Annals of Burns and Fire Disasters - vol. XX - n.

1 - March 2007

EXPERIENCE OF BURN INJURIES AT THE PAKISTAN INSTITUTE

OF MEDICAL SCIENCE, ISLAMABAD, PAKISTAN*
Ahmad M.,1 Shahid Hussain S.,2 Ibrahim Khan M.,3 Malik S.A.4
1
2
3
4

Plastic, Reconstructive, and Hand Surgeon, Rawalpindi, Pakistan

Pakistan Institute of Medical Science, Islamabad, Pakistan
Frontier Medical College, Abbottabad, Pakistan
American Board of Plastic Surgery, Shifa International Hospital, Islamabad, Pakistan

SUMMARY. The objective of this prospective study was to consider the demographical data of burn patients admitted to the Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan. The study was carried out at PIMS from January 2002 to December 2003. Only admitted patients of either sex of age more than 12 yr were included. Patients below 12 yr were excluded. Patients requiring outpatient treatment were also excluded. A total number of 77 males and 65 females fulfilled the criteria. The mean
age of the males was 32.2 yr and of the females 24.4 yr, while the male/female ratio was 1/1.18. Burns were commonest during
the winter season (42.2%). In 6% of the patients, the burns were due to suicide attempts and in 15% to homicidal intent. The burns
were accidental in 79% of cases. The major mechanism in females was stove burst (22%) and in males direct flame (18%). The
kitchen was the commonest site of the accident in females (27%). Housewives were the most frequently affected (35%). More married males (39%) were burned than unmarried females (18%). Inhalational injury was present in 23% of the patients. Males had
average total body surface area burned of 27.4% compared with 39.5% in females. Eighteen per cent of the deaths occurred among
males and 16% among females. This study provides a comprehensive overview of hospitalized burn patients in Pakistan. Prevention is always the rule to be safe from burns but, once they occur, immediate and proper care should be given with aggressive
treatment in order to minimize post-burn problems.

Introduction

In all societies, burns continue to constitute a medical,

psychological, and social problem that involves not only
the physician and patient but also all society. Burns are a
major health problem. The preventable nature of the injury,
the social and environmental factors associated with it, and
the age groups involved make the study of burns epidemiology necessary. There are a few burn centres in Pakistan
that are well equipped, but the majority of patients are still
treated in hospitals without established burns units.
The Pakistan Institute of Medical Sciences (PIMS) in
Islamabad, Pakistan, is the major tertiary care hospital in
the capital but it does not have a burns unit. All the patients are managed by the Department of Plastic Surgery.
Thus a study of burns epidemiology in hospitalized
patients is likely to have a bearing on the total picture
available from the entire country.
The aim of the study is to analyse the demographical
data of this problem and to compare the data with other
published reports from neighbouring countries.

Materials and methods

This prospective study was conducted at PIMS between January 2002 and December 2003. Only hospitalized patients aged over 12 years were included. Patients
below 12 years of age were excluded as they were managed by the Childrens Hospital, Islamabad. Outpatients
were excluded. In all, 77 males and 65 females fulfilled
the criteria. The data were analysed at the end of the study.
Results

Age and sex distribution

The mean age of the males was 32.2 yr and of the females 24.4 yr. The majority of the patients were young
(Fig. 1). The male/female ratio was 1/1.18.
Seasonal variations
Burns requiring hospitalization were commonest in
winter (42.2%), followed by summer (27.5%), autumn
(18.3%), and spring (12.0%).

* This article was presented as a poster at the Annual Scientific meeting of the Australian and New Zealand Burn Association in September 2004 and received
the Merit Award.

Annals of Burns and Fire Disasters - vol. XX - n. 1 - March 2007

Fig. 2 - Occupation of patients.

Fig. 1 - Age and sex distribution of patients.

Medico-legal aspects
In 6% of the patients, the burns were due to attempted suicide, while 15% of cases involved attempted homicide. In 79% of the cases the burns were accidental. Patients whose history was doubtful were placed in the accidental group.
Mechanism of burns
Stove burst was the major mechanism in females (22%),
while in males 18% had direct flame injury (Table I).
Table I - Mechanism of burns

Mechanism
Direct flame injury
Stove burst
Flame catching clothes
Electrical injury
Scald
Self-inflicting kerosene oil
Chemical

Males
26
3
19
14
10
4
1

Females
12
31
11
1
4
6
Nil

Place where burns occurred

The kitchen was the place where burns most commonly occurred (27%), whereas in males the courtyard or
workplace was commonest (45%) (Table II).
Table II - Place of accident
Place
Kitchen
Courtyard
Workplace/Outside
Bedroom
Living Room
Bathroom

Males
6
41
23
4
1
2

Females
39
4
5
9
6
2

Occupation
Housewives were the most frequently affected (35%).
Fourteen per cent were dependents or unemployed (Fig. 2).
Marital status
More married males were burned (39%), while 18%
of the females were unmarried (Fig. 3).

