Comprehensive Study of Fatal Burn Injuries: 10-year Retrospective Autopsy Study in Goa Medical College, Goa

Abbreviations

SPSS: Statistical Package for Social Sciences; NBC: National Burn Center; TBSA: Total Burn Surface Area.

Introduction

Throughout history, Fire has perhaps been man’s first double edged weapon. It has both benefitted and harmed harmony [1, 2, 3]. Burn trauma predates human history by the same period as the development of fire, when utilised carefully, it may be extremely beneficial to humanity; Nevertheless, when caution is not taken, it can cause disaster that injure people and destroy property [2]. When dry heat, such as flames or radiant heat or another hot solid material such as glass/metal is applied to the body, it may cause burns. It is difficult to determine where fire was controlled and in use by homo erectus, way before modern humans were evolved. As such there is no written recorded history about learning to control and use fire [2]. Electric spark discharges, flashes and lightening leads to electric burns [4]. Burn injury is one of the common medical emergencies admitted to any hospital and is an important public health problem throughout the world. The obnoxious and ubiquitous practices of dowry has penetrated a new and alarming rise in mortality from burns, the so called “Dowry deaths”. Homicidal burning of married women in India is a major concern for the government, law enforcing authorities, the judiciary, the police and medicolegal expects all over the country [2]. Furthermore, due to the high expense of wound and scar care, extended hospital stays, and rehabilitation, burns are also among the most expensive traumatic injuries. Furthermore, due to the high expense of wound and scar care, extended hospital stays, and rehabilitation, burns are also among the most expensive traumatic injuries [5, 6]. The World Health Organization estimates that 238,000 people died in 2000 from burns connected to fires, with low- and middle-income nations accounting for 95% of these deaths [7]. In the present retrospective study of 10 years an attempt is made to analyse the incidence and circumstances of death due to fire, age and sex distribution, marital status, etiology of burns, manner of death, surface area burns, survival period and cause of death along with various epidemiological and medicolegal aspects in the community.

Materials and Methods

Materials for the present study comprised of total number of 972 cases of death due to burns brought to the mortuary of Goa Medical College and Hospital. All the case files and record of the past 10 years were studied for fatalities among male and female victims due to burns trauma. i.e. from 2014-2023. An In-depth examination of the epidemiological features and medicolegal aspects like age, sex, marital status, type of burn, cause of death, period of survival, socio- economic status was ascertained from in-patient case sheets, in case of hospital admission, inquest reports, records from hospital, post mortem reports of the cases.

The resulting data was tabulated and analysed. On the basis of analysis and observation, Results were drawn, discussed and compared with other relevant literature.

Observations and Results

The incidence of burns whether accidental, homicidal or suicidal case are not uncommon to Indian society since immemorial. Incidence, etiology and nature of burns vary from one community to another and depend mainly on age, sex, economic status, environmental and socioeconomic circumstances.

Total number of 972 cases were studied during the period of 2014 to 2023 which forms about 8.92% of total post mortem examination done during that period. Age group of 31-40 years was the common affected with 21.6%.

Discussion

Humans have been suffering from burn injuries since ancient times. All cultures, developed or developing, face the medical and psychological challenges of burns, but they also have serious social and economic consequences for the patients, their families, and society at large [5].

Karradi et al. conducted a study to investigate the circumstances of death caused by thermal burns and to determine the correlation between the surface area of burns, the duration of survival, and the cause of death. A total of 698 thermal burn death cases were examined. Burn-related deaths occur at a rate of 25.41%, with the age group of 21–30 years old accounting for the highest number of deaths (44.84%). In a 3:1 ratio, women outnumbered men by roughly three times, with 74.39% of the 511 females being married and 25.61% being single. While 30.66% of victims passed away within five days of the incident and 21.63% of victims died with 80–90 burns, 17.34% of victims were unable to survive for more than twelve hours. Septicemic shock was the cause of death for the majority of victims (65.54%). Additionally, it was noted that 85.67% of the victims had unintentional burns. Burns accounted for 60.08% of all dowry death cases [8].

