Pediatric burns due to hot water from water dispenser: a neglected issue that should be highly conce

Chinese Medical Journal 2012;12511):2053-20562053Clinical experiencePediatric burns due to hot water from water dispenser: aneglected issue that should be highly concernedMA Bing, XI Huijun, WANG Jia-lin, YAN Ying, TANG Hong tai, ZHU Shi-hui, L0 Kai-yang and XIA Zhao-fanKeywords: water dispensers; scalds; burns; pediatrics; risk factorsBackground More and more Chinese drink hot water from water dispensers while many children were scalded due tothis change. The present study aimed to propose a feasible strategy for prevention.Methods A retrospective study was conducted for all water dispensers related pediatric burns admitted to ChanghaiHospital from January 2005 to December 2009.Results The number of new cases and incidences of pediatric burns due to hot water from water dispensers wassignificanly increasing year after year. In the total 238 involved cases, 175 cases happened on males and 78.9% were atthe age of 1-4 years. The burm areas were mainly located in upper extremities. AIl water dispensers in the surveyedfamilies had no isolate protection devices and 85.2% of their locations were easy for children to reach. Nearly half of thechildren were in the same room with their guardians when injured. Total 196 burned children were playing the taps ofwater dispensers before injured, unfortunately, 80.6% of them have not been stopped until burned.Conclusion As the kind of bums is quite serious and with bad outcome, some recommendations should be fllowed,such as buying water dispensers with protection devices, keeping children from touching them and so on.Chin MedJ 2012,12511):2053-2056R um injuries are very common among children. It wasand using habi), the paren/caregiver's factors and other工) reported that 21% hospitalized accidental injuredrclated contexts were completed by the parent/caregiverchildren in China were duc to burns.' And in the Unitedin the Emergency Department or by the investigator afterStates, more than 440 000 children rccive medicalconducting a telephone follow-up of the parent/caregiver.attention and 1{ 000 arc admitted to a bum center eachMedical records of all new burns cases admitted toyear' With the improvement of daily liCc, more and moreChanghai Ilospital during this period were also analyzedChinese drink hot water from water dispensers withfor comparative analysis and incidence description.heating devices just like coffe machines. Unfortunately,the change of life style put children in the danger ofDescriptive statstics was used to analyze our data mainly.scalds caused by hot water from water dispensers. TheAlI the data were expressed as frequency (n) and/orpresent study was just conducted to discuss this commonpercentage (%). The time-varying incidence (percenlagc)situation might happened in each family, explore the riskwas tested using linear trend chi square method (Rx2factors, and propose a feasible strategy for prevention.table, Cochran-Armitage trend test). P value <0.05 wasconsidered statistically significant. Data were analyzed byMETHODSSPSS16.0 software (SPSS Inc., USA).A retrospective review was conducted of case-notes forRESULTSpatients aged under 14 years sufrring scalds due to hotwater from water dispcnscrs directly, who were admittedIncidence changesto the Bum Centre of Changhai Hospital from 1st,During the period from 2005 to 2009， there wereJanuary, 2005 to 31st, December, 2009. Pediatric buminjuries were identified using three data sources: theInjury Report and Registration Database in theDOI: 1.3760/emaj.ssn.0366-6999.2012.11.037Emergency Department, the Bum Center Registry, andDepartment of Bum Surgery (Ma B, Tang HT, Zhu SY, La KY andthe Rchabilitation Services Database of the Bum CenterXia ZF)， Department of Emergency (Xi HJ and Wang JL),Changhai Hospital, Second Military Medical Universily, Shanghai(The patient who referral for dressing change, register as200433, ChinaChinptwo or more paticnt IDs, or admitted at each of the threeDepartloral of People's Liberaiondepartment, was recorded as a single onc case). ClinicalArmy,中国煤化工(YanY)data were gathered including age, gender, information ofCorreCNMH， Department of Bumburms and treatment procedures. A one-page questionnaireSurgeTYHG:ond' Miliary Medicalwith open-ended items about injury contributing factors,University, Shanghai 200433, China (Tel: 86-21-81873471. Fax:86-21-65589829. Email: xiazhaofan@ hotmail.com)including the injury sequence, the water dispensersMA Bing and XI Hui-jun contributed equally to this work.related factors (typc, location, isolate protection deviceThere are no conict of intcrest disclosures..2054Chin MedJ 2012; 12511):2053-20565approximately 2000 to 2300 new cases with burn injuricsClinical characteristicsadmitted to the Burm Centcr of the Changhai Hospital perA total of 238 pediatric bum paticnts were identified asyear, and the pcrcentage of pediatric patients aged fromhaving been injured by hot water from water dispensers0-14 years old was nearly 35% with no significantduring the study period. There were 175 males and 63changes (P=0.088). Scald was still the major cause offemales, representing a male to female ratio of 2.8:1.0. Aspediatric burms and the incidence was steady betweenshown in Figure 2, the highest incidence (78.9%) of agc83.60% 87.36%, just like other reported.' It