Emergency (****); * (*): *-* This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Copyright © 2015 Shahid Beheshti University of Medical Sciences. All rights reserved. Downloaded from: www.jemerg.com 40 Emergency (2015); 3 (1): 40-44 ORIGINAL RESEARCH Independent Predictive Factors of Hospitalization in a North-West Burn Center of Iran; an Epidemiologic Study Samad Shams Vahdati1*, Bita Hazhir Karzar2, Negar Momen2 1. Road Traffic injury research center, Assistant professor of emergency medicine, Tabriz University of medical science, Tabriz, Iran. 2. Education Development Center and Talented Students’ Office, Tabriz University of Medical Science, Tabriz, Iran. *Corresponding Author: Samad Shams Vahdati; Assistant Professor of Emergency Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. Tel: +989141156941; Email: sshamsv@yahoo.com; shams@tbzmed.ac.ir Received: July 2014; Accepted: September 2014 Abstract Introduction: A high-grade burn is one of the most devastating injuries with several medical, social, economic, and psychological effects. These injuries are the most common cause of accidental deaths after traffic injuries in both the developed and developing countries. Therefore, this research was aimed to determine demographic characteristics of patients with burn injury admitted to the emergency department and identify predictive factors of hospitalization. Methods: This is a cross sectional descriptive study, which is done in 20 March up to 20 Sep- tember 2011 in emergency department of Sina Hospital, Tabriz, Iran. Patients’ information including demograph- ic characteristic, cause of burn, place of accident, anatomical areas burned, grading and percent of burning and disposition were gathered and analyzed using SPSS version 18.0 statistical software. Stepwise multivariate re- gression analysis was used for recognition of independent predictive factors of hospitalization in burned patients . Results: One hundred and sixty patients were enrolled (54.4% female). The average age of those was 20.47±13.5 years. The prevalence of burn was significantly higher in ages under 20 years (p<0.001). Lower limb (37.5%), head and neck (21.25%) and upper limb (17.5%) were three frequent site of burn. The most common cause of burns was boiling water scalding (34.4%). Home related burn was significantly higher than other place (p<0.001). The most frequent percent of burn was <5% (46.25%). Finally, 50 (31.25%) cases hospitalized. Uni- variate analysis demonstrated that age under 20 years old (p=0.02) female gender (p=0.02), burning site (p=0.002), cause (p=0.005), place (p<0.001), grade (p<0.001), and percent (p<0.001) was related to disposition of patients. Stepwise multiple logistic regression showed female gender (OR=3.52; 95% CI: 1.57-7.88; p=0.002), work related burning (OR=1.78; 95% CI: 1.26-2.52; p=0.001), and burning over 5 percent (OR=2.15; 95% CI: 1.35-3.41; p=0.001) as independent predictive factors of hospitalization. Conclusion: The results of present study showed that burns injury are most frequent in age under 20 year old, lower limbs, with boiling water, and at home. In addition, the most frequent type and percentage of burned area were second degree and <5% of total body surface area, respectively. Among age under 20 years old, female gender, burning site, cause, place, grade, and percent only female gender, work related burning, and burning over 5% were detected as independent pre- dictive factors of hospitalization. Key words: Epidemiology; burn units; hospitalization; risk factors; emergency department Cite this article as: Shams Vahdati S, Hazhir Karzar B, Momen N. Independent Predictive Factors of Hospitalization in a North- West Burn Center of Iran; an Epidemiologic Study. Emergency. 2015;3(1):40-4. Introduction: high grade burn is one of the most devastating injuries with several medical, social, economic, and psychological effects (1). These injuries are the most common cause of accidental deaths after traf- fic injuries in both developed and developing countries (2). The patients with widespread burning damage die, but others suffer from prolonged recoveries (3). The survived patients require various operations with a long-term hospitalization and readmission. Under- standing the relationship between the host- environment and harmful agent can help designing preventive programs (4). Such injuries occur in specific geographic and demographic patterns (5, 6). In all age groups men had higher percentage of admission than women (2, 7). In some studies most of burn events ap- peared in children under 5 years (7, 8). Home was the most common place of the events and scalding as well A mailto:sshamsv@yahoo.com mailto:shams@tbzmed.ac.ir This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Copyright © 2015 Shahid Beheshti University of