Fig. 3 - Marital status of patients.

Time interval between injury and admission

Nearly half of the patients presented within 12 h (46%).
These included patients from within the city and surrounding areas. Thirty-six per cent presented after 12-24
h, mostly referred from other cities (Fig. 4).
Hospital stay
The average duration of hospital stay was 40 days
(range, 6 h to 5 months).
Body regions affected
The majority of the patients had involvement of the
trunk and limbs (Table III). Inhalational injury was present in 23% of the patients.
Severity of burns
Males had an average burned TBSA of 27.4% and females 39.5%.
Mortality
The mortality rate was 18% among the males and 16%
among the females.

Annals of Burns and Fire Disasters - vol. XX - n. 1 - March 2007

Fig. 4 - Time interval between injury and hospitalization.

Table III - Body regions affected
Area
Head
Neck
Chest
Abdomen
Back
Buttocks
Perineum
Upper limbs
Hands
Lower limbs
Feet
Eyes
Inhalational injury

Discussion

Males
3
5
8
10
14
7
4
21
19
25
5
2
14

Females
11
11
31
21
24
23
9
37
14
34
9
3
19

Burns continue to be a major environmental factor responsible for significant morbidity and mortality in developing countries.1 The present study presents data from the
major hospital in our capital. There is no burn unit in this
hospital or in the city. All burn patients are managed by
our Department of Plastic Surgery.
In our review, flame was the commonest cause of
burns, followed by electrical injuries and scalds, as reported elsewhere.1-4 In this study, gas explosion and
kerosene were most frequently involved. This can be explained by the fact that gas and kerosene are widely used

as domestic fuel in Pakistan. Unwise use of kerosene by

some people was also noted. The majority of the patients
(42%) were burned during the winter, when gas and
kerosene were used for fuel and heating. This observation
is consistent with other reports.1,5 In the majority of patients (79%) the burns occurred accidentally, and patients
having a doubtful history were also included in the accidental group. Attempted suicide by burning accounted for
6% of the patients in our study, with a female:male ratio
of 1:2. This is in contrast to observations in other studies.4,5 However, this higher ratio in males corresponds to
observations in studies carried out in other countries.6-8 The
reason may be that males in this area are the main stressbearers and the only earning hands in the family. When
problems are encountered, it appears that people with a
lower level of literacy find it harder to resolve them easily, and they give up during financial crises.
Homicide by the infliction of a burn injury is another important issue that has received little attention in the
literature in the past. In the present study 15% were so affected, and this is probably an underestimate of the true
figure due to reluctance - for legal reasons - to report the
real reason for the injury. The majority of burn injuries
reported here occurred at home, the kitchen being the commonest location. This finding is consistent with those of
other recent studies.4,5
In our study, the most commonly injured body regions
were the trunk and the lower and upper limbs. An important factor was the presence of inhalational injury, noted
in 23% of the patients - this was definitely a factor as regards mortality.
It is commonly thought that females are more affected in burn injuries. In contrast, our study showed that burns
were more frequent in males than females. However, females were more severely burned than males: the average
burn was 27.4% TBSA in males and 39.5% TBSA in females.
In our study, 35% of the patients were housewives and
14% were unemployed or dependent workers. A similar
observation was made in other studies.2,4 The overall mortality in our study was 34%, a similar finding to other studies.9,10 This is in contrast to the very low mortality noted
in some other studies,4,11 a contrast due to the obvious factor of the specialized care provided at burns centres.
TBSA burned also affected overall mortality. The female:male death ratio in this study was 1:1.1. The high
mortality confirms the necessity of specialized burn units.
Conclusion

This study provides a comprehensive overview of hospitalized burn patients in Pakistan. Prevention is always
the rule to be safe from burns but, once they occur, immediate and proper care should be given.
9

