Sear

Burn

A burn is a type of injury to skin, or other tissues, caused by heat, cold, electricity, chemicals,
friction, or ultraviolet radiation (like sunburn).[6] Most burns are due to heat from hot liquids
(called scalding), solids, or fire.[10] While rates are similar for males and females, the underlying
causes often differ.[7] Among women in some areas, risk is related to use of open cooking fires
or unsafe cook stoves.[7] Among men, risk is related to the work environments.[7] Alcoholism and
smoking are other risk factors.[7] Burns can also occur as a result of self-harm or violence
between people (assault).[7]
 Burn

Second-degree burn of the hand

Specialty Dermatology Critical care medicine, plastic

surgery[1]

Symptoms First degree: Red without blisters[2]

Second degree: Blisters and pain[2]
Third degree: Area stiff and not painful[2]Fourth
Degree: Bone and tendon loss [3]

Complications Infection[4]

Duration Days to weeks[2]

Types First degree, Second degree, Third degree,[2]

Fourth degree [5]

Causes Heat, cold, electricity, chemicals, friction,

radiation[6]

Risk factors Open cooking fires, unsafe cook stoves, smoking,

alcoholism, dangerous work environment[7]

Treatment Depends on the severity[2]

Medication Pain medication, intravenous fluids, tetanus

toxoid[2]

Frequency 67 million (2015)[8]

Deaths 176,000 (2015)[9]

Burns that affect only the superficial skin layers are known as superficial or first-degree
burns.[2][11] They appear red without blisters and pain typically lasts around three days.[2][11]
When the injury extends into some of the underlying skin layer, it is a partial-thickness or second-
degree burn.[2] Blisters are frequently present and they are often very painful.[2] Healing can
require up to eight weeks and scarring may occur.[2] In a full-thickness or third-degree burn, the
injury extends to all layers of the skin.[2] Often there is no pain and the burnt area is stiff.[2]
Healing typically does not occur on its own.[2] A fourth-degree burn additionally involves injury to
deeper tissues, such as muscle, tendons, or bone.[2] The burn is often black and frequently leads
to loss of the burned part.[2][12]

Burns are generally preventable.[7] Treatment depends on the severity of the burn.[2] Superficial
burns may be managed with little more than simple pain medication, while major burns may
require prolonged treatment in specialized burn centers.[2] Cooling with tap water may help pain
and decrease damage; however, prolonged cooling may result in low body temperature.[2][11]
Partial-thickness burns may require cleaning with soap and water, followed by dressings.[2] It is
not clear how to manage blisters, but it is probably reasonable to leave them intact if small and
drain them if large.[2] Full-thickness burns usually require surgical treatments, such as skin
grafting.[2] Extensive burns often require large amounts of intravenous fluid, due to capillary fluid
leakage and tissue swelling.[11] The most common complications of burns involve infection.[4]
Tetanus toxoid should be given if not up to date.[2]

In 2015, fire and heat resulted in 67 million injuries.[8] This resulted in about 2.9 million
hospitalizations and 176,000 deaths.[9][13] Most deaths due to burns occur in the developing
world, particularly in Southeast Asia.[7] While large burns can be fatal, treatments developed
since 1960 have improved outcomes, especially in children and young adults.[14] In the United
States, approximately 96% of those admitted to a burn center survive their injuries.[15] The long-
term outcome is related to the size of burn and the age of the person affected.[2]

Signs and symptoms

The characteristics of a burn depend upon its depth. Superficial burns cause pain lasting two or
three days, followed by peeling of the skin over the next few days.[11][16] Individuals suffering
from more severe burns may indicate discomfort or complain of feeling pressure rather than
pain. Full-thickness burns may be entirely insensitive to light touch or puncture.[16] While
superficial burns are typically red in color, severe burns may be pink, white or black.[16] Burns
around the mouth or singed hair inside the nose may indicate that burns to the airways have
occurred, but these findings are not definitive.[17] More worrisome signs include: shortness of
breath, hoarseness, and stridor or wheezing.[17] Itchiness is common during the healing process,
occurring in up to 90% of adults and nearly all children.[18] Numbness or tingling may persist for
a prolonged period of time after an electrical injury.[19] Burns may also produce emotional and
psychological distress.[20]