Medical Sciences. All rights reserved. Downloaded from: www.jemerg.com 41 Emergency (2015); 3 (1): 40-44 as flame the most frequent cause (2, 7-10). No burn study has yet been performed in the North-West of Iran. Therefore, this research was undertaken to determine demographic characteristics of patients with burn inju- ry admitted to the emergency department of Sina Hos- pital, the burn center of North-West of Iran and identify populations at increased risk. Methods: This cross sectional study was done through 20 March to 20 September 2011 in the emergency department of Sina Hospital, Tabriz, Iran. Sina Hospital is a burning center of North-West of Iran and the only burning hos- pital of Tabriz. Data of patients attending the hospital with any burn injury were collected on a checklist in- cluded: patient characteristic, cause of burn, place of accident, disposition, anatomical areas, and grading and percent of injury. Burning grading was divided into I, IIa, IIb, III and IV degrees (11). Types of injuries includ- ed were boiling water, gas, electrical, oil, chemical and other burns were treated on an inpatient or outpatient basis in the hospital. The protocol of study was ap- proved by ethical committee of Tabriz University of Medical Sciences. Authors were adhered to ethical prin- ciples of Helsinki declaration in all parts of study. In- formed consent forms were fulfilled for all participants. Statistical analysis Data were analyzed using SPSS version 18.0 statistical software. Descriptions of qualitative and quantitative variables were respectively performed by frequency tables and calculation of mean± standard deviation. Chi- squared test was used to compare qualitative variables and independent t-test for quantitative. Univariate analysis was applied to evaluation of predictive factors of hospitalization. Stepwise multivariate regression analysis was used for recognition of independent pre- dictive factors of hospitalization in burned patients. Statistical significance was defined as p<0.05. Results: One hundred and sixty patients were enrolled (54.4% female). Table 1 shows baseline characteristics of stud- ied patients. The average age of cases was 20.47±13.5 years. Most of the patients were under 20 years old (56.9%). The multinomial logistic regression showed a significant difference among burn prevalence in age groups (p<0.0001). Based on this analysis, the preva- lence of burn was significantly higher in ages under 20 years (p<0.001). Lower limb (37.5%), head and neck (21.25%), and upper limb (17.5%) were three frequent sites of burn. Lower limb burn was significantly higher than other organs (p<0.001). The most common cause of burns was boiling water scalding (34.4%), followed by hot oil (16.9%) and gas contact (16.9%) (p=0.001). Seventy-three (45.6%) cases of burns occurred at home, 39 (24.4%) outdoors, and 30 (18.75%) work- place. Home related burn was significantly higher than other places (p<0.001). Forty-nine (30.6%) patients have first-degree of burn, 67 (41.9%) second-degree, 36 (22.5%) third degree, and 8 (5.0%) fourth-degree. Mul- tinomial logistic regression showed that the prevalence of second-degree burns were significantly higher than third degree (p=0.003) and fourth degree (p<0.001). The most frequent percentage of burn was <5% (46.25%) that is significantly more than 5-10% (p=0.009) and >10% (p=0.002). Finally, 50 (31.25%) cases were hospitalized. Table 2 shows the relation be- tween disposition of patients and clinical and demo- graphical variables. Univariate analysis demonstrated that age under 20 years old (p=0.02), female gender (39.1; p=0.02), burning site (p=0.002), burning cause (p=0.005), burning place (p<0.001), grade of burning (p<0.001), and the percent of burning (p<0.001) were related to disposition of patients. Stepwise multiple logistic regression showed female gender (OR=3.52; Table 1: The baseline variable of studied patients Variable N (%) Age (year) 1-10 44 (27.5) 11-20 47 (29.4) 21-30 36 (22.5) 31-40 21 (13.1) >40 12 (7.5) Gender Male 73 (45.6) Female 87 (54.4) Site of Burn Lower limb 60 (37.5) Head and neck 34 (21.25) Upper limb 28 (17.5) Thoraces 25 (15.6) Back trunk 7 (4.4) Abdomen 6 (3.75) Cause of burn Boiling water 55 (34.4) Oil 27 (16.9) Gas 27 (16.9) Electrical burning 23 (14.4) Others 28 (17.5) Place of injury Home 73 (45.6) Work 30 (18.75) Out door 39 (24.4) Others 18 (11.25) Grade I 49 (30.6) II 67 (41.9) III 36 (22.5) IV 8 (5.0) Percent of burn < 5% 74 (46.3) 5-10 % 45 (28.1) >10% 41 (25.6)  Total body surface area This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Copyright © 2015 Shahid Beheshti University of Medical Sciences. All rights reserved. Downloaded from: www.jemerg.com Shams Vahdati et al 42 95% CI: 1.57-7.88; p=0.002), work related burning (OR=1.78; 95% CI: 1.26-2.52; p=0.001), and