Annals of Burns and Fire Disasters - vol. XX - n. 1 - March 2007

RSUM. Les Auteurs de cette tude prospective se sont proposs de considrer les donnes dmographiques des patients brls
hospitaliss dans lInstitut Pakistanais des Sciences Mdicales (IPSM), Islamabad, Pakistan. Ltude a t effectue par lIPSM entre janvier 2002 et dcembre 2003. Seulement les patients gs dau moins 12 ans, de tous les deux sexes, ont t admis. Les patients gs de moins de 12 ans ont t exclus, comme aussi les patients traits en rgime externe. En tout, 77 patients du sexe masculin et 65 du sexe fminin ont satisfait ces critres. Lg moyen des patients mles tait de 32,2 ans et des femelles de 24,4 ans,
tandis que le rapport mles/femelles tait 1/1,18. Les brlures taient plus communes pendant lhiver (42,2%). Dans 6% des patients les brlures ont t causes par des tentatives de suicide et dans 15% des cas par des intentions homicides. Dans 79% des
cas les brlures taient accidentelles. Le mcanisme principal chez les femmes tait lexplosion des poles (22%) et, chez les hommes, la flamme directe (18%). Le site le plus commun des accidents chez les femmes tait la cuisine (27%). Les mnagres taient
la catgorie la plus intresse (35%). Un nombre suprieur dhommes maris (39%) a subi des brlures par rapport aux femmes
non maries (18%). Les lsions par inhalation taient prsentes dans 23% des patients. Les patients mles prsentaient une surface corporelle brle moyenne de 27,4% par rapport 39,5% dans les femmes. Dix-huit pour cent des dcs se sont vrifis parmi les patients mles et 16% parmi les patients du sexe fminin. Les Auteurs de cette tude fournissent une analyse comprhensive des patients brls au Pakistan. La prvention est toujours la rgle pour tre protg contre le risque des brlures mais, une
fois quun cas se vrifie, il faut traiter le patient immdiatement et correctement en manire agressive pour rduire au minimum
les problmes aprs les brlures.
BIBLIOGRAPHY
01. Lari A.R., Alaghehbandan R., Nikui R.: Epidemiological study of
3341 burns patients during three years in Tehran, Iran. Burns, 26:
49-53, 2000.
02. Subrahmanyam M.: Epidemiology of burns in a district hospital
in Western India. Burns, 22: 439-42, 1996.
03. Tejerina C., Reig A., Codina J. et al.: An epidemiology study of
burn patients hospitalized in Valencia, Spain, during 1989. Burns,
18: 15-18, 1992.
04. Chein W.C., Pai L., Lin C.C., Chen H.C.: Epidemiology of hospitalized burns patients in Taiwan. Burns, 29: 582-88, 2003.
05. Panjeshahin M.R., Lari A.R., Talei A., Shamsnia J., Alaghehbandan R.: Epidemiology and mortality in South West of Iran. Burns,
27: 219-26, 2001.
06. Wallace K.L., Pegg S.P.: Self-inflicted burn injuries: An 11-year
retrospective study. J. Burn Care Rehabil., 20: 191-4, 1999.
07. Wagle S.A., Wagle A.C., Apte J.S.: Patients with suicidal burns
and accidental burns: A comparative study of socio-demographic
profile in India. Burns, 25: 158-61, 1999.

08. Hadjiiski O., Todorov P.: Suicide by self-inflicted burns. Burns,

22: 381-3, 1996.
09. Gupta M., Gupta O.K., Yaduwanshi R.K. et al.: Burn epidemiology: The Pink City scene. Burns, 19: 47-51, 1993.
10. Jayaraman V., Ramakrishan M.K., Davies M.R.: Burns in Madras,
India: An analysis of 1368 patients in one year. Burns, 19: 33944, 1993.
11. Ho W.S., Ying S.Y.: An epidemiological study of 1063 hospitalized burn patients in tertiary burns centre in Hong Kong. Burns,
27: 119-23, 2001.
This paper was received on 16 May 2006.
Address correspondence to: Dr Muhammad Ahmad,
PO box #1533, GPO Rawalpindi, 46000 Pakistan.
E-mail: plasticsurgeon999@yahoo.com or
plasticsurgeon999@gmail.com

CLARIFICATION
On 22 March 2006, Dr George Virich, of Queen Elizabeth Central Hospital, Blantyre, Malawi,
submitted to the attention of our Editorial Office an article entitled Burns in Malawi for
publication in Annals of Burns and Fire Disasters. The request for publication and the copyright declaration were attached. The article was published in Vol. XIX, no. 4, December 2006.
On 31 December 2006, after the Journal had been printed, the author sent an e-mail asking
to withdraw the article because ...the paper has been withdrawn as it has been revised. The
title is changed, the content is slightly different, etc.... Under these circumstances the Editorial Office publishes this clarification.
10