Chopra M, Kettle H, Wilkinson D, Stirling S
Hlabisa Hospital, KwaZulu-Natal.
S Afr Med J. 1997 May;87(5):600-3.
To describe the epidemiology, clinical features, management and outcome of children with burns admitted to a rural district hospital.
A retrospective analysis of the case notes of consecutive cases of paediatric burns.
Hlabisa Hospital, KwaZulu-Natal-a 450-bed rural district hospital serving approximately 200,000 people.
All cases of paediatric burns (age < 12 years) admitted to Hlabisa Hospital in 1994.
Number of admissions, month of admission, age, sex, time to presentation, site of burn, complications, number of surgical procedures, adherence to management protocol and outcome.
One hundred and forty-nine children presented to the outpatient department in 1994 and 88 (59%) were admitted. The median age of those admitted was 36 months with 66 (75%) aged less than 5 years; 42 (48%) were boys. Thirty-nine children (44%) were admitted during the four winter months of May to August. The average interval from the time of the burn to presentation at hospital was 42 hours (range 1-120). Sixty-eight burns (77%) were due to hot fluid or food burning the legs, trunk or arms. There was a high level of morbidity. Nineteen (22%) children developed wound infections, 5 (6%) developed contractures and 20 (23%) required a total of 32 surgical procedures. There was 1 death. Burns were responsible for more paediatric patient days spent in hospital than any condition other than malnutrition, and a longer length of stay was associated with delay in presentation. Children presenting within 24 hours of the burn had a mean length of stay of 12.8 days, compared with 25.2 days (P = 0.03) for children presenting 24 hours or more after the burn. Twenty of the 22 children who stayed for longer than 3 weeks or who required transfer were judged to have been managed inadequately in at least one respect compared with 3 of 48 who were discharged within 2 weeks or not transferred (P < 0.001).
This study shows that paediatric burns are an important cause of morbidity and contribute significantly to inpatient stay in this rural setting. The lengthy delay from time of burn to presentation at hospital is of serious concern and our results show that this delay is associated with increased hospital stay. As most burns were due to spillage of hot fluids or food there seems to be significant potential for preventive interventions. Community-based studies would help to estimate the true incidence of burns and would contribute to an understanding of the reasons for delay in presentation. The information gathered is being used to inform the development of a burns prevention programme.
描述一家农村地区医院收治的儿童烧伤患者的流行病学、临床特征、治疗及预后情况。
对连续性儿科烧伤病例记录进行回顾性分析。
夸祖鲁 - 纳塔尔省的赫拉比萨医院——一家拥有450张床位的农村地区医院，服务约20万人。
1994年在赫拉比萨医院收治的所有儿科烧伤病例（年龄<12岁）。
入院人数、入院月份、年龄、性别、就诊时间、烧伤部位、并发症、手术次数、治疗方案依从性及预后。
1994年有149名儿童到门诊部就诊，88名（59%）入院。入院儿童的中位年龄为36个月，66名（75%）年龄小于5岁；42名（48%）为男孩。39名儿童（44%）在5月至8月这四个冬季月份入院。从烧伤到医院就诊的平均间隔时间为42小时（范围1 - 120小时）。68处烧伤（77%）是由于热液或食物烫伤腿部、躯干或手臂。发病率较高。19名（22%）儿童发生伤口感染，5名（6%）出现挛缩，20名（23%）共需要进行32次手术。有1例死亡。烧伤导致的儿科住院天数比除营养不良外的任何疾病都多，就诊延迟与住院时间延长相关。烧伤后24小时内就诊的儿童平均住院时间为12.8天，而烧伤后24小时或更长时间就诊的儿童为25.2天（P = 0.03）。在住院超过3周或需要转院的22名儿童中，有20名被判定在至少一个方面治疗不充分，而在2周内出院或未转院的48名儿童中有3名（P < 0.001）。
本研究表明，儿科烧伤是发病的重要原因，在这个农村地区对住院时间有显著影响。从烧伤到医院就诊的长时间延迟令人严重担忧，我们的结果表明这种延迟与住院时间增加有关。由于大多数烧伤是由于热液或食物溢出所致，似乎有很大的预防干预潜力。基于社区的研究将有助于估计烧伤的真实发病率，并有助于理解就诊延迟的原因。所收集的信息正用于为烧伤预防计划的制定提供依据。
