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 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 2  |  Issue : 2  |  Page : 117-121

An analytical study on burns in Isfahan province from 2009 to 2011 focusing on ICD-10


Health Information Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Date of Web Publication18-Aug-2014

Correspondence Address:
Maryam Jahanbakhsh
Health Information Management, Shahid Beheshti University of Medical Sciences, Tehran - 81745346
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2347-9019.139071

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  Abstract 

Background: Among the critical world health problems, burns are considered as one of the major causes of illness and death. Materials and Methods: This research is an analytical-retrospective. The study population included all inpatients (n = 2604) admitted to Imam Musa Kazim Center from 2009-2011. The demographic data and in-hospital outcomes in the burned people were classified based on factors in ICD-10 (anatomical site, cause of burn, place of burn and total burn surface area, TBSA) and then were analyzed by analytical statistics. Results: The finding showed the ratio of women's mortality due to burns to men's was 2:1. The probability of mortality was also doubled by an increase in TBSA. The rate of burns in men compared to the women was 1.6-1 with the highest frequency in the patients aged 15-30. There was statistically significant correlation between TBSA and gender, age, marital status and finally mortality factors (P < 0.0001). The frequency of burns, from 2009 to 2011, was higher for the 15-30 age group, females as well as the married ones. TBSA, age, gender, marital status, and cause of burn found to be the most significant factors influencing mortality's risk due to burns, respectively. Conclusion: ICD-10 can portray many epidemiological information needs in health care domain. It can be used as a proper tool for providing statistics reports and preventive guidelines.

Keywords: Burn, classification, hospital


How to cite this article:
Moghadasi H, Hosseini A, Jahanbakhsh M. An analytical study on burns in Isfahan province from 2009 to 2011 focusing on ICD-10. Int J Health Syst Disaster Manage 2014;2:117-21

How to cite this URL:
Moghadasi H, Hosseini A, Jahanbakhsh M. An analytical study on burns in Isfahan province from 2009 to 2011 focusing on ICD-10. Int J Health Syst Disaster Manage [serial online] 2014 [cited 2024 Mar 29];2:117-21. Available from: https://www.ijhsdm.org/text.asp?2014/2/2/117/139071


  Introduction Top


Globally, in 2004 the incidence of burns was nearly 11 million people and ranked fourth in all injuries. Burns account for over 300,000 deaths each year throughout the world. [1]

Burns injuries remain one of the leading causes of morbidity and mortality in East Mediterranean Region's states including Iran. [2],[3],[4],[5]

Based on the studies, burn injuries are a major health problem in Iran. [6],[7] However, due to the limited number of studies conducted on this problem, its nature and spread are still unknown. [8] Having enough information about the epidemiology of burn injuries can lead to adopting proper and efficient strategies for its prevention and treatment. [7] To achieve this goal, designing a standard system for burn injuries classification such as ICD-10 is required. [9] In ICD-10, the burns are categorized based on anatomical site, total burn surface area (TBSA), cause and place of burn and these factors are very important in selection of treatment approaches. [10] Hence, this study intended to analyze the burns injuries in the Province of Isfahan, I.R.I applying the above-mentioned classification.


  Materials and Methods Top


The present study had an analytical-retrospective nature. The study's population included all inpatients (n = 2604) admitted to Imam Musa Kazim Center from 2009-2011. Imam Musa Kazim Center is one of the known Isfahan's medical centers specialized in burns. The data required for this study were obtained from this Center's database. They were divided into three parts as follows:

  • The factors categorized in ICD-10 including anatomical site, cause of burn, place of burn and TBSA
  • Demographic data including gender, age and marital status
  • In-hospital outcomes including length of stay (LOS) and mortality.


After segmenting the data, the researchers embarked upon analyzing them focusing on ICD-10.


  Results Top


From 2009-2011, totally 2604 people with burn injuries were admitted to Imam Musa Kazim Medical Center. The data related to these inpatients were analyzed in terms of three separate areas presented below.