Layers Healing Prognosis a

Type[2] Appearance Texture Sensation
involved Time Complicatio

Heals well.[2]
Repeated
Superficial
Red without 5– sunburns
(first- Epidermis[11] Dry Painful[2]
blisters[2] 10 days[2][21] increase the r
degree)
of skin cancer
later in life.[22]

Superficial
Extends into Redness with Local infectio
partial
superficial clear blister.[2] 2–3 (cellulitis) but
thickness Moist[2] Very painful[2]
(papillary) Blanches with weeks[2][16] scarring
(second-
dermis[2] pressure.[2] typically[16]
degree)

Deep Yellow or Scarring,

Extends into
partial white. Less contractures
deep Fairly Pressure and
thickness blanching. 3–8 weeks[2] (may require
(reticular) dry[16] discomfort[16]
(second- May be excision and s
dermis[2]
degree) blistering.[2] grafting)[16]

Scarring,
Full Extends Stiff and Prolonged
contractures,
thickness through white/brown.[2] (months)
Leathery[2] Painless[2] amputation (e
(third- entire No and
excision
degree) dermis[2] blanching.[16] incomplete[2]
recommended

Extends
Amputation,
through
Does not significant
entire skin,
Fourth- Black; charred heal; functional
and into Dry Painless
degree with eschar Requires impairment an
underlying
excision[2] in some cases
fat, muscle
death.[2]
and bone[2]

Cause
Burns are caused by a variety of external sources classified as thermal (heat-related), chemical,
electrical, and radiation.[23] In the United States, the most common causes of burns are: fire or
flame (44%), scalds (33%), hot objects (9%), electricity (4%), and chemicals (3%).[24] Most (69%)
burn injuries occur at home or at work (9%),[15] and most are accidental, with 2% due to assault
by another, and 1–2% resulting from a suicide attempt.[20] These sources can cause inhalation
injury to the airway and/or lungs, occurring in about 6%.[4]

Burn injuries occur more commonly among the poor.[20] Smoking and alcoholism are other risk
factors.[10] Fire-related burns are generally more common in colder climates.[20] Specific risk
factors in the developing world include cooking with open fires or on the floor[6] as well as
developmental disabilities in children and chronic diseases in adults.[25]

Thermal
…

See or edit source data.

Rate of deaths (per 100,000) due to fire between 1990 and 2017.[26]

In the United States, fire and hot liquids are the most common causes of burns.[4] Of house fires
that result in death, smoking causes 25% and heating devices cause 22%.[6] Almost half of
injuries are due to efforts to fight a fire.[6] Scalding is caused by hot liquids or gases and most
commonly occurs from exposure to hot drinks, high temperature tap water in baths or showers,
hot cooking oil, or steam.[27] Scald injuries are most common in children under the age of five[2]
and, in the United States and Australia, this population makes up about two-thirds of all burns.[4]
Contact with hot objects is the cause of about 20–30% of burns in children.[4] Generally, scalds
are first- or second-degree burns, but third-degree burns may also result, especially with
prolonged contact.[28] Fireworks are a common cause of burns during holiday seasons in many
countries.[29] This is a particular risk for adolescent males.[30] In the United States, For non-fatal
burn injuries, white males, aged <6 comprise most cases.[31]  Thermal burns from
grabbing/touching and spilling/splashing were the most common type of burn and mechanism,
while the bodily areas most impacted were hands and fingers followed by head/neck.[31]

Chemical
…
Chemical burns can be caused by over 25,000 substances,[2] most of which are either a strong
base (55%) or a strong acid (26%).[32] Most chemical burn deaths are secondary to ingestion.[2]
Common agents include: sulfuric acid as found in toilet cleaners, sodium hypochlorite as found
in bleach, and halogenated hydrocarbons as found in paint remover, among others.[2]
Hydrofluoric acid can cause particularly deep burns that may not become symptomatic until
some time after exposure.[33] Formic acid may cause the breakdown of significant numbers of
red blood cells.[17]

