in adults presented to Pinderfields Regional Burn Centre over a 15-year period. Demographics
No. (%)
Age
104 126 215 194 205 143 66 80 741 392
Gender
16 19 20 24 25 34 35 44 45 54 55 64 65 74 >75 Male Female
(9.1%) (11.1%) (18.9%) (17.1%) (18%) (12.6%) (5.8%) (7%) (65.4%) (34.6%)
Mechanism
No. (%)
Scald Chemical Contact Flame Flash Radiation Cold Friction Electrical Missed information
503 184 148 143 46 26 11 6 1 65
(44.4%) (16.2%) (13%) (12.6%) (4%) (2.2%) (0.9%) (0.9%) (0.08%) (5.7%)
TBSA
No. (%)
<1% 1 4% 5 9% 10 14% 15 19% 20 29% 30 39% Burn Depth Deep dermal to Full Thickness Superficial to mid-dermal
408 635 74 10 4 1 1 No. (%) 320 813
(36%) (56%) (6.5%) (0.8%) (0.3%) (0.08%) (0.08%) (28.2%) (71.8%)
Please cite this article in press as: A. Sharaf, et al., Epidemiology of isolated adult lower limb burns over 15 years with a focus on preventable work-related injuries, Burns (2019), https://doi.org/10.1016/j.burns.2019.12.011
JBUR 6009 No. of Pages 4
burns xxx (2019) xxx
3
xxx
Table 2 – Mechanism of work-related lower limb burns in adult patients presented to Pinderfields Regional Burn Centre over a 15-year period. Work-related burns (total = 265) Mechanism Scald Chemical Contact Flame Flash
Work-related chemical burns (total = 145)
No. (%) 65 145 27 21 7
Chemical (24.5%) (54.7%) (10.1%) (7.9%) (2.6%)
No. (%)
Cement Hydrofluoric acid Unspecified acid Unspecified alkali Unknown Chemical
67 2 19 31 26
(46.2%) (1.3%) (13.1%) (21.3%) (17.9%)
Safety standards. We however advise periodic refresher sessions, two or three times a year, undertaken either online or face to face paying attention to:
Fig. 1 – Increasing work-related lower limb burn rates between 2003 and 2018.
4.
Discussion
Burn injuries are noted by WHO to be one of the leading causes of preventable injuries [2]. In our population, scalds were the most common mechanism of isolated lower limb burns. Chemical burns were the second most common with the majority of injuries occurring at work. We found that isolated lower limb burns predominantly affect active working sector of society which has a significant socioeconomic impact. A large number of these patients did not receive first aid until they presented to the emergency departments or our burns centre. Kneeling on concrete is the most common cause of workrelated of lower limb burns. Majority of these patients were unable to predict the duration of contact with the burning agent (cement) and estimated it as more than two hours. The construction industry statistics report released by the Office of National Statistics in October 2019, shows that between 2010 and 2018, the United Kingdom sustained year-on-year growth in the volume of construction industry with the highest growth since 2015 at 10.2% [9]. This may in part explain the increase in incidence of cement burn treated between 2013 and 2018. We propose a better education system to highlight the risks, reduce the incidence, and improve awareness of first aid measures in burn injuries, especially in work-related accidents. Those at higher risk of occupational injuries such as people working with flammables, chemicals and cement products receive mandatory training as part of Health and
Personal Protective Equipment (PPE) including fire and/or chemical resistant materials, proper gloves, footwear and eye protection. Thorough understanding of chemical they work with, safe handling, storage and management in case of exposure. For people who use cement/concrete, we recommend inspection of skin at the end of the shift. Functioning fire-extinguishing equipment, first aid kits and eyewash stations must be visible and easily accessible. Training sessions can be augmented by external education of local burns department. The suggestions we have made are largely based on the principles of mandatory training that NHS employees are expected to undertake and the pre and post procedural safety checks that are carried out to prevent any incidents.
5.
Conclusion
Our figures draw attention to areas where possible better education and preventive measures can be implemented. The outcome of this epidemiological analysis may not be applicable to other areas of the United Kingdom. We advise this study should be replicated in all burns centres in the country to provide a clearer picture and to help plan national prevention strategies.
Declaration The outcome of this study was presented in British Burns Association (BBA) annual scientific meeting 2019 and won the National Burn Care Poster Prize.
Funding None.
Conflict of interest None.
Please cite this article in press as: A. Sharaf, et al., Epidemiology of isolated adult lower limb burns over 15 years with a focus on preventable work-related injuries, Burns (2019), https://doi.org/10.1016/j.burns.2019.12.011
JBUR 6009 No. of Pages 4
4
burns xxx (2019) xxx
REFERENCES
[1] The World Health Organisation Global Burden of Disease Report: 2004 Update. World Health Organization Website https://www.who.int/healthinfo/global_burden_disease/2004_ report_update/en/ Published 2004, updated 2008, part 3, page 28, table 5 (Accessed December 28, 2019). [2] The World Health Organisation. Newsroom/Fact sheets/Detail/ Burns. World Health Organization Website https://www.who. int/news-room/fact-sheets/detail/burns/ Published March 2018 (Accessed December 28, 2019). [3] Hemington-Gorse S, Pellard S, Wilson-Jones N, Potokar T. Foot burns: epidemiology and management. Burns 2007;33(8):1041 5. [4] Shah BR. Burns of the feet. Clin Paediatr Med Surg 2002;19 (1):109 14.
xxx
[5] Barret JP, Herndon DN. Plantar burns in children: epidemiology and sequelae. Ann Plast Surg 2004;53(5):462 4. [6] Kılıç T, Krijnen P, Tuinebreijer WE, Breederveld RS. Epidemiology of foot burns in a Dutch burn centre. Burns Trauma 2015;3:5. [7] Lawrence E, Li F. Foot burns and diabetes: a retrospective study. Burns Trauma 2015;3:24. [8] Momeni M, Jafarian AA, Maroufi SS, Ranjpour F, Karimi H. Diabetes and foot burns. Ann Burns Fire Disasters 2018;31 (3):181 4. [9] Office of National Statistics, UK. Construction statistics, Great Britain: 2018 Report. Office of National Statistics Website https://www.ons.gov.uk/businessindustryandtrade/ constructionindustry/articles/constructionstatistics/2018/ Published October 2019; International comparisons; Figure 20 (Accessed December 28, 2019).
Please cite this article in press as: A. Sharaf, et al., Epidemiology of isolated adult lower limb burns over 15 years with a focus on preventable work-related injuries, Burns (2019), https://doi.org/10.1016/j.burns.2019.12.011