  Demographic Data Top


All in all, the rate of burns for males and females were 61.4% and 38.6%, respectively (that is a ratio of 1.6:1). The mean age was 25.6 ± 18.3 years with the majority of the burns (41.5%) among the people 15-30 years of age. In addition, the single people (51.7%) had suffered more burns compared with the married (48.3%).

In-hospital outcomes

The average length of stay (ALOS) was found to be 13.8 ± 14.7 days. T-test results reflected a remarkable difference between ALOS in women (16.5 ± 16) and men (12.2 ± 13). With reference to Pearson tests results, it should be noted that there was no statistically significant relationship between age and length of stay (r = -0.05, P = 0.19) [Table 1].
Table 1: Demographic data and risk factors classified in ICD-10 and in-hospital outcomes in burn injuries

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The overall in-hospital mortality rate was 19.1% (13.3% for males and 28.3% for females). In age‐groups older than 1 year, this rate went higher in parallel with the increase in age so that the highest rate of mortality occurred in the group aged ≥65 years. Mortality in the married people was higher than the important factors influencing mortality due to burns.

Analysis of demographic data and in-hospital outcomes based on burn classification in ICD-10

Anatomical site and demographic data

0According to the results, the majority of the recorded burns (97.1%) had affected multiple regions of body, regardless of gender, age group and marital status with the lower limbs' burn (1.9%) in the second rank.

Cause of burn and demographic data

As far as the cause of burn is concerned, the results indicated that burns due to explosions (25.3%), exposure to electric current (8.6%) and chemical and toxic substances (4.2%) were more frequent in men than women. Conversely, exposure to fire and steam (52.2%) and exposure to hot substances (24.1%) had a higher frequency in female patients compared with the males. On the whole, the most common cause of burns in both genders was fire and hot steam. In addition, an upward trend was observed for mortality in burn cases whose TBSA equaled ≥70%. Burns due to explosion of materials (29.8%) and exposure to electric current (7.8%) in the group aged 31-64 years, exposure to fire and flames (54.8%) in the group aged 15-30 years, exposure to heat and hot substances (92.5%) in the group aged less than 1 year, chemical and toxic substances (4.7%) in the group aged older than 64 years were more frequent compared with the other groups. Generally, exposure to heating substances (85.3%) and exposure to fire and steam were the primary factors contributing to burns for the age-group less than 6-years-old and other groups, respectively. In the same vein, burn due to exposure to fire and steam (51%), explosion of materials (27.8%), exposure to electric current (7.4%), and chemical and poisonous substances (4.1%) were more common in the married than the single people, while exposure to heating substances (37.1%) was more common in the single ones. Totally, self-inflicted burns accounted for 8.7% of the causes of burns (male = 1.4% and female = 20.2%). The age-specific rate of suicidal behavior by burns peaked at age of 15-30 years and it had been on increase from 2009-2011.

Place of burn and demographic data

The majority of home burns (67.9%) belonged to the female patients. Except the group of 15-64 years old, for other groups the burns had occurred at home. All in all, the main place of the majority of burn injuries that is 57.3% was found to be home.

TBSA and demographic data

The burns of TBSA less than 40% and the burns of TBSA more than 40% were more frequent in men and women, respectively. According to the results obtained from Mann-Whitney test, the TBSA of burns was significantly higher for the females and married subjects compared with that of the males and the single subjects (P < 0.001). Spearman correlation test revealed that there was a statistically significant relationship between age and TBSA (r = 0.0018, P < 0.001). The TBSA values for the patients under 15 and over 64 years of old, the patients aged 15-30 years and the patients aged 31-64 years were 10-19%, 20-29%, and 20-39%, respectively. Similarly, the TBSA in the majority of burns was 20-39% for the single and 10-19% for the married [Table 1],[Table 2] and [Table 3].
Table 2: The relationships between the burn's factors classified in ICD-10 and patients' demographic data based on cross tab

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Table 3: The relationships between the burns' factors classified in ICD-10 and in-hospital outcomes based on cross tab

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Anatomical site and in-hospital outcomes

In all fatal burns which accounted for 19.7% of the burns, multiple areas of the body were affected.