To provide a summary of the patterns in burn epidemiology in Manipal from 2011 to 2015, Harikumar et al. conducted research. In the study area, the mortuary connected to the tertiary care teaching hospital served as the site of the five-year retrospective study. From 2011 to 2015, their study included all cases of thermal injury-related deaths. Post mortem records were consulted for pertinent information, which was then analyzed using the Statistical Package for Social Sciences (SPSS) 21 for descriptive statistics. Thermal injury deaths accounted for 14% of all unnatural deaths that transpired during the study period. Of the victims, 68% were women. The victims’ ages ranged from one to eighty years. The percentage of body surface area that was burned ranged from 22% to 100%. The period of time between the incident and the victim’s death varied from one day to three months. The months of April, May, and June saw the most cases. Complications including pulmonary edema, hypovolemia, septicemia, and renal failure were among the causes of death [9]. In the Varanasi area, Pandey et al. carried out a retrospective study on cases that were brought to the Department of Forensic Medicine, IMS, BHU, Varanasi, over a two-year period, from 2009 to 2010. During the study period, burn injuries accounted for 17.98% and 17.07% of all unnatural deaths reported, respectively, indicating a relatively stable trend. Burn deaths typically involve females and dowers, with the female dying in her in-laws’ home within seven years of marriage. In a 1:4 ratio, female burn deaths outnumbered male burn deaths. The married group accounted for the majority of the dead (73.19%), followed by the unmarried (23.55%). Young adults were more likely to be involved in these kinds of deaths, as evidenced by the fact that the main age group was 21–30 years old (45.13%), followed by 11–20 and 31–40 years old, which showed nearly the same rate of about 20%. 90.28% of deaths occurred in hospitals, indicating that timely and appropriate medical care was provided, whereas only 9.72% of deaths occurred on the spot or while traveling to the hospital. Regardless of how death occurs In contrast to male burn deaths, which are investigated by police under 174 Cr.P.C. as routine cases and medico-legal postmortem examinations by a single doctor, female burn deaths are investigated by magistrates under 176 Cr.P.C. and cases registered under 304B IPC (Dowry Death) and a panel of two doctors [10].

Over a 17-year span since the National Burn Center (NBC) opened in 2006, Anna et al. examined changes in burn patient referrals, hospitalizations, treatment, and outcomes. Patients who meet the American Burn Association’s requirements for a burn center referral are treated in four burn centers located around the country. The major metropolitan region is home to the NBC, which also accepts further referrals for “severe” burn injuries (such as those with a total burn surface area (TBSA) of greater than 30%). Their study presented the changing models of treatment over time and examined the burden of referrals. The average population of a US state is 5.7 million people scattered across 182, 949 km2, however our entire catchment population is 5.1 million people spread throughout 268, 021 km2 [11].

According to the pertinent statistics above, married persons constituted the largest group, potentially due to dowry, in-law conflicts, or other familial troubles. Married women were more adversely affected, potentially due to familial obligations, insufficient emotional support, or other issues. Kerosene and petrol were predominantly utilized due to their widespread availability in households, particularly for cooking purposes.

In Goa, the socio-economic position is exaggerated, resulting in the age group of 31-40 being the most affected, since family duties intensify during this period. This stress can subsequently lead to suicide, which is identified as a prevalent cause of death according to both existing research and our study.

The middle class was most adversely affected, likely due to a deficiency of financial and emotional support, prompting some to take the drastic step of committing suicide.

Conclusion

According to our study, the year 2016 had the highest number of thermal deaths, with 102 out of 1072 instances occurring in the year 2017 followed by 2023. The population aged 31 to 40 was the highest.

Among 314 instances of thermal fatalities, 226 involved males and 88 involved females. Married individuals constituted the greatest number at 78.4%. Of the 762 total married instances of thermal fatalities, 352 were male and 410 were female. The middle class ranked highest, with an aggregate of 62.2%. Flame burns constituted the highest percentage of 83.4%. The predominant cause of burns was kerosene stove explosions, accounting for 30.67%, followed by petrol/diesel incidents at 25%. The percentage of surface area burned was determined using the Rule of Nine and was found to be 42.2%, with 51-75% of the burn area encompassing 410 cases. The survival span peaked at 3-7 days, with a proportion of 22.6% among 220 cases. The primary cause of mortality was septic shock, accounting for 60.3% of cases, totalling 586 instances. The most prevalent microorganisms discovered during treatment were Pseudomonas, which accounted for 35% with 340 cases. Suicide was the most prevalent cause of death accounting for 56.5% of the 549 cases.