Gunpowder explosion burns in fireworks factory: causes of death and management

The mortality rate of gunpowder explosion burns from fireworks factory accidents was high. The aim of this study was to evaluate the impact of different managements on outcome of these burns patients and to optimize treatment measures and decrease the morbidity and mortality. During the period from January 1987 to December 1999 in our center, 44 patients burned in gunpowder explosions died. Fifty sex-, age-, TBSA- and full-thickness-matched patients who survived were selected randomly as a comparison group. Data on time and causes of death, fluid resuscitation, and management of inhalation injury, associated injuries and wound were collected. Half of the deaths occurred during the first week after burn. The commonest cause of death was sepsis (27 patients), followed by MODS (11 patients), then hypovolaemic shock (4 patients) and pulmonary infection (2 patients). Thirty-six dead patients and 10 surviving patients had received insufficient fluid resuscitation and developed severe shock. Prophylactic tracheotomy was undertaken in 15 patients, of whom 6 died. Thirty-two patients had undergone emergency tracheotomies, of which 29 died. All associated injuries had been well-managed and no death was related to associated injuries or their complications directly. In the group of patients who died, 20 had undergone early excision (within 1 week of injury) and grafting. The number of patients in the survivor group who underwent early excision and grafting was 31. These results indicate that the sepsis and MODS are the two commonest causes of death for the patients who sustained burns by gunpowder explosions in fireworks factory. The optimal managements of this type of burn are as follows: (1) sufficient fluid resuscitation and invasive monitoring if necessary; (2) prophylactic tracheotomy and mechanical ventilation for the patients whose upper-airway edema is present or airway patency is threatened; (3) early excision and grafting of lager-deep wounds and covering with allograft with microautograft (1:10); (4) life-threatening associated injuries must be treated immediately after admitting.