ABSTRACT

KEY WORDS: Adolescent, Burn injury, Burn prevention, Young adult

INTRODUCTION

Youth is classified as a combination of adolescence and young adulthood. In today’s era of intense development, there is an excessive pressure on this age group because of early starts into adulthood within unsafe working and living conditions. Rapid spread of misinformation and harmful addictions are other problems among youth.

When we consider the ongoing complex physiological and mental development in this age group along with responsive changes in their lives, it can be predicted that this age group is prone to injuries. According to the World Health Organization (WHO), injuries (including road traffic injuries and drowning), interpersonal violence, self-harm, and maternal health conditions are the leading causes of death among adolescents and young adults.¹ Differences in burn injuries, which result in fatalities worldwide, affect young people depending on the conditions of societies in which they live; information on burn injuries in this age group (10-24 y) is scarce and far from descriptive.

Here, we investigated the features of burn trauma in this age group to provide more functional information for burn injury epidemiological and preventive strategies for young people.^2,3 Our aim was to investigate the features of burn injuries among young people who were treated at our burn center.

MATERIALS AND METHODS

Our burn center at Başkent University Hospital, located in the capital of Türkiye, was established with the union of the Haberal Foundation and the Turkish Transplantation and Burn Foundation in 1994. Outpatient and inpatient burn care services for burn patients are available for all ages. Our burn center also performs research for all aspects of burn trauma, including prevention, treatment, and rehabilitation. In 2003, the subdivision of Burn and Fire Disasters Institute of Başkent University was established, which is the first and unique institute dedicated to burn trauma and disasters in our country.⁴

We analyzed patients with burn injuries who were treated at our burn center between 2010 and 2024. We collected available data on 410 adolescents (aged 10-18 y) and on 396 young adults (aged 19-24 y). We collected data on age, sex, social security residency, status, occupation, marital status, scene of injury, burn extent, burn cause, history of injury, affected major body sites, and need for inpatient care.

We first analyzed data on all young patients (aged 10-24 y) and then compared the subgroups of adolescents versus young adults. We used the Statistical Package for the Social Sciences version 25 (IBM-SSPS Inc) to document frequencies and quantitative variables. We presented results for quantitative variables as median (range) or mean ± SD. We used the X² test with Monte Carlo simulation to compare the distributions; P < .05 was considered statistically significant.

RESULTS

Mean age for the whole study group was 18 ± 4.25 years, with mean of 13 ± 3.02 years for adolescents and 22 ± 1.7 years for young adults. Male-to-female ratio was 0.68:1 with female predominance especially among young adults (66.7%) ( Figure 1). Most patients were from urban areas who lived in our province (96.3%). Most patients had easy access to health services and were under the umbrella of the civil social security system (n = 756; 93.7%) (Figure 2). Most patients were students (n = 625, 77.5%), but 136 patients were in the labor force (16.9%) and 45 were unemployed (5.6%) (Figure 3). Most patients were single (n = 781, 96.9%), but 4 patients in the adolescent group and 21 patients in the young adult group were married (n = 25, 3.1%); 19 married patients were female (76%) (P < .05) (Figure 4).

Injuries occurred mostly at home (n = 528, 65.5%). Occurrence at school was more common in the adolescent group (P < .001). Occurrence at the workplace was more common in the young adult group (P < .001) ( Figure 5). Mean total body surface area (TBSA) of burn injury was 3.23 ± 7.9% (range, 0.2-80) for the whole study group, with mean of 3.6 ± 9.7% (range, 0.2-80) for the adolescent group and 2.8 ± 5.6% (range, 0.2-46) for the young adult group.

Leading cause of burns was scalds (69.4%), with no significant difference between the 2 groups. In the whole study group, no significant differences in the distribution of burn causes were shown (Figure 6). Female patients had greater frequency of scald injuries (n = 511, mean TBSA of 1.9 ± 2.1%); scalds were more frequent in male adolescents than in male young adults. Most married female patients had scald injuries (n = 15/19; 78.9%), with accidents mostly occurring at home (n = 16/19, 88.9%). Most patients with flame burns (n = 51 [79.1%]; mean TBSA of 13.0 ± 21.9%) and electrical burns (n = 14 [7.5%], mean TBSA of 15.9 ± 15.8%), especially severe cases, were male patients.

