Characteristics of Patients Who Admitted to the Emergency Department Because of Burns Due to Dens Liquids Such as Hot Milk / Oil Acil

Burn is tissue damage to the body that is caused by heat, electric shock, light, chemical substances and the effects of radiation. Although burns can easily be avoided, treatment is difficult and expensive, and, despite improvements in medicine, a burn may be fatal. The primary factors that affect the prognosis of a patient are age, extent of burned area, and the presence of inhalation injuries [1]. In the evaluations of the causes of burns, those that are most frequently reported are scalding and flame [2]. Scalding burns are primarily caused by hot water, followed by hot milk, oil, and other hot liquids. Abstract Objective: Burn is the tissue damage on body caused due to various reasons. Although all burns caused by hot liquids are investigated as scalding burns, dense liquid burns (DLB) caused by such as milk and oil are different from other burns. The aim of this study was to report the properties of DLB.


Introduction
Burn is tissue damage to the body that is caused by heat, electric shock, light, chemical substances and the effects of radiation.Although burns can easily be avoided, treatment is difficult and expensive, and, despite improvements in medicine, a burn may be fatal.The primary factors that affect the prognosis of a patient are age, extent of burned area, and the presence of inhalation injuries [1].In the evaluations of the causes of burns, those that are most frequently reported are scalding and flame [2].Scalding burns are primarily caused by hot water, followed by hot milk, oil, and other hot liquids.All burns caused by hot liquids are investigated under the sub-heading of scalding burns.However, dense liquid burns (DLB), caused by liquids such as milk and oil, generally have a different clinical picture and result, compared to less dense liquids burns (LDLB), such as those caused by hot water, although they are evaluated as parts of the same group.This study aimed to report the properties of DLB.

Materials and Methods
We retrospectively examined the patients admitted to the Atatürk University, Faculty of Medicine Hospital Emergency Service, Turkey, between June 2003 and December 2008.We included only those patients with isolated DLB; we excluded cases of electric shock, water vapour burn and carbon monoxide poisoning.
Age, gender, the month of admission to the emergency service, anatomy of the burned areas, circumstances in which the burn occurred, the total burn surface area and outcomes had previously been recorded.In calculating the degree of burns, we regarded the highest degree of burn present as the criterion (e.g., if there were burn injuries of both 1 and 2 degrees, the burn degree was accepted as a rating of 2).We categorized the localizations of burns as head-neck, the body, the body front or back, the right upper extremity, the left upper extremity, the right lower extremity, the left lower extremity, and the genital region.The outcomes had been recorded as discharged, hospitalized, transferred to another centre, or death.
Demographic, clinical, and socio-cultural features had been recorded by an emergency service doctor, and particular features of patients had been saved on the "SPSS.18for Windows" program.Numeric variables were given together with their median (min-max) values.

Results
During the study, 28 individuals with DLB had been admitted to the emergency service, 75% (n=21) of whom were female, and the median age was 26.5 years (min=20, max=53).There were no additional problems, for example, trauma, electric shock, or carbon monoxide poisoning, in any of the cases.Totally 89.3% (n=25) of the patients had been initially admitted to our emergency service.All patients were from Erzurum; 96.4% (n=27) were living in the city centre, while 3.6% (n=1) came from rural areas.
When we examined the admission to the emergency service according to the seasons; 28.6% (n=8) of admissions occurred in autumn, 25% (n=7) in summer, 25% (n=7) in spring and 21.4% (n=6) of patients were admitted in winter (Figure 1).When we arranged the admissions in order, according to the months, 17.9% (n=5) occurred in May and June, 14.3% (n=4) occurred in January and October, and at least 3.6% (n=1) of patients were admitted in February, March, July, August, November, and December, respectively (Figure 2).
In an investigation of the circumstances of the burn occurrence; 60.7% (n=17) of the cases had been caused by hot milk, while 39.3% (n=11) had been caused by hot oil (Figure 3).
The frequency of burns according to bodily regions involved were as follows: 50% (n=14) of patients had right upper extremity burns, the left upper extremity was burned in 35.7% (n=10) of the patients, the head-neck area in 39.3% (n=11), the right lower extremity in 21.4% (n=6), the left lower extremity in 10.7% (n=3), the front of the body in 14.3% (n=4), and the back of the body in 17.9% (n=5) of the patients, while the genital region was not burned in any of the patients (Figure 4).The mean burn ratio of the cases was 28% +/-3.45%.The burn degree of all patients was determined as second degree.
Totally 75% (n=21) of the patients had been discharged from our emergency service after their first treatment, 14.3% (n=4) had been hospitalized in the burn centre, 7.1%, (n=2)

Percent
had been transferred to another centre, since there were no available rooms in our hospital, 3.6% (n=1) had declined hospitalization, 7.1% (n=2) had left the burn centre before their treatment had been finished, at the request of themselves or their relatives, and 7.1% (n=2) had been discharged from the burn centre after their treatment (Figure 5).None of the DBL patients died during their treatment in the emergency service or burn centre.The median number of hospitalization days was 24, and this varied between 3 and 37 days.

