Profile of scald injury among Paediatrics patient attending tertiary care hospital

Background: Scald injuries among children are a significant cause of mortality and morbidity. This is compounded by the additional risk factors such as poverty, higher birth order and urban slums which are seen in developing countries. But very few studies are available regarding the burden of this issue. This study seeks to assess the same. Methods: A prospective observational study was conducted in a tertiary care hospital for one year.A total of 66 children less than 12 years of age were included. Their demographic profile and treatment outcome were studied. Results: Most participants were less than 10 years old and almost half had first degree burns. Hot water scalds were the most common etiology followed by household liquid foods such as sambar and kanji. Most burns affected the front of the body. Silver nitrodiazine was the most common treatment followed by collagen application and open dressing. After treatment 81.5% improved. The mortality was 16.7%. Conclusions: Scald injuries are a common cause of morbidity among young children. Most incidents occur at home and are preventable. This indicates the need for parental education and the child safety measures for reducing mortality and morbidity due to scalds.


Introduction
Scald injuries are an issue of significant public health importance. It is also one of the major contributors of significant mortality and morbidity in the world [1]. It has multiple adverse sequelae such as pain and a protracted duration of treatment which may extend up to a life time in some instances. Approximately onethird to a half of all the burn injuries among high-and middle-income countries are due to scalds and 5% of all the deaths due to burn are scald injuries [2,3].
Although the incidence of burn injuries has considerably declined in the developed countries, there is still a need for information regarding the epidemiology of burn injuries and the potential risk factors. Children in the pre-school age experience a higher proportion of mortality when compared to other age groups. The mortality rate due to scald injuries among children under 4 years of age was 46.9%. The mortality reported in the current study was much higher than the reported mortality of 12.9% among older children reported by a previous study [2] Manuscript received: 30 th June 2018 Reviewed: 9 th July 2018 Author Corrected: 17 th July 2018 Accepted for Publication: 21 st July 2018 Scald injuries have multiple economic consequences as well. In a report by Miller et al observed that scald injuries and deaths among children less than 14 years of age alone account for $2.1 billion dollars expenses in the United States each year [3]. In a report by the British Burns Association, a case of serious bath water scald on intensive treatment would cause an expenditure of $280,000 [4].
Various studies have been conducted regarding the risk factors for injuries among children. A study by Bijur P et al identified problem drinking among mothers and problem drinking among both parents to be associated with an increased risk of injuries [5]. Other factors such as male gender, deprived urban neighborhood, number of older siblings and increased distance from the hospital were also found to be risk factors for scald injuries among children [6]. A study by Shah et al (2013) identified that the risk for scald injuries was greatest at 13 to 24 months of age compared to older children [1]. This is probably due to the fact that preschool children are more dependent on their mothers while at home [7]. Previous history of perinatal depression was also found to be a risk factor for scald Pediatric Review: International Journal of Pediatric Research Available online at: www.pediatricreview.in 363|P a g e injuries among children [1]. Since majority of the scald injuries occur at home, the etiology are mostly household items. Earlier in developed countries, tap water at high temperature was the commonest etiology of scald injuries [8]. But the profile has changed in recent times, to include other causes as well. In a study by Agbenorku et al found that hot water was the commonest cause of scald injuries among children amounting to 68.1%. Other factors were hot soup (15.6%), hot tea (4.3%), hot oil (9.2%), hot stew (9.7%) and hot stock (2.1%) [9].
Despite the vast information available on scald injuries in the pediatric age group, very few studies have been done in developing countries such as India. Knowledge of the epidemiology of pediatric scald injuries will enable the planning of appropriate preventive measures. These may include parental education, identifying the households at risk and implementation of child safety measures. This study seeks to assess the burden of scald injuries and the associated factors.

Objectives
1. To analyze the demographic and clinical profile of scald injuries presenting to a tertiary care teaching hospital 2. To analyze the treatments procedures done and the treatment outcome in pediatric patients presenting with scald injuries.

Results
A total 66 people participants were included in the analysis. The mean age was 54.09 ± 38.4 in the study population, minimum age was 9 months and maximum age was 144 months. Among the study population, 3 (4.50%) participants were aged below 1 year, 22 (33.30%) participants were aged between 1 to 2 years, 17 (25.80%) participants were aged between 3 to 5 years, 19 (28.80%) participants were aged between 6 to 10 years and 4 (6.10%) participants were aged above 10 years. Among the study population, 31(47%) participants were male, and remaining 35 (53%) participants were female. (Table 1)    (Table 4).

Socio-demographic profile of the study participants:
Almost three-fourths of the participants belonged to the age group of 13 months to 120 months. The mean age was 54.09 months. The mean age is similar to the study by Palmieri T. L et al (57.6 months) and is higher than in the study by Rimmer RB et al (20.7 months) and Agbenorkuet al (26.16 months). The mean age is slightly lesser than the mean age in the study by Yeoh et al (1994) where the mean age was 40.14 months [9, [11][12][13].

Etiologic agents of scald injuries:
With regards to the etiologic agents of scald injuries, similar to other studies, hot water is the most common cause [8,9,14].
In developed countries, bath water scald injuries were more common while in this study, scald injuries in the kitchen were more common. This was similar to the study by Delgado et al who mention that kitchen is a common site for occurrence of pediatric scald injuries [14]. Household liquid food items such as sambar and kanji were some of the etiologic agents of scalds. Furthermore, there were no reported cases of scalds due to non-accidental causes in this study [1,11,15].

Conclusion
A majority of the scald injuries occur in children who are less than 10 years of age with more than half occurring in the under 5 age group. More than half were first degree burns with majority affecting the front of the body. The common etiologies were hot water and other hot edible items. The etiologic agents of pediatric scald injuries are different from those found in the studies conducted in developing countries. Despite treatment, 16.7% expired. Kitchen is the most common site of occurrence of scalds. This necessitates childhood safety measures and health education to the mothers and care givers of the child regarding preventive measures.
In addition, this study provides scope for further studies to assess the risk factors for this increase in mortality. This would help in reducing the morbidity and mortality from scald injuries in the pediatric age group.

Addition of new knowledge
 Liquid food items are the most common sources of pediatric scald injuries  Majority of scald injuries occurs in children less than 5 years of age  Front of the body especially the upper limbs are commonly affected areas  A higher proportion of patients have more than 30% BSA affected by burns compared to other studies, in addition to a higher mortality rate due to scalds Author contribution: Dr.S. Prabakaranis the only author, who has conceptualized the study, conducted data collection, prepared and reviewed all the drafts and had prepared the final version of the manuscript.

Declarations
Funding: Nil, Conflict of interest: None initiated, Perission from IRB: Yes Ethical approval: the study was approved by the institutional human ethics committee