Cause of burn and in-hospital outcomes

Exposure to hot substances (3.9%) and exposure to fire and steam (29.9%) were found to be the lowest and highest frequent causes of death due to burns. Explosion with a frequency of 18.2% ranked second as far as the causes of fatal burns were concerned.

Place of burn and in-hospital outcomes

Most fatal burns (19.9%) had occurred at home.

TBSA and in-hospital outcomes

Based on Mann-Whitney test results, it TBSA was significantly higher for fatal burns (P < 0.001).

ALOS and in-hospital outcomes

It is noteworthy that the ALOS as one of the in-hospital outcomes showed no statistically significant difference in terms of other factors under study and was approximately 14 days.


  Discussion Top


Similar to previous studies, [2],[6],[7] this study also showed that the majority of burns had occurred in the 15-30 age group, while the highest rate of mortality belonged to the age group ≥65. In other words, this study proved that half of the burns had led to death in this age group so that following an increase of 1 year in the age, there was a rise in the chance of mortality by 6% compared to the previous age. This might be attributed to this age group's senility and physical weakness. The researchers also found that the burns are more frequent in the males compared with the females, again consistent with the previous studies. [6],[11],[12] It seemed to be explained by the men's presence in hazardous environments and their high-risk jobs. Notwithstanding, like past studies the rate of mortality due to burns in women to men found to be at 2:1. [11],[12],[13],[14],[15] Although, most burns occurred in single patients, the proportion of mortality was higher in the married justifiable considering the higher rate of self-inflicted burns in this group.

In this study, exposure to fire and steam was the most common cause of the burns studied here with boiling water being the most frequent cause of burns occurred for the children under 6. This result was again in line with the previous studies. [13],[14],[15],[16],[17],[18] In terms of order, fire and steam, hot substances and explosion were the leading causes in the vast number of the reported burns. In all age‐groups and both genders, that is female and male, the burns had affected multiple areas of the body. More than half of the burns, especially for the group aged less than 6 years, had occurred at home, as reported elsewhere. [2],[3],[6],[19] The highest TBSA reported for the group aged less than 15 and over 64 and the single was 10-19% and for the group aged 15-64 old years and the single patients was 20-29%.

According to Mann Whitney test, TBSA was greater in the females than the males (P < 0.001), again in agreement with other studies. [11] As in other studies, [17] a statistically significant correlation was found between TBSA and sex, marriage, length of stay, and death variables. In all fatal burns, multiple areas of body involved and the cause of all of them had been fire. [2] Furthermore, an upward rise was detected in the rate of mortality due to burns of TBSA of about 70% and higher.

Independent T-test reflected a statistically significant relationship between gender and ALOS, that is, compared with the male patients, the average length of stay was greater for the females. In addition, the rate of female mortality was double that of males. Self-inflicted burns were more frequent for the group from 15-30 years old. [20],[21] The rate of this type of burns had increased from 2009-2011 that can be regarded as an indicative of the growth of social problems. Comprising 8.7% of the total reported burns, self-inflicted burns were associated with a very high mortality of up to 41%. [2],[22]

According to the findings, the most leading factors influencing burns' mortality included TBSA, age (the higher the age, the higher the rate of mortality), gender (females having a higher rate of mortality), marital status and the cause of the burn, respectively. [2],[13],[19]


  Conclusion Top


ICD-10 can portray many epidemiological information needs in health care domain and provides a systematic approach for their international classification. It can be used as a proper tool for providing statistics reports and preventive guidelines.

 
  References Top

1.Peck MD. (2011). Epidemiology of burns throughout the world. Available from: www.who.org [Last retrieved on 2010 Sept 14].  Back to cited text no. 1
    
2.Othman N, Kendrick D. Epidemiology of burn injuries in the East Mediterranean Region: A systematic review. BMC Public Health 2010;10:83.  Back to cited text no. 2
    
3.Alaghehbandan R, Rossignol A, Rastegar Lari A. Pediatric burn injuries in Tehran, Iran. Burns 2001;27:115-8.  Back to cited text no. 3
    
4.Authorities should pay special attention to burn. Treat Ind J 2014 ;34:64.  Back to cited text no. 4
    
