The Impact of Bathtub Burn Wounds on Patients With Neurological And Psychiatric Impairments

In the study, Hot Bathtub, Cold Consequences—Misleading Wounds After Scald Injuries: A Retrospective Analysis, a group of authors from the Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Burn Center, Hannover Medical School in Hannover, Germany sought to characterize and assess medical features and outcomes of scalds sustained in the bathtub.¹

Bathtub burns often affect a high amount of the surface area of the skin, making the burns difficult to treat due to the large portion of burns on the body. The initial burns presentation will appear as a stark erythema (superficial reddening of the skin, usually in patches, because of injury or irritation causing dilatation of the blood capillaries) on the skin, which the authors explain, does not often represent the burn’s true depth.   

The retrospective study was conducted at a burn intensive care unit (BICU) and 16 patients were identified between the years 2011 and 2018. The patients were divided into two groups based on mortality rate. The mean total burn surface area was 37.50% ± 19.47%. In more than 80% of patients identified, the authors found history of neurological and psychiatric disorders, with the common trauma triggers being dementia and alcohol abuse.

The statistical analysis showed significant difference for both categories A Body Shape Index (ABSI) score and the presence of multiorgan failure. The erythematous skin areas tended to progress into full thickness burns. According to the authors, “We, therefore, coined the term ‘lobster redness’ [to denote] these regions.”

The authors caution that devastating injuries can often result from scalds sustained in the bathtub. It is important for clinicians to carefully assess these wounds because the initial assessment can be misleading and delay early removal of necrotic tissue.

According to the authors, burn wounds that occur during a period of unconsciousness need closer attention due to the extended exposure to heat. Early surgical removal of necrotic tissue (necrectomy) should be considered; likewise, a biopsy with a histological workup may be useful when treating burn wounds. Additionall, the authors recommend clinicians take “special safety precautions” for patients living with neurological and/or psychiatric impairments.

Reference:

1. Bingoel AS, Krezdorn N, Jokuszies A, Dastagir K, Vogt PM, Mett TR. Hot bathtub, cold consequences—misleading wounds after scald injuries: A retrospective analysis. Journal of Burn Care & Research. 2020;42(3):390-397. doi:10.1093/jbcr/iraa157.