Electrical …
Electrical burns or injuries are classified as high voltage (greater than or equal to 1000 volts),
low voltage (less than 1000 volts), or as flash burns secondary to an electric arc.[2] The most
common causes of electrical burns in children are electrical cords (60%) followed by electrical
outlets (14%).[4][34] Lightning may also result in electrical burns.[35] Risk factors for being struck
include involvement in outdoor activities such as mountain climbing, golf and field sports, and
working outside.[19] Mortality from a lightning strike is about 10%.[19]

While electrical injuries primarily result in burns, they may also cause fractures or dislocations
secondary to blunt force trauma or muscle contractions.[19] In high voltage injuries, most
damage may occur internally and thus the extent of the injury cannot be judged by examination
of the skin alone.[19] Contact with either low voltage or high voltage may produce cardiac
arrhythmias or cardiac arrest.[19]
Radiation
…
Radiation burns may be caused by protracted exposure to ultraviolet light (such as from the sun,
tanning booths or arc welding) or from ionizing radiation (such as from radiation therapy, X-rays
or radioactive fallout).[36] Sun exposure is the most common cause of radiation burns and the
most common cause of superficial burns overall.[37] There is significant variation in how easily
people sunburn based on their skin type.[38] Skin effects from ionizing radiation depend on the
amount of exposure to the area, with hair loss seen after 3 Gy, redness seen after 10 Gy, wet skin
peeling after 20 Gy, and necrosis after 30 Gy.[39] Redness, if it occurs, may not appear until some
time after exposure.[39] Radiation burns are treated the same as other burns.[39] Microwave
burns occur via thermal heating caused by the microwaves.[40] While exposures as short as two
seconds may cause injury, overall this is an uncommon occurrence.[40]

Non-accidental
…
In those hospitalized from scalds or fire burns, 3–10% are from assault.[41] Reasons include:
child abuse, personal disputes, spousal abuse, elder abuse, and business disputes.[41] An
immersion injury or immersion scald may indicate child abuse.[28] It is created when an
extremity, or sometimes the buttocks are held under the surface of hot water.[28] It typically
produces a sharp upper border and is often symmetrical,[28] known as "sock burns", "glove
burns", or "zebra stripes" - where folds have prevented certain areas from burning.[42] Deliberate
cigarette burns most often found on the face, or the back of the hands and feet.[42] Other high-
risk signs of potential abuse include: circumferential burns, the absence of splash marks, a burn
of uniform depth, and association with other signs of neglect or abuse.[43]

Bride burning, a form of domestic violence, occurs in some cultures, such as India where women
have been burned in revenge for what the husband or his family consider an inadequate
dowry.[44][45] In Pakistan, acid burns represent 13% of intentional burns, and are frequently
related to domestic violence.[43] Self-immolation (setting oneself on fire) is also used as a form
of protest in various parts of the world.[20]

Pathophysiology
Three degrees of burns

At temperatures greater than 44 °C (111 °F), proteins begin losing their three-dimensional shape
and start breaking down.[46] This results in cell and tissue damage.[2] Many of the direct health
effects of a burn are secondary to disruption in the normal functioning of the skin.[2] They
include disruption of the skin's sensation, ability to prevent water loss through evaporation, and
ability to control body temperature.[2] Disruption of cell membranes causes cells to lose
potassium to the spaces outside the cell and to take up water and sodium.[2]

In large burns (over 30% of the total body surface area), there is a significant inflammatory
response.[47] This results in increased leakage of fluid from the capillaries,[17] and subsequent
tissue edema.[2] This causes overall blood volume loss, with the remaining blood suffering
significant plasma loss, making the blood more concentrated.[2] Poor blood flow to organs such
as the kidneys and gastrointestinal tract may result in kidney failure and stomach ulcers.[48]

Increased levels of catecholamines and cortisol can cause a hypermetabolic state that can last
for years.[47] This is associated with increased cardiac output, metabolism, a fast heart rate, and
poor immune function.[47]

Diagnosis
Burns can be classified by depth, mechanism of injury, extent, and associated injuries. The most
commonly used classification is based on the depth of injury. The depth of a burn is usually
determined via examination, although a biopsy may also be used.[2] It may be difficult to
accurately determine the depth of a burn on a single examination and repeated examinations
over a few days may be necessary.[17] In those who have a headache or are dizzy and have a fire-
related burn, carbon monoxide poisoning should be considered.[49] Cyanide poisoning should
also be considered.[17]

Size
…

Burn severity is determined through, among other things, the size of the skin affected. The image shows the makeup of
different body parts, to help assess burn size.

