Burns due to gunpowder explosions in fireworks factory: a 13-year retrospective study

The aim of this study was to evaluate the epidemiology of burns due to gunpowder explosions in fireworks factories. Three hundred and fifty-one patients having burns caused by gunpowder explosions in a fireworks factory were admitted to our center from 1 January 1987 to 31 December 1999 and the clinical notes of 339 patients were available for review. Data on age, sex, size, depth and sites of burn, incidence by month, inhalation injury, associated injuries, number of operations, length of hospital stay, morbidity, mortality, and causes of explosions were recorded. The majority of the patients were male, with a mean age of 36.7 years. The mean total burn surface area was 40.9%, mostly deep burns. The commonest areas of the body to be injured were the head and neck. One hundred and eighty-five patients (55%) were injured in December, November, and January. Sixty-five patients (19%) had an inhalation injury, 35 having tracheotomies and mechanical ventilation. Thirty-five patients (10%) had associated injuries, the commonest being the fracture of limbs (25 patients). Two hundred and thirty-two patients (68%) required operations while the number of operations including debridement and grafting, or tracheotomy, per patient were 2.7. The mean time in hospital of the survivors was 32 days with a range of 1-94 days. Acute respiratory distress syndrome (ARDS) and sepsis were the commonest complications during the early post-burn period (7 days or less) and the later period (>7 days), respectively. Forty-four patients died in this series giving a mortality rate of 13%. The commonest cause of death was sepsis (27 patients), followed by multiple organ dysfunction syndrome (MODS) (11 patients). Most accidents (71%) were caused by too much gunpowder put in at one time and accidents resulting from carelessness while making fireworks. Prevention measures are also discussed.