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ABSTRACT

OBJECTIVES: Our aim was to describe the pediatric patients with contact burn injury treated in our burn center to gain insight into general characteristics and possible precautions.

MATERIALS AND METHODS: We studied 377 contact burn cases for patients who were less than 18 years old treated in our burn center (2004-2024). For each case, we collected age; sex; place of residence; environment, daytime interval, and season in which the injury occurred; cause and extent; body sites affected; and treatment modality (outpatient/inpatient). We presented results as mean ± SE, range, and number (%).

RESULTS: There were 206 boys and 171 girls (male-to-female ratio of 1.2); mean total body surface area burned was 1.01 ± 0.06% (range, 0.01%-11%). The largest proportion of the test group comprised patients younger than 4 years of age (77.9%, n = 294). Most patients were from urban areas (85.4%, n = 322). The most common environment was “home” (85.7%, n = 323). Injuries commonly occurred between 6 am and 6 pm and in spring and summer seasons (60.2%, n = 227). The most common causes were domestic appliances, including kitchen devices (35.2%, n = 133), clothes iron (22.9%, n = 86), and heating devices (20%, n = 75). Injuries via materials such as battery, hair dryer, hair curling/straightening iron, or vehicle exhaust pipe comprised 22.0% (n = 83), with a frequent occurrence among adolescents (51.1%, n = 22). Hands were the most common body sites (63.9%, n = 241). Most patients were outpatients (98.1%, n = 370) who were followed up with nonsurgical scar treatment modalities for at least 6 months.

CONCLUSIONS: Children in our series were prone to contact burn injuries. Causes for contact injuries varied for different age groups, with a high incidence of home devices, which indicated the need for meticulous age-focused preventive measures within public awareness programs.

KEY WORDS: Burn injury in childhood, Epidemiology, Prevention, Quality of burn care

INTRODUCTION

The World Health Organization estimates that burn injuries are the fifth most common cause of nonfatal childhood injuries.¹ In fact, more than half a million children worldwide are hospitalized with burn injuries each year, and most of these injuries occur in developing countries.^2,3 Most burn injuries in the pediatric age group are preventable and unintentional and occur due to naive curiosity and lack of awareness of danger.^4-6 Unawareness of danger is typically high among infants and toddlers. However, naive curiosity and lack of attention persist into late adolescence. Although scalds are the most common burn causes in various world regions,^5-7 contact burns, which are underestimated in childhood, are also a significant problem because contact burn injuries usually affect small surface areas of the body but tend to be deep and usually affect functional body areas. Inadequate design of domestic and public spaces and unawareness of the society (especially inattentive behaviors of caregivers) have important roles in occurrence of the injuries among children. In some cases, contact burns can be a method of intentional abuse inflicted by a third party, and the incidence rate of these intentional contact burn cases is likely underestimated.^8-10
In the present retrospective study, we investigated the basic features of contact burn injuries among the children and adolescents who were treated at our burn center during the past 20 years. Our aim was to name the general characteristics of contact burn injuries and develop prevention strategies, with the expectation that our results may assist the differential diagnosis of unintentional injuries versus intentional injuries.

MATERIALS AND METHODS

Our burn center at Başkent University Hospital was established with the union of the Haberal Foundation and the Turkish Transplantation and Burn Foundation in 1994. The center (in Ankarathe, capital city of our country) has been serving burn patients of any age as outpatients and inpatients. In 2003, it became a subdivision of Burn and Fire Disasters Institute of Başkent University, which was established as the first and unique institute dedicated to burn trauma and disasters in our country.¹¹
We selected cases from 3044 pediatric burn cases for patients younger than 18 years who were treated at our burn center from 2004 to 2024. We obtained details from records of 377 pediatric patients with contact burns. For each case, we collected age; sex; place of residence; environment and daytime interval in which the injury occurred; the season in which the injury occurred; cause and extent of the injury; and body sites affected and the treatment modality (outpatient vs inpatient). We evaluated data in different age groups with different predominant activities and social behaviors (age groups of 0-4 years, 5-9 years, and 10-18 years). We used SPSS software (version 25, IBM) to document frequencies and quantitative variables. Results for quantitative variables are given as mean values ± SE and range. We used the χ² test with Monte Carlo simulation to compare distributions (P < .05).

RESULTS

Contact burns were the second most common burn injury in children after scalds (12.3% of the pediatric burn cases). Pediatric patients with contact burns included 206 boys and 171 girls (ratio 1.2); mean total body surface area burned was 1.01 ± 0.06% (range, 0.01%-11%). Mean age was 3.7 ± 0.23 years (range, 0-18 years). The largest proportion of the test group comprised patients younger than 4 years of age (77.9%, n = 294) (Figure 1). Most included patients were local urban residents (85.4%, n = 322), most of whom lived in centrally radiator-heated homes (89.9%, n = 339) or homes heated by stoves or electrical heating devices. The most common environment in which contact burn injury occurred was the home (85.7%, n = 323), followed by other various public environments such as shopping center, store, restaurant or café, hair dresser, parents’ workplace, swimming pool (6.6%, n = 25), outdoors (5.57%, n = 21), workplace (1.33%, n = 5), and school (0.8%, n = 3) (Figure 2).
Injuries most commonly occurred between 6 am and 6 pm (60.2%, n = 227). The most common causes were various domestic appliances (77.9%, n = 294), including kitchen devices (35.2%, n = 133), clothes iron (22.9%, n = 86), and indoor heating devices (20%, n = 75). Other hot surfaces such as battery, hair dryer, hair curling/straightening iron, vehicle exhaust pipe, and garden barbeque comprised 22.0% (n = 83) (Figure 3). These surfaces were frequent causes of contact injury among patients who were 10 to 18 years old (51.1%, n = 22) (Figure 4).
When we evaluated the relationship between seasons and injuries, we found that contact burns more frequently occurred during spring-summer versus autumn-winter (P < .05). As expected, indoor heating devices were more frequent problems in the winter months; burns due to hot surfaces outside the home were more common in the summer months. Compared with the other seasons, the low incidence rate in autumn was significant (P < .05) (Figure 5).
Hands were the most frequently affected major body site (63.9%, n = 241), followed by the head and neck (19.9%, n = 41) and feet (10%, n = 34). Most cases were treated in outpatient settings (98.1%, n = 370). All 7 hospitalized cases were treated with debridement; surgeries included split thickness skin graft performed for 1 foot and full thickness skin graft performed for wounds to the hands. The follow-up protocol for the patients who did not miss their follow-up appointments consisted of nonsurgical scar treatment modalities implemented by trained families or professional physical therapists for at least 6 months.