percent of burning over 5% (OR=2.15; 95% CI: 1.35-3.41; p=0.001) as independent predictive factors of hospitali- zation (Table 3). Discussion: The results of present study showed that burn injuries are more common in age less than 20 years old, in low- er limbs, with boiling water, and at home. In addition, the most frequent type and percentage of burned area were second degree and <5% of total body surface area, respectively. Among age under 20 years old, female gender, burning site, burning cause, burning place, grade of burning, and percent of burning only female gender, work related burning, and percentage of burn- ing over 5% were identified as independent predictive factors of hospitalization. Burns are one of the serious preventable events (12, 13). This study was the first research on burn injury in the North-West of Iran. We focused on those patients who attended to the emergency department of Sina Hospital. The findings of present study revealed that most of burn patients were aged 20.47±13.5 years. The mean age of burn patients is different from 19 to 35 years in various studies. In most papers this age was reported between 21 and 23 years old (14). Generally, young adults are active both at home and at work and this may be susceptible them to hazardous situations. Most of cookers with 20-47years old are not expert, one of the reasons that this age group is more disposed to burn events. Because of social structure in our country, older people usually live with their family and thus their exposure to hazardous situations has been greatly reduced. This might be explained why they have low percentage of accidents in the present study. Females had higher incidence in this study as other ones (3, 15, 16) contrasts with others (17-21). It seems that some of factors such as culture and career have more effects on Table 2: Relation of baseline variable of studied patients and disposition Variable Disposition p-value Discharged Hospitalized Age (year) 1-10 34 (77.3) 10 (22.7) 0.02 11-20 28 (59.6) 19 (40.4) 21-30 21 (58.3) 15 (41.7) 31-40 15 (71.4) 6 (28.6) >40 12 (100.0) 0 (0.0) Gender Male 57 (78.1) 16 (21.9) 0.02 Female 53 (60.9) 34 (39.1) Site of Burn Lower limb 44 (73.3) 16 (26.7) 0.002 Head and neck 21 (61.8) 13 (38.2) Upper limb 21 (75.0) 7 (25.0) Thoraces 18 (72.0) 7 (28.0) Back trunk 0 (0.0) 7 (100.0) Abdomen 6 (100.0) 0 (0.0) Cause of burn Boiling water 45 (81.8) 10 (18.2) 0.004 Oil 12 (44.4) 15 (55.6) Gas 15 (55.6) 12 (44.4) Electrical burning 16 (69.6) 7 (30.4) Others 22 (78.6) 6 (21.4) Place of injury Home 61 (83.6) 12 (16.4) <0.001 Work 13 (43.3) 17 (56.7) Out door 29 (74.4) 10 (25.6) Others 7 (38.9) 11 (61.1) Grade I 46 (93.9) 3 (6.1) II 33 (48.25) 34 (50.75) III 27 (75.0) 9 (25.0) <0.001 IV 4 (50.0) 4 (50.0) Percent of burn < 5% 64 (86.5) 10 (13.5) 5-10 % 21 (46.7) 24 (53.3) <0.001 >10% 25 (61.0) 16 (39.0) This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Copyright © 2015 Shahid Beheshti University of Medical Sciences. All rights reserved. Downloaded from: www.jemerg.com 43 Emergency (2015); 3 (1): 40-44 the gender predominance in burn injuries. Home was the most common sites of burns. Similar to most Iranian studies (14), the highest percentage of burning place in this research was at home as well. This findings are comparable to other reports from developing countries (22, 23). In developed countries because of safer cook- ing devices this results are lower than developing coun- tries. Developed countries have more occupational burn events (24, 25). This study showed that the most com- mon cause of burn is scalding like other studies (4, 7, 17, 19, 26-29) unlike other researches (2, 3, 8, 9, 30- 33). Cooking and repairing the car radiator is more fre- quent cause of burning, occur with boiled water. In poor countries electricity and scalding are common causes of burn events (18). Burning under 5% is more common than other types (4), dissimilar to other stud- ies (7-9, 17). Because patients are not in danger to have high grade and high percent burning illness, and of course outpatient is more frequent than disposition. In this study the most common anatomical area burned is lower limb unlike previous reports (7, 26). Since using boiled water either in cooking or repairing the car radi- ator is in standing position, the most common burning site is lower limb. Thus, for such cases it was suggested to change the life style and manage oil and heat re- sources of houses (34). Conclusion: The results of present study showed that burns injury are most frequent in age under 20 year old, lower limbs, with boiling water, and at home. In addition, the most frequent type and percentage of burned area were sec- ond degree and <5% of total body surface area, respec- tively. 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