Pattern of presentation and short term management outcomes of hand burns as seen at Kenyatta National Hospital

Abstract

This study looked at the pattern of hand burn injuries as a seen at KNH during the study period. It covered children in the 0 - 13 years age group category admitted at the hospital. It comprised both prospective and retrospective components with the aim of establishing the pattern of presentation of hand burns, current management modes and short term management out comes as seen at the plastic surgical unit in KNH. Thestudy covered a period of three months prospectively from 1st June 2004 to 31 st August 2004 during which 34 cases were seen having met the inclusion criteria. It also retrospectively looked at 531 cases from 1st September 1999 to 31st May 2004. The main parameters documented were patients age, sex, residence, family size, place of bum, site of burn, degree of burn, management mode and outcome of burn. The data was collected using a questionnaire and SPSS computer package used for analysis. In the study it was observed that there was an equal sex distribution of hand burns and that the age group of 1 - 5 years was the most affected amongst children of age thirteen years and below. Most hand burns occurred in the cooking areas and were mainly caused by hot fluids. The majority of patient's (76.5%) were brought to hospital within the first 24 hours of injury. Burns injuries were mostly managed conservatively and for the few who required surgical care the commonest surgical procedure carried out was escharotomy, while early excision and grafting was carried out infrequently. Most patients (61.8%) recovered fully with no complications; however upto 20.6% developed debilitating complications like loss of digits and contractures. From the findings in this study it is recommended that a more pro-active approach in the management of hand burns should be undertaken whenever these injuries are diagnosed; this should include early excision and grafting of burn wounds. In order to provide this kind of optimum care, specialized units well versed in set national hand burns management protocols should be established so as to minimize debilitating complications of these kind of injuries.