61 Tap Water: Still Burning After All These Years

Introduction Hot tap water has long been recognized as a cause of burns, especially for children. Standards for appliance manufacture and building codes were established several decades ago to avoid excessively high hot water temperature at the tap in order to reduce the incidence of these injuries. The purpose of this study was to determine the prevalence and impact of tap water scalds (TWS) seen at burn centers in a recent time period. Methods We reviewed the National Burn Repository (NBR) for the years 2015–2017. We identified all scald burn injuries from the primary ICD10 code (former ECodes in ICD9, now External Cause Codes in ICD10). The codes for the cause of burns include X00 – X19. The X11 series identifies TWS. The data fields were analyzed using SAS 9.4 (Cary, NC). Data are expressed as Mean ± SEM or Mean (95% CI). Differences in continuous variable means were tested with TTest and categorical variables with Chi square and Fisher’s Exact Test. Logistic regression analysis was used to test differences between groups and identify risk factors for death. Results There were 16,318 patients included in the two-year data set. Of those, 5,014 (30.7 ± 0.4 %) had scald burns identified by the Primary ICD10 code, and 1,029 (20.5 ± 0.6 %) of those were due to hot tap water. The prevalence of TWS among children < 5 with scald injuries was 21.8% (15.9–23.8); among children 5–14, 19.4% (15.9–22.8); among young adults 15–44, 14.7% (12.8–16.5); those 45-64 24.1% (21.3–26.8); and those 65 and older 27.9% (23.7–32.2). Burn size for those 45–64 tended to be larger with TWS than other scald injuries (3.3 ± 0.7 % TBSA vs 2.0 ± 0.2, p=0.08), and was significantly larger in those 65 and older (3.8 ± 0.9 % vs 1.2 ± 0.3, p< 0.01). Case fatality for all TWS was greater than that for all other scalds (1.4 ± 0.4 % vs 0.3 ± 0.1, p< 0.01). No patient less than 45 died following TWS. Case fatality for those 45–64 tended to be greater for TWS than other scalds (0.9 ± 0.6 % vs 0, p=0.06.), and it was substantially higher for 65 and older (10.0 ± 2.8 % vs 2.3 ± 0.8, p< 0.01). Among patients 65 and older, those with TWS were slightly older than those with other scalds (76.3 ± 0.7 years vs 74.6 ± 0.4, p< 0.05). Conclusions TWS burns still account for a substantial proportion of scald burns across the country, despite the wide application of building codes and manufacturing standards designed to prevent these injuries. They are most prevalent among children and older adults. In older patients they are more extensive than other scalds and result in an appreciable case fatality. Hot tap water continues to be a clear and potentially deadly hazard, especially for the elderly. Additional strategies to prevent these injuries should be sought. Applicability of Research to Practice Directly Applicable.