Discussion
Scalding is the most frequent cause of burns [3][4][5].Burns from hot liquids may be LDLB, such as water burns, or DLB, such as hot oil, hot milk, tar or wax burns.Hot milk creates a similar effect with oil, due to the oils it includes.Tar is a liquid oily material that does not dissolve in water, and is used for road construction [6].Wax tree resin is a substance with high viscosity, constituting vegetable oils and powder, which is used for epilation [7].As compared to less dense liquids, such as water, dense liquids are more capable of retaining heat and, due to their viscosity; they adhere to the skin more firmly.Therefore, with the same volume of exposure, DLB are deeper than LDLB.The viscosity of oil is reduced when heated, but it is still 20 times greater than that of water [8,9].Therefore, when assessing hot liquid burns as scalding, many investigators evaluate hot oil or hot-milk burns in a separate category [10,11].
In general, the male/female ratio has been reported as 2:1 for burns [12][13][14].In a study on hot-milk burns, Tarim et al. [5] reported that 52.9% of the patients were female [15].Uzkeser et al. [15] determined that 97.7% of the patients with tandoor burns were female, and they concluded that this was because of the fact that women use tandoors to prepare bread [16].In this study, DLB were also more common in women than men with a ratio that was three times higher (75%, to 25%).This may be due to the fact that women boil milk in large kettles to prepare cheese, and use very hot oil at home in food preparation.
In their study of 75 cases over 4 years, Sarıtaş et al. [16] reported that the mean age of patients was 20.0±20.7 years, the mean burn percentage was 8.1%±8.9%,and the burn degree was second degree in 65.3% of the cases and third degree in 22.7% of the cases [17].In a study of 43 cases of tandoor burns, Uzkeser et al. [15] found that the median age of the individuals involved was 45 years (min:20, max:75), and the mean burn percentage was 18%.Burns were reported as second-degree in 23.3% of patients and as third-degree in 76.7% of patients [16].In our study, the median patient age was 26.5 years (min=20, max=53), the mean burn percentage  was 28%±3.45,and the burn degree of all patients was seconddegree.
Although some studies have reported that burns are most commonly observed to the upper extremities and head/neck areas [16,17], others have indicated that they are most frequently seen in the upper and lower extremities, especially the hands [18,19].In our study, we most frequently found burns in the right upper extremity (50%), left upper extremity (35.7%), and head and neck region (39.3%),respectively.Burns to the head-neck and arms are generally caused by pulling down hot fluid, due to accidentally upsetting a kettle that is full of hot milk or oil.Moreover, while slipping down of the stew pot filled with hot fluid while taking it from fire, fluid may be dispersed as a result of reflex, and burns on the head, neck and upper extremities may take place by this way.The reason for more burns to the right arm than the left arm is that the right hand is that which is dominant in the general population.
In their study, Tarim et al. [5] determined a mortality rate of 15.7% in 140 children, 75.6% of whom were living in rural areas.Türegün reported that, of 15 children involved in their study, 14 were living in rural areas and, while the remaining child was living in a city, the burn to that patient occurred during a visit to a rural region.They reported a mortality ratio of 20% [5].Interestingly, in the present study, all the patients had been living in the city centre.The results we found may be due to the fact that, in our region, the habits observed by people living in rural areas continue in the city centre.Moreover, in neighbouring rural areas, burns may be treated in their primary or secondary care centres.We observed no mortality in our study, which might be connected to the fact that active treatments were begun earlier, since the patients came from the city centre.
The primary limitation of our study was the low number of patients assessed.A second limitation was that, due to the retrospective study design, complete patient data were not available; therefore, we could not conduct cost estimation of DBL.In our opinion, further similar studies, carried out in a large number of patients, are necessary.
In conclusion, DLB, a burn type that is commonly observed in women, causing second-degree burns, is frequently reported in the upper extremities and head/neck regions, and, in contrast to previous studies, we observed DLB in patients living only in the city centre in our region.

Figure 3 .
Figure 3. Distribution of burns according to the type of occurrence.