Injuries occurred mostly at home (77.9%). Although most home accidents occurred in female patients in both subgroups, male young adults compared with male adolescents were more frequently injured at a work setting. Distribution of burn causes and injury scenes by sex is shown in (Figure 7).

All cases were preventable accidents except 1 suicide attempt. The unique addiction-related burn injury was due to smoking or ignition of subjects during butane lighter-liquid inhalation in 15 cases (1.9%). Five of these cases were young adults, and 10 were adolescents with a male predominance. Inpatient care (hospitalization) was required in 65 cases (8.1%): with 35 involving adolescents (53.9%) and 30 involving young adults (46.1%). Mean TBSA of burn injury among inpatients was 13.5 ± 19.6% (range, 1-80), with TBSA of 17.3 ± 23.9% in adolescents and 10.1 ± 13.8% in young adults.

Mortality rate was 0.2%, which involved 2 adolescents with severe flame burns associated with preexisting septic shock due to multiresistant bacteria at admission.

DISCUSSION

Our results confirmed that young people in our region are prone to burn injuries; we observed similar burn injuries occurring in adolescents and young adults, with some details varying according to social factors and sex.^5-8 We surmised that a main reason for the basic similarity was the ongoing growth and maturation processes in both groups. The body starts a rapid and asynchronous change in size, shape, and composition in early adolescence; difficulties in functional and mental adoption produced by this overall maturation continue until the end of young adulthood, with manifestations of clumsiness in daily life and possible injuries occurring in environments where young people are mostly present.^9-11

In our series, the most common injury setting was at the home among male and female patients in both subgroups; the workplace setting occurred more among young adults, whereas outdoors and the school occurred more for adolescents. The most common burn causes among adolescents and young adults were scalds, followed by contact burns. Flame-related burns were frequent for male subjects. These findings were in contrast to some previous reports, which reported flame burns as a more common burn cause for both age groups.^2,12 Differences versus our study could be because of regional factors and the homogeneous socioeconomic distribution of burn patients in our series, with most being students from urban areas whose health insurance was covered by government or private insurance. Further studies are needed to compare young populations in rural versus urban areas.

Many young girls (married or single) take on housework at an early age in many societies all over the world; thus, the young female population deserves a special attention with regard to home-related burn injuries. Although the number of married subjects in our study was low, female patients in our study were predominant with regard to home-related burn injuries, having scald injuries more frequently than male married subjects and confirming the risks of housework responsibilities. However, male patients in our study had predominantly more severe flame burns and electrical injuries than female patients, suggesting that young men may not have sufficient knowledge of the dangers and precautions involved with electricity and fire. Information and training programs for young people are needed to learn about safe home conditions, safe social activities, and appropriate workplace precautions.

Suicide is not rare among young people; previous reports, including 1 from our group, involving 3 different burn centers revealed that suicide with flammable objects (with or without catalyzers) is one of the used methods for this age group.^13-15 In the present study, we documented 1 suicide-related case; however, ours was a single-center experience with people with middle socioeconomical status. Further understanding is needed on suicide with flammable objects and prevention strategies for this age group.

Addiction and addiction-related burns are also common among adolescents and young adults.^12,16 In our present study, we had 15 cases with flammable butane lighter-liquid addiction-related burns. This substance produces transient euphoria when sniffed and has some long-term negative effects on central nervous system maturation.¹⁷ In addition, the substance is easy to reach and relatively cheap. It is flammable, and burn injuries occur when the user wants to smoke at the same time. An important note on this issue is that not only one person but friend groups who sniff it together can all become injured. The wounds are generally second-degree burns, but this liquid can result in indoor fires such as houses fires and car fires. Sniffing butane lighter liquid is a dangerous and underestimated type of addiction, and we suggest that this addiction should be recognized in prevention and education programs for parents and young people.

CONCLUSIONS

Adolescents and young adults, who are experiencing new social life and other experiences, had similar numbers of burn injuries, with young female patients having more burn injuries but young male patients having more severe injuries. Further evaluations of adolescents and young adults together may provide purposive data for preventive strategies for social health.

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