was a mattergroups appeared in the I- 4 years group, mainly becauseof great concerm that the number of pediatric burnschildren of that age began to have the initial activity,caused by hot water flowing out from water dispenserscuriosity, and might be no awareness of dangerous things.directly was significantly increasing year after yearThe average burned total body surface arca (TBSA) was(Figure 1, P <0.001). The new cases in 2009 were nearly(1.82+1.15)% with a range of 0.2% 8.0%, and most ofthree times more than those in 2005, and the incidence inthe burns were mainly located in upper extremities,2009 was nearly two times higher than that in five yearsespecially in hands and forearms (93.7%). Thirty-sixbefore (Table I). On the contrary, from the adults casespatients (15.1%) were admitted for inpaticnt care, and 17due to hot water flowing out from water dispenserscascs (7.14%) received autologous skin grafing,directly, there were only two-year-old patients whoincluding a itelligence challenged child with 2% TBSAfull thickness burns. The mean time of wound healing ofsuffering from hemiparalysis after cercbral stroke.the 221 patients having not received opcrations was(18.84+10.66) days, 78 patients had spent more than 3◆Perentige in pudiatic bumswecks healing wounds fully. Unfortunately, 65 involved| 000r甘Promgeg in putatic scald bum口The numher of nW causchildren having not reccived operations (27.3%) had9.00 tdeveloped visible hypertrophic scars on the healing800 rwounds 6 months post burms, and 22 cases' scars were7.00-located at the finger joints and fingerwebs, which600-5.000Eindicated that plastic operations might be applicd in the40040future because fingers movement would be limited byscar contracture.3.0030兰2.00 47 20082009J 20The related risk factorsWater dispensers related riskfactorsand2 200厂18parents/caregivers rclatcd risk factors were analyzed inthis study (Table 2). The results showed that 113 children150(47.5%) were injured by water dispensers of floorstanding type, and 125 children (52.5%) were by the table .00 tstanding type. Meanwhile, it scemed much meaningful38that all the water dispcnsers in the surveyed cases have noisolate protection devices, which might keep the childrenfrom touching the taps. Otherwisc, the locations of the0-147.14dispensers should also be concerned, because 202Age grnupssurveyed cases (85.2%) have their water dispensers beingFigure I. The numbcrs of new cases of pediatric bums due toplaced on or ncarby some furmiture, especially beside sofahot water from water dispensers from 2005 to 2009, and theand cofTce tables, which provided ways for children topercentages of this kind of injury in pediatric bums and irclimb up and close to the water dispensers.pediatric scald bums.' The percentages of pediatric bumns causedby hot waler from water dispenscrs compared with that in 2005,P <0.05. *The percentages of pediatric burms caused by hotMost involved cascs (80.7%) in this study were localwater from water dispensers compared with that in 2006, Presidents, and most surveyed families (91.6%) had stable<0.05.income, who could afford to drink clean water from theFigure 2. The distribution of new cases by age groups.dispensers. When we investigated the parents/caregiversTable 1. Numbers and incidences of pedatric bums caused by hot waler from water dispensers (linear trend chi square test)Years New cascs (7) Pediatric bums (n (%)Pediatric scald burms (n (%)少Pedatric bums causcd by hot watcr from water dispensers (n (%，%'2005 2031683 (3.62)571 (83.60)21 (3.07.3.68)2078729 (35.08)633 (86.83)中国煤化工20072178814 (37.34)690 (84.77)20082150795 (36.98)688 (86 54}CNMHG2000 .2311823 (35 61)719 (87 36)MH'The percenlages of pediatrnc burns caused by hot water from water duspensers compared wth that in 2005, P <0.05. The percentages of peduatnc burns caused by hotwater from water dispensers compared with that in 2006, P <0.05. : incidence of pediatric burns in entire burms population, x'=2.906. P-0 088.9: Percenage of scaldinjuries in pediarice bums, x'-3.182, P-0.074.↓Percentage of bums caused by hot waler from waler dispensers in pediaric bums,x =20.918, P <0.001.1 Percenage ofbums caused by hor water from water dispensers in pediarie scald burms, x2-19.497, P <0.001.Chinese Medical Journal 2012:;12511):2053 20562055Table 2. Summary of the rclatcd risk factorsimportant than the type, because all those depended onNumber of Percentagewhether they provided a fcasible way for chilren toSurvey contentscasesreach the taps much easily. Thercforc, water dispenscrsWater dispensers related risk factorsshould be placed singly and keeping a certain distanceMachine oypes (n=238)Floor standing type1147.5from other furniture in order to prevent children climbingTable standing oype1252.5ip. However, it is obviously not enough to follow theIsolation prolection devices (r 225)advice mentioncd above, we still believe that the bestWithout2299.9solution to pediatric burns is that parents/caregivers2should take active prevcntion bcfore children bcingClimbing objects next to water dispensers (r=237)2085.2burned.' In the presented study, we found that nearly3514.8ninety percent of the surveyed cases were from localParents/caregivers related risk factors (n=238)residcnts with stablc incomes, who could afford drinkingSupevised or not (n-238)mineral water or purified water with water dispensers.Parents or