5.Amiralvi S, Mobaien M, Tolui M, Nursalehi E, Gholipur A, Gholamalipur N, et al. Epidemiology and burn outcome in burned patients in gilan province. Ghom Univ Med Sci J 2013;7:36.  Back to cited text no. 5
    
6.Vaseei N, Boduhi N, Molavi M, Jahangiri K, Babaei A. Identifying the indicatives of mortality rate in the burn patients. Payesh Q 2009;8:297-301.  Back to cited text no. 6
    
7.Aqakhani N, Rahbar N, Feizi A, Karimi H, Vafashoar N. Epidemiology of the patient admitted to burns unit of Orumieh′s hospital. Res Sci Q Kermanshah′s Med Sci Univ 2008,12:141.  Back to cited text no. 7
    
8.Rajabian MH, Aghaei S, Fouladi, V. Analysis of survival and hospitalization time for 2057 burn patients in Shiraz, southwestern Iran. Med Sci Monit 2007;13:CR353-5.  Back to cited text no. 8
    
9.Holder Y, Peden M, Krug E, Lund J, Gururaj G, Kobusingye O. Injury Surveillance Guidelines. Centers for Disease Control and Prevention, Atlanta, USA, by the World Health Organization, 2001.  Back to cited text no. 9
    
10.Khankeh H, Forutan R. Countries how encountered with the burn phenomenon in pre-hospital care area. J Rescue Aid 2013;3:88-90.  Back to cited text no. 10
    
11.Soltani K, Zand R, Mirghasemi A. Epidemiology and mortality of burns in Tehran, Iran. Burns 1998;24:325-8.  Back to cited text no. 11
    
12.Maghsoudi H, Pourzand A, Azarmir G. Etiology and outcome of burns in Tabriz, Iran. An analysis of 2963 cases. Scand J Surg 2005;94:77-81.  Back to cited text no. 12
    
13.Panjeshahin MR, Lari AR, Talei A, Shamsnia J, Alaghehbandan R. Epidemiology and mortality of burns in the South West of Iran. Burns 2001;27:219-26.  Back to cited text no. 13
    
14.Sadeghi Bazargani H, Arshi S, Ekman R, Mohammadi R. Prevention-oriented epidemiology of burns in Ardabil Provincial Burn Centre, Iran. Burns 2011;37:521-7.  Back to cited text no. 14
    
15.Hosseini RS, Askarian M, Assadian O. Epidemiology of hospitalized female burns patients in a burn centre in Shiraz. East Mediterr Health J 2007;13:113-8.  Back to cited text no. 15
    
16.Groohi B, Alaghehbandan R, Lari AR. Analysis of 1089 burn patients in province of Kurdistan, Iran. Burns 2002;28:569-74.  Back to cited text no. 16
    
17.Korasani Q, Salehifar A, Eslami G. An investigation of the causes of burns and their consequences in the in-patients in the burn section of Sari′s Zareh Hospital. Mazandaran′s Med Univ J 2007;17:123.  Back to cited text no. 17
    
18.Sheikhazad A, Gharedaghi GH, Ghadiani MH. The epidemiologic survey of fatal burns in Tehran-2006. Sci J Legal Med 2007;12:151-7.  Back to cited text no. 18
    
19.Saadat M. Epidemiology and mortality of hospitalized burn patients in Kohkiluye va Boyerahmad province (Iran): 2002-2004. Burns 2005;31:306-9.  Back to cited text no. 19
    
20.Alaghehbandan R, Lari AR, Joghataei MT, Islami A, Motavalian A. A prospective population-based study of suicidal behavior by burns in the province of Ilam, Iran. Burns 2011;37:164-9.  Back to cited text no. 20
    
21.Mohammadi A, Danesh N, Sabet B, Amini M, Jalaeian H. Self-inflicted burn injuries in southwest Iran. J Burn Care Res 2008;29:778-83.  Back to cited text no. 21
    
22.Sharqi A, Masheofi K, Babaei E. The epidemiology of fatal burns in the city of Ardebil from 1998 to 2010. Sci J Legal Med 2011;15.  Back to cited text no. 22
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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