Elsevier

Burns

Volume 32, Issue 2, March 2006, Pages 242-245
Burns

Are paediatric burns more common in asylum seekers?: An analysis of paediatric burn admissions

https://doi.org/10.1016/j.burns.2005.09.004Get rights and content

Abstract

The number of asylum seekers in Ireland has increased dramatically over the last 10 years. Based on our impression that the number of children admitted to our burn unit was disproportionately represented by children of asylum seekers we performed an audit to establish (1) what proportion of admissions are from this subgroup and (2) the characteristics of their burns. All paediatric burn admissions from May 2003 to April 2004 were reviewed. Data collected from a retrospective chart review included patient demographics and details of the burn injuries. The National Census of 2002 and the Office of the Refugee Applications Commissioner were consulted for population statistics.

Total burn admissions for the period were 126: Irish nationals (n = 107), non-national residents (n = 2), asylum seekers (n = 14) and patients of unknown asylum status (n = 3, excluded from study). In the asylum seeker group, the median age was 18.6 months (range 10 months–5.3 years) with the majority less than 2 years (n = 11). All burns occurred in the domestic setting. Scalds accounted for 13 cases, one contact burn occurred from a hot grill. The median total body surface area burned was 5.7% (range 1.5–26%). The National Census of 2002 recorded a population of 3,917,203. With less than 12,000 asylum seekers in the country, they comprise only approximately 0.3% of the population yet they account for 11.4% of the burn patients admitted to our unit, p < 0.0001. Children of asylum seekers are over-represented in our series of paediatric admissions for burns and are more likely than Irish children to sustain a burn at a younger age and in the domestic setting. This may indicate an increased risk of injury and warrants further investigation.

Introduction

The numbers seeking asylum in Ireland have increased dramatically since the early 1990s [1]. Our hospitals have consequently seen a notable increase in the numbers of non-Irish patients requiring admission and treatment. Over a short period of time we observed a disproportionate number of children from asylum seeking families admitted to our burn unit including one 18-month-old girl with a major burn (see Case report). These cases prompted us to undertake an audit of all burn admissions to establish (1) what proportion of these are from asylum seeking families and (2) the characteristics of burns in this sub-group. Previous studies have shown that the paediatric population, in particular infants and toddlers, are at greater risk of sustaining burns [2]. Two of the major risk factors identified in these cases are poverty and overcrowding [3], [4], [5], [6].

The aims of this study were to outline the profile of burn injuries in children of asylum seekers and to determine if these children were at an increased risk of sustaining such an injury.

Case report

An 18-month-old Nigerian girl sustained 26% total body surface area burns to her buttocks, perineum and both lower limbs. Her family are seeking asylum in Ireland and at the time of her burn they were living in a hotel with a number of other asylum seeking families. The communal kitchen was situated four floors from the family bedroom. This girl's mother had to leave two daughters unsupervised in their room when she went to prepare a family meal as children were not allowed in the kitchen. She secured the doors and thought the girls would be safe during the short time she was away. Unfortunately, they gained access to the adjoining bathroom and the older girl (aged 4) turned on the hot water tap while her younger sister was in the bathtub. This resulted in the serious burn seen in Fig. 1.

Section snippets

Patients and methods

Patients in the catchment area of our hospital with burn injuries usually present to the Accident & Emergency department (A&E) directly or are referred by their family doctor. They are assessed by the plastic surgery team in A&E and the policy of the unit is to admit any child with one or more of the following:

  • 1.

    Full thickness burn of 1% or greater.

  • 2.

    Partial thickness burn of 10% TBSA or greater.

  • 3.

    Burn to a primary area (i.e. face, hands, feet, perineum, flexor surface of major joint).

  • 4.

    Electrical burn.

Nationality and asylum status

A total of 126 patients were admitted between May 2003 and April 2004. The nationality and asylum status of 3 patients was unknown so these patients were excluded from the study, n = 123. One hundred and seven patients were Irish. Two of the non-Irish patients identified were born in Ireland to non-national residents and these children were included in the Irish sub-group. Fourteen patients were asylum seekers, mainly of Nigerian and eastern European origin.

Age and sex

The median age in the Irish group was

Discussion

The basic pattern of burns seen in this study is similar to that in other studies [8], [9], [10]. When we compare the burn characteristics of the two sub-groups in our cohort we see that both groups sustained similar sized burns and required the same length of hospital stay to treat their injuries. There is a significant difference, however, in the age distribution, the place where the injury happened and the type of burn sustained. Thirteen of the 14 asylum seeking children sustained hot water

Conclusion

Children of asylum seekers are over-represented in this series of paediatric admissions for burns. While our study is limited by the small number in this sub-group, the trend so far shows that these children are more likely to have sustained their burn in the domestic setting when compared to the Irish children. The median age of injury is also much younger than in the Irish group. This may indicate an increased risk of burn in the home environment and warrants further study.

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