DISCUSSION

Our results are consistent with many previous studies that indicated that the most vulnerable groups with burn injuries in childhood are infants and toddlers.^12-15 This finding explains why the most common hot surfaces that resulted in injuries in our study were household appliances (eg, kitchen appliances, clothes irons, indoor heating systems). Children younger than 4 years of age are frequently at home with their caregivers. Therefore, the prevention of contact burns in this age group is relevant to the awareness of caregivers. In addition to various types of devices, attention to the household’s use of a clothes iron is indispensable, since this device alone was the cause of contact burn injuries in 22.9% of all cases in our study; the clothes iron has also been reported as a device used for abuse.⁹ Among the kitchen appliances, the electric cooking stove, which provides additional space on the kitchen counter, is a rising problem as it has become increasingly preferred in urban homes in recent years. On the other hand, we suggest that the relatively low prevalence of indoor heating devices in the present study is due to our patient population living in centrally heated houses, mostly in urban areas. Although not reflected in our series, stoves and electric heaters are a significant hazard, especially for children living in suburban households. Our recommendation considers a previous study showing that people living in the highest Area Deprivation Index quartile were more likely to suffer more severe burns in residential structure fires.¹⁵
Scalding burns and flame burns are top burn injuries in different series; however, studies concerning minor burns have revealed more contact burns cases among outpatients compared with inpatients.^12-14,16-19 Our present study showed that contact burns were the second most common burn cause among children treated at our burn center (12.3%), which contrasts with our previous study in 2007 in which we reported a low prevalence of contact burns (1.7%).⁵ The reason for this significant difference may be that our study published in 2007 evaluated a period from 1997 and 2005 and included data from 3 burn centers located in 2 different regions of our country; also, during that period, these centers provided services to hospitalized major burn patients more frequently than to outpatients. Thus, because contact burns are generally suitable for outpatient treatment, the frequency of contact burns that we encountered has increased as outpatient treatment services have improved over the years at our center.
Medical evaluation is crucial to determine burn severity, potential complications, and appropriate treatment for contact burns. Unfortunately, because the wounds of contact burns are usually smaller than the wounds from scalds and flame burns, caregivers may underestimate complications and decline to seek medical attention, despite the fact that contact burns affect functional body areas and, if left untreated, can cause serious aesthetic problems and loss of function in the hands, feet, mouth, and joints.^8,19 Our findings support the necessity of meticulous wound care, as the most commonly affected body sites among the children that we treated were functional areas, such as hands, head and neck, and feet.
Because of risk of negative aesthetic and functional outcomes, our treatment protocol included providing information to caregivers with regard to outcome scenarios of contact burns; standard practice at our center is to continue follow-up protocols for at least 6 months. Increasing the awareness of caregivers even in the period after the burn incident should be considered among the important responsibilities of burn professionals. Our results suggested that adolescents are at high risk of contact burns outside the home; therefore, not only their caregivers but also adolescents themselves need to be provided information on the risks of public settings and misguided curiosity, and public service messages on social media could prove useful to inform this high-risk group.
The potential complications of untreated contact burns should also be emphasized, as the adolescent age group tends to underestimate the severity of their medical problems. We strongly suggest education programs for caregivers and for teenagers via meetings at public venues such as kindergartens, schools, and recreation complexes. Other potential methods to raise awareness include posting notices on walls of public places and broadcasting public service announcements on television, radio, and social media. Placing protective barriers and warning signs around any surfaces in public places that are likely to overheat is another crucial precaution. Everyone in society must contribute to these efforts.
Intentional contact burns in children are difficult to differentiate from unintentional injuries. The shape, severity, location of the burn wounds, and the consistency of the description given can provide valuable information. In addition to the general examination of the child, any extraordinary location, appearance, or depth that is contrary to the features that typify unintentional injury should serve as an alert for the physician.^8-11 Early detection can affect the patient’s entire life. Consideration of the common characteristics of burn injuries will contribute to a more realistic suspicion pattern without being overly accusatory.
In conclusion, contact burns are quite common in childhood and can have negative consequences. Prevention strategies for contact burns are needed more than previously thought; the characteristics of the age groups of burn patients, home safety, community safety, and consumer safety, among other aspects, should be taken into consideration and focused on separately. The value of seeking immediate medical attention for burn injuries should be emphasized in society.

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