Epidemiology, Clinical Profile, and Outcomes of Firecracker-Related Burns in the Paediatric Population during Diwali: A Prospective Study from a Tertiary Burn Unit in India

Abstract

Background: Firecracker-related burn injuries in children continue to be a preventable cause of morbidity during Diwali in India. Despite public awareness campaigns and regulatory measures, children remain disproportionately vulnerable, often requiring specialized emergency care.

Methods: We conducted a prospective observational study at a tertiary care hospital in Tamil Nadu during the pre-Diwali, Diwali, and post-Diwali days of 2024. A disaster management protocol supervised by the Ministry of Health and Family Welfare, Government of Tamil Nadu, was implemented for the study period. All children under 13 years presenting with firecracker-related injuries were included, while cases occurring outside Diwali or those unwilling to participate were excluded.

Results: Twenty-four children (n = 24) presented with cracker-related burns. The mean age was 7.5 years (range: 2–13 years), and boys constituted 79.1% (n = 19). Eleven children (45.8%) required inpatient admission, while 13 (54.2%) were treated on an outpatient basis. The most commonly affected site was the right hand (45.8%), followed by the face. The extent of burns ranged from 1% to 13% total body surface area (TBSA), with 75% of cases involving <5% TBSA. Flower pots (37%) and atom bombs (17%) were the most frequent causative crackers. Conservative management with wound wash and topical antimicrobials was sufficient in most cases. Three patients underwent surgical interventions, including wound debridement, suturing, ray amputation, and skin grafting. On follow-up, the majority showed good outcomes, with Vancouver Scar Scale scores of 0–4 in 66% of burn cases and 90% of surgical cases.

Conclusions: Firecracker-related injuries among children remain a significant public health concern during Diwali. Hands and face are the most vulnerable sites, with flower pots and atom bombs being the leading causes. While most cases were minor and managed conservatively, severe cases required complex surgical procedures. Implementation of disaster management protocols, strict enforcement of firecracker regulations, and intensified community awareness are essential to minimize such preventable injuries.