Original Article
Incidence and risk factors of burn injuries among infants, Finland 1990–2010,☆☆,

https://doi.org/10.1016/j.jpedsurg.2014.05.034Get rights and content

Abstract

Background

Our aim was to study the incidence, mechanisms, treatment, and risk factors of burn injuries in infants younger than 1 year.

Methods

Data on burn-injured infants during 1990–2011 in Finland came from the National Hospital Discharge Register (NHDR). Information on birth and maternal-related factors came from the Finnish Medical Birth Register, and data on fatal injuries from the Cause of Death Register of Finland.

Results

This study included 1842 children, female to male 1:1.5. The annual overall incidence of inhospital and outpatient admissions increased during the study period (p < 0.05). Major risk factors were male gender, parity, and the mother's socioeconomic status and young age. The most common causes were scalds and contact burns. Severity of the injury increased along with increasing age, and children aged 9–12 months had the highest prevalence of surgical treatment.

Conclusions

Burn injury incidence in children under 1 year has increased during recent decades in Finland. First-born 9- to 12-month-old boys of young mothers of low socioeconomic status are at higher risk of burn injuries. Preventative work needs strengthening to reduce infant burn injuries.

Section snippets

Patients and methods

Inclusion criteria for this current register linkage study were that the child was aged less than 1 year when the burn injury occurred and had been treated in a hospital in Finland in 1990–2011. Burn-injured patients born in Finland between 1.1.1990 and 31.12.2010 were included, and the last admission date for hospital treatment in this study was 31.12.2011. ICD-9 is the 9th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD).

ICD-9 codes (during

Statistical analyses

We calculated risk ratios with 95% confidence intervals for various risk factors involved in burn injuries. Tests of relative proportions and chi square tests were calculated where appropriate.

P values of 0.05 or below were considered statistically significant.

The Helsinki University Central Hospital review board approved the study and its plan. Permissions to use the register information in scientific research were obtained from the data-holding governmental organizations after consultation

Results

A total of 1923 patients aged less than 1 year of age were diagnosed with burn injury during 1990–2011 in Finland. Of these, 1842 patients were included in this study; 78 (4.1%) could not be tracked because of a missing or incomplete PIC. These excluded children had no valid PIC, or they were noncitizens/nonresidents, or the child was born elsewhere than in Finland. Three burn-injury-related deaths occurred at the burn accident site, and these two girls and a boy, were excluded. No deaths were

Seasonal and weekday variation

In total, 30% of the injuries occurred during the 3 winter months (p < 0.001). The highest number of burn injuries was recorded in December, when 205 (11%) burns occurred. Monthly variation ranged from 125 (7%) burns in August to 179 (10%) burns in February. In the beginning of the week, on Mondays and Tuesdays (p < 0.001), risk for burn injuries was highest, 642 (34%) burns occurring on Mondays and Tuesdays, Table 3 illustrates the burns stratified by weekday in detail. We recorded no increase of

Injury etiology and location

Etiology and external causes of injury were available in 618 (33.6%) cases, with 37 of the external causes impossible to track, 581 (31.5%) ICD-9/10 codes were included. We found 274 (14.9%) contact burns and 220 (11.9%) scalds. Only 16 (2.8%) of burn accidents had external causes related to exposure to smoke, fire, or flames or heat of man-made origin.

Burns of the wrist and hand affected 714 (38.8%) patients, of whom 519 (28.2%) were aged 9–12 months, only 20 (1.1%) being less than 6 months.

Operative treatment

Operative treatment was recorded 1012 times for 302 (16.4%) children, and 271 (14.7%) had more than one operative treatment code. In 19 cases, the codes could not be tracked, so the total operative codes included was 993; 588 (59.2%) of the codes were related to treatment of burn injuries such as dressing changes, debridement, excision, and skin grafting. Autologous skin grafting was performed 125 (12.6%) times. The oldest children, 9–12 months, were recorded with the highest prevalence of

Risk factors

Gender, parity, socioeconomic status, and especially mother's age are factors influencing risk for infant burn injury. Boys were at higher risk, risk ratio (RR) of 1.47 (95% CI 1.34–1.62). First-born children were at higher risk than were later siblings, RR 1.26 (95% CI 1.00–1.58).

Children of young mothers, below 25, were at higher risk for burn injuries. Among teenaged mothers, the RR was 5.33 (95% CI 3.70–7.68), which fell to 2.67 (95% CI 1.98–3.58) for mothers aged 20–24 years. RR decreased

Incidence

Annual overall incidence per 1000 for all infant burn injuries increased during follow-up from 0.77 to 2.04, and similarly outpatient burns from 1.11 to 1.67. Incidence of inpatient burns fell from 0.77 to 0.36 (Table 6).

Incidence by gender by age-group showed that in the youngest age groups, below 6 months, numbers for girls and boys were almost equal, but in older age groups appeared a clear male dominance. Incidence in the youngest age-group, less than 3 months, in girls was 7% higher, similar

Discussion

During 1990–2011, 1842 Finnish-born patients less than 1 year of age were seen in hospital owing to burn injury. The inhospital mortality in this cohort was zero, although, 3 burn-related deaths occurred at the burn-injury site. The male to female ratio was 1.5:1, in line with the earlier studies [5], [11], [12], [13], [14], [15]. Yet, in the current study, in the youngest age group, less than 6 months, the incidence of burn injuries was higher in girls. Our previous work on inhospital-treated

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  • Cited by (0)

    Funding Source: This study was financially supported by the Competitive Research Financing of the Expert Responsibility area of Tampere University Hospital, Kanta-Häme Central Hospital, Grant 3097.

    ☆☆

    Financial Disclosure: The authors have no financial disclosures to report in relation to the content of this article.

    Conflict of Interest: Authors have no conflicts of interest to disclose.

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