Elsevier

Burns

Volume 26, Issue 3, 1 May 2000, Pages 251-259
Burns

Burns sustained by hot bath and shower water

https://doi.org/10.1016/S0305-4179(99)00127-8Get rights and content

Abstract

An 8-year retrospective review of patients admitted to Stoke Mandeville Hospital (Aylesbury, UK) because of burns sustained by hot bath and shower water was undertaken. Fifty-seven patients of all ages were identified and stratified into paediatric (<16 years) and adult groups. Nine patients died. The main characteristics of the burns, causes and outcomes of treatment were analysed for each group. Children were predominantly under three years of age (83%), sustaining most frequently only superficial burns (41%) with areas of less than 10 % total body surface area (72%). Parents' supervision was inadequate in 85% of cases. Eighty-three percent of the adults were over the age of 60. Two thirds had some form of psycho-motor disorder that predisposed to an accident which should have been anticipated. In comparison to children, adults suffered more extensive and deeper burns that resulted in a mortality of 44% (8/18). In both groups, the lower parts of the body were most frequently involved. The observed decline in the number of admissions for the period of investigation is encouraging. It supports an ultimate need for further development and actual implementation of preventative measures for hot water burns in the homes of people who are at greatest risk.

Introduction

Although scald burns are the most common type of thermal injury in childhood [1], [2] and the second commonest in the elderly [3], [4] those caused by hot tap water have received little attention in the literature. Burns sustained during bath or shower account for approximately 5–10% of all burn admissions and represent a significant clinical problem with morbidity and mortality usually higher than for those burns caused by other hot modalities [5], [6]. Risk of burn accident is, unfortunately, the highest in the most vulnerable groups of society: infants, the elderly, handicapped and incapacitated.

One of the most important attributes of these accidents is that they are particularly amenable to prevention. Although, simple measures could virtually eliminate this cause of burn morbidity, the incidence of tap water scald burns does not seem to have declined [7], [8].

Despite the fact that hot water has been recognised as hazardous for a long time it was not until the 1970's that the epidemiology of tap water scalds was studied and the importance of prevention emphasised [5]. At that time the water heater industry practice used to pre-set water heaters at temperatures as high as 60–65°C, resulting in significant numbers of bath accidents [2], [5]. Continuous pressure and endeavours to legalise lower home water temperatures by changes in building regulations etc. in most countries resulted in the publication of safety recommendations by health authorities, but rarely implementation of these in practice [8], [9], [10].

This study was undertaken to determine the magnitude of tap water scalds as a clinical and public-health problem. We have identified groups at risk, the scenario of the injury and the extent and outcome of burns treatment in patients who required hospitalisation.

Basic measures that can reduce the incidence of hot tap water burns are also discussed.

Section snippets

Patients and methods

This study included all patients admitted to a regional burns unit, Stoke Mandeville Hospital (SMH) because of burns inflicted by hot bath or shower between January 1990 and December 1997 (8 years). Data were collected retrospectively from hospital admission records and patients notes.

The total number of paediatric and adult burn admissions for the period was 1498, and 57 (3.8%) of those were sustained by hot water during a bath. Eighteen (32%) were adults and 39 (68%) children (age under 16).

Patient's age and gender

Among the 39 children 26 were male, 13 female (male:female ratio 2:1). The mean age was 3.95±3.2 (range between 11 months and 13 years). Children under age of 4 represented the largest single group — 82% of paediatric and 56% of all patients sustaining bath burns.

Ten female (55%) and eight male patients (44%) represented the adult group with the mean age 66±S.D. 19 (range 27–88 years). Ten (55%) were over 70 and 15 (83%) over 60 years of age (Fig. 2).

Burn size

The mean burn size in children was

Discussion

In the context of more frequent hot liquids scalds and flame burns, tap water scalds may seem to be an infrequent and insignificant problem. However, they account for approximately 10% of paediatric admissions and 1–4% of adult burn admissions with nearly twice as many patients treated on an outpatients basis [2], [6], [11], [12], [13]. Tap water scalds are life threatening injuries; mortality rates reported in adults are 15–46% [2], [3], [8] and children between 8 and 12.5% [2], [7]. It is a

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