Severity of burns is expressed through degrees of burns. Obviously, not all burns are the same and some require basic first aid treatment, if even that, and some are life-threatening and require constant care of medicinal professionals with no certain outcome. There are several classification systems, but the one that is most easily understood uses severity of burns to determine the degree of burns. The worse the burn, the higher the degree.
So how many degrees are there?
It is likely that you will think 'there are four', and you would be wrong. There are six burn degrees. The catch is that the last three are rarely mentioned because the people who get fourth degree burns have a very slight chance of survival, while burns of the fifth and sixth degree are always fatal. So there is little reason to differentiate between „dead“ and „very dead“ and the classification is almost never used beyond the fourth degree. Now let us discuss the degrees, their symptoms and treatment options.
First degree
First degree burns are recognizable by redness of skin and some pain in the burnt region. The burnt region can swell and is typically sensitive to touch. Most first degree burns come from contact with hot water or prolonged exposure to the sun. Most of these can be treated at home but few cases might require proper medical help.
Second degree
Second degree burns are more severe because they affect the deeper layer of the skin. They are recognizable by red blisters on the surface of the burnt skin and hurt significantly more. Most second degree burns are caused by short contact with flames and boiling liquids, or some chemicals chemicals. Destruction of the affected section of skin opens the door to possible infection so you should consult a doctor to see what treatment method to apply.
Third degree
These burns are most severe burns in the sub-lethal category, as prompt and proper treatment of these virtually ensures that there will be no loss of life. These burns destroy all three layers of the skin, and require hospitalization. Typical causes of third degree burns are coming in contact with aggressive chemicals, suffering an electric shock or fire breakout.
Fourth degree
These are the first burns that cause damage that reaches deeper than skin and affect the organs beneath the skin, such as muscles, ligaments and tendons. Most cases of these burns are caused by a fire break out or a severe electric shock. Fatality rate in victims of fourth degree burns are high. Individuals that survive will have to undergo skin grafting procedure as a part of treatment.
Fifth degree
Damage from burns of this degree affects all soft tissues and all organs in the affected area and might even damage the bone to some extent. Chances of survival are virtually none, and very rare individuals that did survive had to have the affected region amputated.
Sixth degree
If an individual is diagnosed with this degree of burn, then the person is dead and lying on the autopsy table. Damage from this type of burns is so extensive that even bones are badly damaged or even charred. Burns so severe are not survivable.
Classifications and Burn Statistics
- Alkaline chemicals cause colliquative necrosis (whereby the tissue is transformed into a liquid, viscous mass), whereas acidic burn causes a coagulation necrosis (whereby the architecture of the dead tissue can be preserved).
- Electrical injuries are entirely different because they can cause deep tissue damage that is greater than the visible skin injury; tissue damage in electrical injuries is correlated with the electric field strength (amperes and resistance of the tissue), although for ease of comprehension the voltage is often used to describe the circumstances of injury.
- Thermal injury can also occur through cold. Frostbite is caused by a number of mechanisms including direct cellular injury from crystallization of water in tissue and indirect injury from ischaemia and reperfusion. These mechanisms lead not only to skin necrosis but also to deep tissue damage.
- Although burn injuries are decreasing in high-income countries, the prevalence of burn injuries remains high elsewhere, with ~90% of burns occurring in low- and middle-income areas. The WHO estimates that 11 million burn injuries of all types occur annually worldwide, 180,000 of which are fatal. There is a wide variability in the incidence of burn injury. For example, the number of burn-related deaths per 100,000 population ranges from 14.53 in Cote D’Ivoire to 0.02 in Malta. Burn-related deaths of children are 7 to 11 times higher in low-income than in high-income countries.
- In the USA, a bimodal age distribution of all burn injuries is evident, with the majority of injuries occurring in young children (1–15.9 years of age) and in those of working age (20–59 years of age). Regardless of country, burns in children are more equally distributed between boys and girls, especially in toddlers. However, this ratio changes as age increases; in most countries, nearly twice as many men are injured as women.
- The uniqueness of a severe or major burn injury is anchored in the body responses to it. After the injury, an immediate systemic and local stress response is triggered that, unlike sepsis or trauma, does not recover quickly. Severe burns cause a complex pattern of responses that can last up to several years after the initial insult. In general, immediately after the insult, an inflammatory response is triggered to promote the healing process. However, in severe burns, this inflammatory process can be extensive and become uncontrolled, leading to an augmented inflammation that does not induce healing but rather causes a generalized catabolic state and delayed healing. This response is almost unique to burns and is referred to as the hypermetabolic response; it is associated with catabolism, increased incidence of organ failure, infections and even death.
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