J. R. Amundson1,2, I. Citron2, S. Saluja2,8, H. Jenny2, A. G. Guilloux9, M. Scheffer9, M. Shrime2,3, N. Alonso4,5 8Weill Cornell Medical College,Department Of Surgery,New York, NY, USA 9Universidade De São Paulo,Departamento De Medicina Preventiva, Faculdade De Medicina,São Paulo, SÃO PAULO, Brazil 1University Of Miami,Miller School Of Medicine,Miami, FL, USA 2Harvard School Of Medicine,Program In Global Surgery And Social Change,Boston, MA, USA 3Massachusetts Eye And Ear Infirmary,Department Of Otology And Laryngology And Office Of Global Surgery,Boston, MA, USA 4Universidade De São Paulo,Craniofacial Surgery Unit, Division Of Plastic Surgery, Department Of Surgery, Faculdade De Medicina,São Paulo, SÃO PAULO, Brazil
Introduction: Burns are a significant public health issue in Brazil, accounting for $13.06 million in spending and 2500 deaths annually. Although Brazil is considered an upper middle-income nation, it is one of the most wealth disparate countries in the world. Healthcare disparities are also prevalent, with state of the art burns care available in the Southeast and no dedicated burns units in the North. To date, there has been no systematic nationwide study assessing the epidemiology of burns and burns mortality in Brazil. Our goal is to assess the epidemiology of burns in Brazil to both quantify the problem and inform the strengthening of existing burns networks, a system shown to benefit burns care.
Methods: Data regarding deaths due to burns, place of residence and admitting facility for patients burned via mechanisms of scald, flame, electrical and contact injury from 2008 through 2014 were extracted for each of Brazil’s 27 Federal Units from DATASUS, the electronic national data reporting system for Brazil. Admissions and death registry data were extracted using ICD-10 codes corresponding to the evaluated mechanisms of injury. Pediatric patients were defined as less than 15 years of age. Population data was taken from IBGE 2014 projections, based on the 2010 census. Geographic distributions were mapped using DATASUS and ArcGIS software.
Results: There were, on average, 18,551 burns admissions and 514.7 (SE 20.59) inpatient deaths per year, a 2.77% mortality rate. Pediatric burns account for a third of all burns admissions (33.72%) and 9.35% of inpatient burns mortalities. Regarding mechanism of burn, flame burns made up 44.00% of admission, scalds 28.52%, contact burns 15.67%, and electrical burns 11.82%, with significant regional disparities in mechanism of burns. Both Goiás and Paraíba reported greater than 60 scalds admissions per 100,000 residents. Flame burns predominated in Paraná, with an admission incidence of 87 per 100,000. Overall burn admissions were highest in Goiás with greater than 200/100,000 population, followed by Paraná and Paraíba, with over 100/100,000 population. There was also significant regional variation in inpatient mortality, with 5.16% mortality in Rio de Janeiro and 0.31% mortality in Amazonas. During the same period of 2008-2014, there were an average of 2,459 burns deaths registered per year under the same ICD-10 codes, indicating 79% of burns mortality occurring out of hospital.
Conclusion: This epidemiologic study of burns in Brazil describes significant regional discrepancies in mechanism of injury and inpatient mortality rates. The differences in inpatient mortality between urban and rural states, considered alongside the percentage of burns deaths occurring outside of hospitalization reflects a lack of access to inpatient burns care in rural areas. Further studies are needed to evaluate which addressable factors correlate with burns care outcomes across Brazil.