PEDIATRIC BURNS IN A RURAL SOUTH-AFRICAN DISTRICT HOSPITAL

Objectives. To describe the epidemiology, clinical features, managemen t and outcome of children with burns admitted to a rural district hosp ital. Design. A retrospective analysis of the case notes of consecutiv e cases of paediatric burns. Setting. Hlabisa Hospital, KwaZulu-Natal - a 450-bed rural district hospital serving approximately 200 000 peop le. Subjects. All cases of paediatric burns (age < 12 years) admitted to Hlabisa Hospital in 1994. Main outcome measures. Number of admissio ns, month of admission, age, sex, time to presentation, site of burn, complications, number of surgical procedures, adherence to management protocol and outcome. Results. One hundred and forty-nine children pre sented to the outpatient department in 1994 and 88 (59%) were admitted , The median age of those admitted was 36 months with 66 (75%) aged le ss than 5 years; 42 (48%) were boys, Thirty-nine children (44%) were a dmitted during the four winter months of May to August, The average in terval from the tirne of the burn to presentation at hospital was 42 h ours (range 1 - 120). Sixty-eight burns (77%) were due to hot fluid or food burning the legs, trunk or arms, There was a high level of morbi dity, Nineteen (22%) children developed wound infections, 5 (6%) devel oped contractures and 20 (23%) required a total of 32 surgical procedu res, There was 1 death, Burns were responsible for more paediatric pat ient days spent in hospital than any condition other than malnutrition , and a longer length of stay was associated with delay in presentatio n, Children presenting within 24 hours of the burn had a mean length o f stay of 12.8 days, compared with 25.2 days (P = 0.03) for children p resenting 24 hours or more after the burn. Twenty of the 22 children w ho stayed for longer than 3 weeks or who required transfer were judged to have been managed inadequately in at least one respect compared wi th 3 of 48 who were discharged within 2 weeks or not transferred (P < 0.001). Conclusion. This study shows that paediatric burns are an impo rtant cause of morbidity and contribute significantly to inpatient sta y in this rural setting. The lengthy delay from time of burn to presen tation at hospital is of serious concern and our results show that thi s delay is associated with increased hospital stay. As most burns were due to spillage of hot fluids or food there seems to be significant p otential for preventive interventions. Community-based studies would h elp to estimate the true incidence of burns and would contribute to an understanding of the reasons for delay in presentation. The informati on gathered is being used to inform the development of a burns prevent ion programme.