The size of a burn is measured as a percentage of total body surface area (TBSA) affected by
partial thickness or full thickness burns.[2] First-degree burns that are only red in color and are
not blistering are not included in this estimation.[2] Most burns (70%) involve less than 10% of
the TBSA.[4]

There are a number of methods to determine the TBSA, including the Wallace rule of nines, Lund
and Browder chart, and estimations based on a person's palm size.[11] The rule of nines is easy
to remember but only accurate in people over 16 years of age.[11] More accurate estimates can
be made using Lund and Browder charts, which take into account the different proportions of
body parts in adults and children.[11] The size of a person's handprint (including the palm and
fingers) is approximately 1% of their TBSA.[11]

Severity
…

American Burn Association severity classification[49]

Minor Moderate Major

Adult <10% TBSA Adult 10–20% TBSA Adult >20% TBSA

Young or old < 5% Young or old 5–10%

Young or old >10% TBSA
TBSA TBSA

<2% full thickness burn 2–5% full thickness burn >5% full thickness burn

High voltage injury High voltage burn

Possible inhalation injury Known inhalation injury

Significant burn to face, joints, hands, or

Circumferential burn
feet

Other health problems Associated injuries

To determine the need for referral to a specialized burn unit, the American Burn Association
devised a classification system. Under this system, burns can be classified as major, moderate,
and minor. This is assessed based on a number of factors, including total body surface area
affected, the involvement of specific anatomical zones, the age of the person, and associated
injuries.[49] Minor burns can typically be managed at home, moderate burns are often managed
in a hospital, and major burns are managed by a burn center.[49] Severe burn injury represents
one of the most devastating forms of trauma.[50] Despite improvements in burn care, patients
can be left to suffer for as many as three years post-injury. [51]

Prevention

Historically, about half of all burns were deemed preventable.[6] Burn prevention programs have
significantly decreased rates of serious burns.[46] Preventive measures include: limiting hot
water temperatures, smoke alarms, sprinkler systems, proper construction of buildings, and fire-
resistant clothing.[6] Experts recommend setting water heaters below 48.8 °C (119.8 °F).[4] Other
measures to prevent scalds include using a thermometer to measure bath water temperatures,
and splash guards on stoves.[46] While the effect of the regulation of fireworks is unclear, there is
tentative evidence of benefit[52] with recommendations including the limitation of the sale of
fireworks to children.[4]

Management

Resuscitation begins with the assessment and stabilization of the person's airway, breathing and
circulation.[11] If inhalation injury is suspected, early intubation may be required.[17] This is
followed by care of the burn wound itself. People with extensive burns may be wrapped in clean
sheets until they arrive at a hospital.[17] As burn wounds are prone to infection, a tetanus booster
shot should be given if an individual has not been immunized within the last five years.[53] In the
United States, 95% of burns that present to the emergency department are treated and
discharged; 5% require hospital admission.[20] With major burns, early feeding is important.[47]
Protein intake should also be increased, and trace elements and vitamins are often required.[54]
Hyperbaric oxygenation may be useful in addition to traditional treatments.[55]

Intravenous fluids
…
In those with poor tissue perfusion, boluses of isotonic crystalloid solution should be given.[11] In
children with more than 10–20% TBSA burns, and adults with more than 15% TBSA burns, formal
fluid resuscitation and monitoring should follow.[11][56][57] This should be begun pre-hospital if
possible in those with burns greater than 25% TBSA.[56] The Parkland formula can help
determine the volume of intravenous fluids required over the first 24 hours. The formula is based
on the affected individual's TBSA and weight. Half of the fluid is administered over the first
8 hours, and the remainder over the following 16 hours. The time is calculated from when the
burn occurred, and not from the time that fluid resuscitation began. Children require additional
maintenance fluid that includes glucose.[17] Additionally, those with inhalation injuries require
more fluid.[58] While inadequate fluid resuscitation may cause problems, over-resuscitation can
also be detrimental.[59] The formulas are only a guide, with infusions ideally tailored to a urinary
output of >30 mL/h in adults or >1mL/kg in children and mean arterial pressure greater than
60 mmHg.[17]

