Introduction Epidemiology

Each year some 50 000 burnt or scalded children attend emergency departments. Of these, 5000-6000 require hospital admission. In England and Wales in 1998, 20 children died from burns. Seventy per cent of those burnt are pre-school children, the most common age being between 1 and 2 years. Scalds occur mostly in the under-4s. Boys are more likely to suffer burns and serious scalds.

Most fatal burns occur in house fires and smoke inhalation is the usual cause of death. The number of deaths from burns has decreased because of a combination of factors. The move away from open fires, safer fireguards, smoke alarms and more stringent low flammability requirements for night clothes have all played a part. Nonfatal burns often involve clothing and are often associated with flammable liquids.

Scalds are usually caused by hot drinks, but bath water and cooking oil scalds are not uncommon. The improvement in survival following scalding (which followed improvements in treatment) has reached a plateau.

There is a strong link between burns to children and low socioeconomic status. Family stress, poor housing conditions, and over-crowding are implicated in this.

Pathophysiology

Two main factors determine the severity of burns and scalds - these are the temperature and the duration of contact. The time taken for cellular destruction to occur decreases exponentially with temperature. At 44°C, contact would have to be maintained for 6 hours, at 54°C for 30 seconds, and at 70°C epidermal injury happens within a second. This relationship underlies the different patterns of injury seen with different types of burn. Scalds generally involve water at below boiling point and contact for less than 4 seconds. Scalds that occur with liquids at a higher temperature (such as hot fat), or in children incapable of minimising the contact time (such as young infants and the handicapped), tend to result in more serious injuries. Flame burns can involve high temperatures and prolonged contact and consequently produce the most serious injuries of all.

It must be re-emphasised that the most common cause of death within the first hour following burn injuries is smoke inhalation. Thus, as with other types of injury, attention to the airway and breathing is of prime importance.

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