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Mortality from Thermal Burns in Patients Using EMS in India


Abstract

Abstract

Objectives: Characterize the demographics, management, and outcomes of patients using emergency medical services (EMS) for thermal burns in India.

Methods: A prospective observational study of patients using EMS for thermal burns across five Indian states over four months in 2015.

Results: We enrolled 439 patients, 30-day follow-up rate 85.9%. The median age was 31 years; 50.3% (N = 221) lived in poverty; and 65.6% (N = 288) were women. EMS transported most patients within two hours (94.3%; N = 395). Overall 30-day mortality was 64.5%, but was 90.2% in women with self-inflicted burns. In total, 45.6% (N = 200) reported self-inflicted burns. Intentional burns involved a median total body surface area (TBSA) of 80%, versus 35% in accidental burns.  Inhalation injury (OR 6.7; 95% CI 3.1, 14.5), intentionality (OR 6.6; 95% CI 3.6, 12.2), economic status (OR 2.6; 95% CI 1.2, 6.0), and gender (OR 2.3; 95% CI 1.3, 4.0) predicted mortality by multivariate regression.

Conclusions: EMS connects critically burned patients to needed care in India. Mortality from thermal burns remains exceedingly high, with women disproportionality suffering self-inflicted burns and higher mortality. Burn prevention in India must recognize the prevalence and severity of self-inflicted burns and the need for mental health and gender-based violence supportive services.

Poster
non-peer-reviewed

Mortality from Thermal Burns in Patients Using EMS in India


Author Information

Jennifer A. Newberry Corresponding Author

Department of Emergency Medicine, Stanford University School of Medicine

Corey Bills

Emergency Medicine, University of California, San Francisco

Elizabeth A. Pirrotta

Department of Emergency Medicine, Stanford University School of Medicine

Sybil Zachariah

Emergency Medicine, Stanford University School of Medicine

G.V. Ramana Rao

Emergency Medicine Learning Centre (EMLC) & Research, GVK Emergency Management and Research Institute

S.V. Mahadevan

Emergency Medicine, Stanford School of Medicine

Matthew C. Strehlow

Department of Emergency Medicine, Stanford University School of Medicine


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  • Author Information
    Jennifer A. Newberry Corresponding Author

    Department of Emergency Medicine, Stanford University School of Medicine

    Corey Bills

    Emergency Medicine, University of California, San Francisco

    Elizabeth A. Pirrotta

    Department of Emergency Medicine, Stanford University School of Medicine

    Sybil Zachariah

    Emergency Medicine, Stanford University School of Medicine

    G.V. Ramana Rao

    Emergency Medicine Learning Centre (EMLC) & Research, GVK Emergency Management and Research Institute

    S.V. Mahadevan

    Emergency Medicine, Stanford School of Medicine

    Matthew C. Strehlow

    Department of Emergency Medicine, Stanford University School of Medicine

    Poster Information
    Meeting

    Consortium of Universities for Global Health (CUGH) April 06, 2017 - April 09, 2017

    Publication history

    Received by Cureus: May 03, 2017
    Published: April 06, 2017

    License

    This is an open access poster distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Abstract

Objectives: Characterize the demographics, management, and outcomes of patients using emergency medical services (EMS) for thermal burns in India.

Methods: A prospective observational study of patients using EMS for thermal burns across five Indian states over four months in 2015.

Results: We enrolled 439 patients, 30-day follow-up rate 85.9%. The median age was 31 years; 50.3% (N = 221) lived in poverty; and 65.6% (N = 288) were women. EMS transported most patients within two hours (94.3%; N = 395). Overall 30-day mortality was 64.5%, but was 90.2% in women with self-inflicted burns. In total, 45.6% (N = 200) reported self-inflicted burns. Intentional burns involved a median total body surface area (TBSA) of 80%, versus 35% in accidental burns.  Inhalation injury (OR 6.7; 95% CI 3.1, 14.5), intentionality (OR 6.6; 95% CI 3.6, 12.2), economic status (OR 2.6; 95% CI 1.2, 6.0), and gender (OR 2.3; 95% CI 1.3, 4.0) predicted mortality by multivariate regression.

Conclusions: EMS connects critically burned patients to needed care in India. Mortality from thermal burns remains exceedingly high, with women disproportionality suffering self-inflicted burns and higher mortality. Burn prevention in India must recognize the prevalence and severity of self-inflicted burns and the need for mental health and gender-based violence supportive services.

Jennifer A. Newberry, M.D.

Department of Emergency Medicine, Stanford University School of Medicine

For correspondence:
newberry@stanford.edu

Corey Bills

Emergency Medicine, University of California, San Francisco

Elizabeth A. Pirrotta

Department of Emergency Medicine, Stanford University School of Medicine

Sybil Zachariah

Emergency Medicine, Stanford University School of Medicine

G.V. Ramana Rao

Emergency Medicine Learning Centre (EMLC) & Research, GVK Emergency Management and Research Institute

S.V. Mahadevan

Emergency Medicine, Stanford School of Medicine

Matthew C. Strehlow, M.D.

Department of Emergency Medicine, Stanford University School of Medicine

Jennifer A. Newberry, M.D.

Department of Emergency Medicine, Stanford University School of Medicine

For correspondence:
newberry@stanford.edu

Corey Bills

Emergency Medicine, University of California, San Francisco

Elizabeth A. Pirrotta

Department of Emergency Medicine, Stanford University School of Medicine

Sybil Zachariah

Emergency Medicine, Stanford University School of Medicine

G.V. Ramana Rao

Emergency Medicine Learning Centre (EMLC) & Research, GVK Emergency Management and Research Institute

S.V. Mahadevan

Emergency Medicine, Stanford School of Medicine

Matthew C. Strehlow, M.D.

Department of Emergency Medicine, Stanford University School of Medicine

Jennifer A. Newberry, M.D.

Department of Emergency Medicine, Stanford University School of Medicine

For correspondence:
newberry@stanford.edu

Corey Bills

Emergency Medicine, University of California, San Francisco

Elizabeth A. Pirrotta

Department of Emergency Medicine, Stanford University School of Medicine

Sybil Zachariah

Emergency Medicine, Stanford University School of Medicine

G.V. Ramana Rao

Emergency Medicine Learning Centre (EMLC) & Research, GVK Emergency Management and Research Institute

S.V. Mahadevan

Emergency Medicine, Stanford School of Medicine

Matthew C. Strehlow, M.D.

Department of Emergency Medicine, Stanford University School of Medicine

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