While lactated Ringer's solution is often used, there is no evidence that it is superior to normal
saline.[11] Crystalloid fluids appear just as good as colloid fluids, and as colloids are more
expensive they are not recommended.[60][61] Blood transfusions are rarely required.[2] They are
typically only recommended when the hemoglobin level falls below 60-80 g/L (6-8 g/dL)[62] due
to the associated risk of complications.[17] Intravenous catheters may be placed through burned
skin if needed or intraosseous infusions may be used.[17]

Wound care
…
Early cooling (within 30 minutes of the burn) reduces burn depth and pain, but care must be
taken as over-cooling can result in hypothermia.[2][11] It should be performed with cool water 10–
25 °C (50.0–77.0 °F) and not ice water as the latter can cause further injury.[11][46] Chemical
burns may require extensive irrigation.[2] Cleaning with soap and water, removal of dead tissue,
and application of dressings are important aspects of wound care. If intact blisters are present,
it is not clear what should be done with them. Some tentative evidence supports leaving them
intact. Second-degree burns should be re-evaluated after two days.[46]

In the management of first and second-degree burns, little quality evidence exists to determine
which dressing type to use.[63] It is reasonable to manage first-degree burns without
dressings.[46] While topical antibiotics are often recommended, there is little evidence to support
their use.[64][65] Silver sulfadiazine (a type of antibiotic) is not recommended as it potentially
prolongs healing time.[63][66] There is insufficient evidence to support the use of dressings
containing silver[67] or negative-pressure wound therapy.[68] Silver sulfadiazine does not appear
to differ from silver containing foam dressings with respect to healing.[69]

Medications …
Burns can be very painful and a number of different options may be used for pain management.
These include simple analgesics (such as ibuprofen and acetaminophen) and opioids such as
morphine. Benzodiazepines may be used in addition to analgesics to help with anxiety.[46] During
the healing process, antihistamines, massage, or transcutaneous nerve stimulation may be used
to aid with itching.[18] Antihistamines, however, are only effective for this purpose in 20% of
people.[70] There is tentative evidence supporting the use of gabapentin[18] and its use may be
reasonable in those who do not improve with antihistamines.[71] Intravenous lidocaine requires
more study before it can be recommended for pain.[72]

Intravenous antibiotics are recommended before surgery for those with extensive burns (>60%
TBSA).[73] As of 2008, guidelines do not recommend their general use due to concerns regarding
antibiotic resistance[64] and the increased risk of fungal infections.[17] Tentative evidence,
however, shows that they may improve survival rates in those with large and severe burns.[64]
Erythropoietin has not been found effective to prevent or treat anemia in burn cases.[17] In burns
caused by hydrofluoric acid, calcium gluconate is a specific antidote and may be used
intravenously and/or topically.[33] Recombinant human growth hormone (rhGH) in those with
burns that involve more than 40% of their body appears to speed healing without affecting the
risk of death.[74] The use of steroids is of unclear evidence.[75]

Surgery
…
Wounds requiring surgical closure with skin grafts or flaps (typically anything more than a small
full thickness burn) should be dealt with as early as possible.[76] Circumferential burns of the
limbs or chest may need urgent surgical release of the skin, known as an escharotomy.[77] This
is done to treat or prevent problems with distal circulation, or ventilation.[77] It is uncertain if it is
useful for neck or digit burns.[77] Fasciotomies may be required for electrical burns.[77]

Skin grafts can involve temporary skin substitutes, derived from animal (human donor or pig)
skin or synthesized. They are used to cover the wound as a dressing, preventing infection and
fluid loss, but will eventually need to be removed. Alternatively, human skin can be treated to be
left on permanently without rejection.[78] Integra LifeSciences’ Integra artificial skin products are
among the most widely used for burn victims.[79]

There is no evidence that the use of copper sulphate to visualise phosphorus particles for
removal can help with wound healing due to phosphorus burns. Meanwhile, absorption of
copper sulphate into the blood circulation can be harmful.[80]