caregivers in the same room53.4But we do not take it seriously because this factor wouldChileChildren alonealone46.6be no more “risk-related as the water dispensers gotDangerous bchavior of children (n=238)Yes (n=196)1982.4much cheaper and could be afforded by many moreSutpped before3819.4Chinese familics. What is more worthy of our concerm isNever been sopped1580.6that some parents/caregivers have no concerm forNo (n=42)3617.6situation changcs and children's dangerous bchaviors. ItRegistered residence (n-238)has made us much surprised when the results showed thatocal80.740193nearly half of the involved children were with theirparents or carcgivers at the time of scalds. But, when weHaving stable income91.6found nearly eighty percent of 135 burmed children whoNor having stable income84having dangerous bchaviors before have never beenstopped until they were burned, it is no doubt that therelated risk factors and children's dangerous behaviors,results confirm it seemed no clear correlation betweenwe found there was no clear correlation betweenchildrcn's scalds and their parents/caregivers' presence.children's scalds and parents/caregivers' prescncc. But196 bumed children have been confirmed having playedThe best treatment is prevention. The best way to healinghe taps of the water dispensers before injured,pediatric burms is to protect the children from beingunfortunatly, only 38 children have been stopped, butbumed. So, we list some recommendations bclow andmost of them (158, 80.6%) have not been stopped untilhope they do help. First, consumers should beburmed.recommended to buy water dispensers with isolationprotcction devices. Second, the houschold waterDISCUSSIONdispensers should be put separately from other furmiture,especially from sofa and coffee tables, to ensure thereAccording to official statistics, the number of householdwas no feasible way for children to climb up and close towater dispensers is more than 180 million and annualwater dispensers. Third, if your children were boys withsales are more than 33 million units in China, which isrestlessness, curiosity, poor awareness of danger, andranking first in the world. Pediatric burns are distinctyounger than four years, you had better put waterfrom adult bums because they are the most devastatingdispensers in a single room where they hardly reach there.and unbcarable injurics to childrcn, which often result inHowever, the most important thing is parents/caregivershypertrophic scars, contracture deformity, evenshould never hesitate to stop the children dangerousdisfigurement, and require long periods of rchabilitation.'bchaviors (playing the taps or using their fingers to touchIt was reported that the temperature of outflow hot waterthe stream from water dispensers) as soon as possible,from water dispenser was normally 95°C (203 F),' thus it .and tcach children to be aware of the danger. Fourth, forwould cause more severe and much deeper scalds aftcrlong-term planning, pediatric bums prevention educationchildren's instant contacts. Since the new cases andprogram should be carricd out by bums surgcons,incidences of pediatric scalds rclated to water dispenserspediatricians or some organizations.incrcased significantly from 2005 to 2009, there were acertain proportion of cases had unsatisfied outcomes.In conclusion, our invcstigation demonstrates a real needTherefore, we believe this issue was worth being highlyfor increased awareness of pediatric burns due to hotconcerned. As the results of our study suggested, peoplewate中国煤化. ih could be achievedhad better purchase water dispensers with isolatewith化上dians' education. Weprotection devices which would prevent children fromC N M H Gamilics some uscfultouching the taps directly. Although the number of waterrecommendations, sucn as buying water dispensers withdispensers of floor standing type in the surveyed cascs isprotection devices and keeping children from touchingfewer than table standing typc, we have taken it forthem and so on, to help parcnts/carcgivers to prolcct theirgrantcd that the location of water dispensers is morechildrcn from this danger of scalds.2056Chin MedJ 2012;12511):2053-2056Acknowledgements: The authors acknowledge Mr. CHANG Fei,Burns 2006; 32: 613-618.Mr. LUO Peng-fei, Miss CAO Qing and Miss HAN Shu for theirChina Water Dispenser Market Report, 2007-2008. Chinaimpressive works and contributions 1o this article.Commodity Marketplace. (Accessed July 2， 2011 alhtp://ww.chinaccm.com/48/4828/482803/news/20080806/1REFERENCES01414.usp)5. Maguire s, Moynihan s, Mann M, Potokar T, Kemp AM. AI. Shang L, Xu YY, Jiang X. Analysis of injury sorts and causcssystematic revicw of the fcatures that indicate intentionalmong hospitalized accidental injured children. Chin Jscals in children. Bums 2008; 34: 1072- 1081.Traumatol (Chin) 2002; 18: 103-107.6. Simons MA, Ziviani J, Copley J. Predicting functional. Shiclds BJ, Comstock RD, Femandcz SA, Xiang H, Smithoutcome for children on admission after bum injury: doGA. lealthcare resource utilization and epidemiology ofparents hold the kcy? J Bum Care Res 2010; 31: 750-765.pediatric burn-associated hospitalizations, United States,2000. J Bum Care Res 2007; 28: 811-826.3. Xin W, Yin z, Qin 2, Jian L, Tanuseputro P, Gomcz M, et al.(Received November 7, 2011)Characteristics of 1494 pediatric burn patients in Shanghai.Edited by CHEN Li-min中国煤化工MHCNMHG