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J Indian Acad Forensic Med. October- December 2011, Vol. 33, No. 4 ISSN 0971-0973
burns involving higher TBSA in colder months
has been reported by Harish et al [3], Sharma et
al [4-6] and Alireza et al. [10]
The overall incidence of septicemia was
recorded at 72% for rural population, 70% for
slum and 45% for the urban population.
Moreover gender analysis showed that
incidence risk of septicemia is more in rural
females (81%) than in rural males (54%). The
low socioeconomic status, unhygienic living
conditions and poor access to burn care health
facilities contribute to expose these post burn
patient to multiple infection sources producing a
higher septicemia incidence in this group. [2-7,
11]
The overall incidence of septicemia for
burns suffered in kitchen was 70%, further the
gender split of these cases showed that only
45% of males burnt in kitchen developed
septicemia as against 80% of females‘ burnt in
kitchen. The other rooms of the house had a
septicemia incidence of 20% and it was 36%
burns suffered at workplace. This higher rate of
septicemic complications in kitchen burnt cases
specially the female patients was due to the
higher TBSA involved in such burn injuries. [3, 7,
11]
Only 12 (22.6%) of the septicemic cases
lived in joint family setup and the incidence of
septicemia within this group was 63% where as
nuclear families recorded 41 (77.4%) cases with
a 58.5% incidence of septicemia within this
group. The difference in risk of septicemic
incidence was not much based on family type
but was high with respect to marital status as
81% septicemic patients were married and this
group had 60% incidence of septicemia as
compared to 55% in the unmarried group. This
is again explainable by the fact that 84% of the
females studied were married and they
constituted 62% of the married group and as
females had a higher TBSA involvement by
burns so had higher septicemic risk. [7]
Majority (96.2%) of the cases
developing septicemia had suffered flame burns
and this group had 66.2% incidence rate for
septicemia. There was only 1(1.9%) septicemic
case among the electrical burns with 16.7%
incidence rate for septicemia. Similarly, 1 (1.9%)
case developed septicemia in the chemical
burns group with 50% incidence rate for
septicemia within this group.
Accidently suffered burns had a 58.8%
incidence rate for septicemia which was 75% for
suicidal group and the only case of homicidal
burns developed septicemia. The higher TBSA
involved by flame burns and by suicidal burns
explains the higher incidence of septicemia in
these patients.
321
Patients who reported to GMCH within
one hour post burn showed a 40% incidence of
septicemia as compared to 66% for the patients
with a delay between 1-6 hours and 100% for
patients with a delay of 6-12 hours. But cases
who had reporting to GMCH after > 1 day post
burn the septicemia incidence was 57%. The
delay and gender wise incidence of septicemia
was 25% in males and 63% in females for up-to
1 hour delay group; 46% versus 77% in 1-6
hours group and 100% each in the 6-12 hours
delay group.
In the present study it was observed that
the severely burnt injured patients, which had
more of females, were directly brought to GMCH
and had higher risk of septicemia due to high
TBSA involved despite early treatment. Those
patients who had less severe burns had
reported late or were referred to GMCH after
variable periods for the management of other
post burn complications. [12-16]
The incidence of septicemia with TBSA
burnt showed an almost directly proportional
relationship with 19% in 70% TBSA range. The female patients
recorded a higher septicemia incidence within
the same TBSA ranges when compared to the
male patients.
The gender wise incidence of
septicemia was 0% in males and 50% in
females with 70% TBSA in
males and female burns respectively. The mean
TBSA in the patients who developed septicemia
was 61.3% while it was 35.1% in those who did
not develop septicemia. The patients with
severe burn injury are immune-compromised,
with the entire spectrum of host defenses being
affected or depressed beyond the mere loss of
the mechanical barrier of skin; this predisposes
the burn victims to burn wound sepsis and to
septicemia. [4-6]
As the study design inherently excluded
majority of the deaths caused by burn shock by
excluding deaths which occur within the first 48
hours post burn, so 45 (88%) deaths recorded in
the study were caused by post burn septicemia.
Within the septicemia group 81.8% patients died
and they had a mean TBSAB of 67.6%.
The mean age of the septicemic
patients who survived was 26.8 years and it was
30.2 years in the fatal septicemic cases.
Similarly the mean TBSA was 37% the
septicemic patients who survived and it was
67.9% in the fatal septicemic cases.
Septicaemia as the major cause of death in the
burn victims has also been observed by other