Alternative medicine …
Honey has been used since ancient times to aid wound healing and may be beneficial in first-
and second-degree burns.[81] There is moderate evidence that honey helps heal partial thickness
burns.[82][83] The evidence for aloe vera is of poor quality.[84] While it might be beneficial in
reducing pain,[21] and a review from 2007 found tentative evidence of improved healing times,[85]
a subsequent review from 2012 did not find improved healing over silver sulfadiazine.[84] There
were only three randomized controlled trials for the use of plants for burns, two for aloe vera and
one for oatmeal.[86]

There is little evidence that vitamin E helps with keloids or scarring.[87] Butter is not
recommended.[88] In low income countries, burns are treated up to one-third of the time with
traditional medicine, which may include applications of eggs, mud, leaves or cow dung.[25]
Surgical management is limited in some cases due to insufficient financial resources and
availability.[25] There are a number of other methods that may be used in addition to medications
to reduce procedural pain and anxiety including: virtual reality therapy, hypnosis, and behavioral
approaches such as distraction techniques.[71]

Patient support
…
Burn victims require support and care – both physiological and psychological. Respiratory
failure, sepsis, and multi-organ system failure are common in hospitalized burn victims. To
prevent hypothermia and maintain normal body temperature, burn victims with over 20% of burn
injuries should be kept in an environment with the temperature at or above 30 degree Celsius.[89]

Metabolism in burn victims proceeds at a higher than normal speed due to the whole-body
process and rapid fatty acid substrate cycles, which can be countered with an adequate supply
of energy, nutrients, and antioxidants. Enteral feeding a day after resuscitation is required to
reduce risk of infection, recovery time, non-infectious complications, hospital stay, long-term
damage, and mortality. Controlling blood glucose levels can have an impact on liver function and
survival.

Risk of thromboembolism is high and acute respiratory distress syndrome (ARDS) that does not
resolve with maximal ventilator use is also a common complication. Scars are long-term after-
effects of a burn injury. Psychological support is required to cope with the aftermath of a fire
accident, while to prevent scars and long-term damage to the skin and other body structures
consulting with burn specialists, preventing infections, consuming nutritious foods, early and
aggressive rehabilitation, and using compressive clothing are recommended.

Prognosis
Prognosis in the USA[90]
TBSA Mortality

0–9% 0.6%

10–19% 2.9%

20–29% 8.6%

30–39% 16%

40–49% 25%

50–59% 37%

60–69% 43%

70–79% 57%

80–89% 73%

90–100% 85%

Inhalation 23%

The prognosis is worse in those with larger burns, those who are older, and females.[2] The
presence of a smoke inhalation injury, other significant injuries such as long bone fractures, and
serious co-morbidities (e.g. heart disease, diabetes, psychiatric illness, and suicidal intent) also
influence prognosis.[2] On average, of those admitted to the United States burn centers, 4% die,[4]
with the outcome for individuals dependent on the extent of the burn injury. For example,
admittees with burn areas less than 10% TBSA had a mortality rate of less than 1%, while
admittees with over 90% TBSA had a mortality rate of 85%.[90] In Afghanistan, people with more
than 60% TBSA burns rarely survive.[4] The Baux score has historically been used to determine
prognosis of major burns. However, with improved care, it is no longer very accurate.[17] The
score is determined by adding the size of the burn (% TBSA) to the age of the person and taking
that to be more or less equal to the risk of death.[17] Burns in 2013 resulted in 1.2 million years
lived with disability and 12.3 million disability adjusted life years.[13]

Complications
…
A number of complications may occur, with infections being the most common.[4] In order of
frequency, potential complications include: pneumonia, cellulitis, urinary tract infections and
respiratory failure.[4] Risk factors for infection include: burns of more than 30% TBSA, full-
thickness burns, extremes of age (young or old), or burns involving the legs or perineum.[91]
Pneumonia occurs particularly commonly in those with inhalation injuries.[17]

Anemia secondary to full thickness burns of greater than 10% TBSA is common.[11] Electrical
burns may lead to compartment syndrome or rhabdomyolysis due to muscle breakdown.[17]
Blood clotting in the veins of the legs is estimated to occur in 6 to 25% of people.[17] The
hypermetabolic state that may persist for years after a major burn can result in a decrease in
bone density and a loss of muscle mass.[47] Keloids may form subsequent to a burn, particularly
in those who are young and dark skinned.[87] Following a burn, children may have significant
psychological trauma and experience post-traumatic stress disorder.[92] Scarring may also result
in a disturbance in body image.[92] In the developing world, significant burns may result in social
isolation, extreme poverty and child abandonment.[20]

Epidemiology

Disability-adjusted life years for fires per 100,000 inhabitants in 2004.[93]

   no data
   < 50
   50–100
   100–150
   150–200
   200–250
   250–300
   300–350
   350–400
   400–450
   450–500
   500–600
   > 600
In 2015 fire and heat resulted in 67 million injuries.[8] This resulted in about 2.9 million
hospitalizations and 238,000 dying.[13] This is down from 300,000 deaths in 1990.[94] This makes
it the fourth leading cause of injuries after motor vehicle collisions, falls, and violence.[20] About
90% of burns occur in the developing world.[20] This has been attributed partly to overcrowding
and an unsafe cooking situation.[20] Overall, nearly 60% of fatal burns occur in Southeast Asia
with a rate of 11.6 per 100,000.[4] The number of fatal burns has changed from 280,000 in 1990
to 176,000 in 2015.[95][9]

In the developed world, adult males have twice the mortality as females from burns. This is most
probably due to their higher risk occupations and greater risk-taking activities. In many countries
in the developing world, however, females have twice the risk of males. This is often related to
accidents in the kitchen or domestic violence.[20] In children, deaths from burns occur at more
than ten times the rate in the developing than the developed world.[20] Overall, in children it is one
of the top fifteen leading causes of death.[6] From the 1980s to 2004, many countries have seen
both a decrease in the rates of fatal burns and in burns generally.[20]

Developed countries
…
An estimated 500,000 burn injuries receive medical treatment yearly in the United States.[46]
They resulted in about 3,300 deaths in 2008.[6] Most burns (70%) and deaths from burns occur in
males.[2][15] The highest incidence of fire burns occurs in those 18–35 years old, while the
highest incidence of scalds occurs in children less than five years old and adults over 65.[2]
Electrical burns result in about 1,000 deaths per year.[96] Lightning results in the death of about
60 people a year.[19] In Europe, intentional burns occur most commonly in middle aged men.[41]

Developing countries …
In India, about 700,000 to 800,000 people per year sustain significant burns, though very few are
looked after in specialist burn units.[97] The highest rates occur in women 16–35 years of age.[97]
Part of this high rate is related to unsafe kitchens and loose-fitting clothing typical to India.[97] It
is estimated that one-third of all burns in India are due to clothing catching fire from open
flames.[98] Intentional burns are also a common cause and occur at high rates in young women,
secondary to domestic violence and self-harm.[20][41]

History
Guillaume Dupuytren (1777–1835), who developed the degree classification of burns

Cave paintings from more than 3,500 years ago document burns and their management.[14] The
earliest Egyptian records on treating burns describes dressings prepared with milk from mothers
of baby boys,[99] and the 1500 BCE Edwin Smith Papyrus describes treatments using honey and
the salve of resin.[14] Many other treatments have been used over the ages, including the use of
tea leaves by the Chinese documented to 600 BCE, pig fat and vinegar by Hippocrates
documented to 400 BCE, and wine and myrrh by Celsus documented to 100 CE.[14] French
barber-surgeon Ambroise Paré was the first to describe different degrees of burns in the
1500s.[100] Guillaume Dupuytren expanded these degrees into six different severities in
1832.[14][101]

The first hospital to treat burns opened in 1843 in London, England, and the development of
modern burn care began in the late 1800s and early 1900s.[14][100] During World War I, Henry D.
Dakin and Alexis Carrel developed standards for the cleaning and disinfecting of burns and
wounds using sodium hypochlorite solutions, which significantly reduced mortality.[14] In the
1940s, the importance of early excision and skin grafting was acknowledged, and around the
same time, fluid resuscitation and formulas to guide it were developed.[14] In the 1970s,
researchers demonstrated the significance of the hypermetabolic state that follows large
burns.[14]

See also
Blister

Frostbite

Scalding

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Notes
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n.org/2012NBRAnnualReport.pdf) (PDF). American Burn Association. 2012. Archived from
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