title: Too hot to handle? Hot water bottle injuries in Sydney, Australia.
abstract: OBJECTIVE
  Hot water bottles are frequently used in the community as a source of warmth, and to alleviate a number of medical symptoms. In Australia it is believed that over 500,000 water bottles are sold annually (Whittam et al., 2010). This simple treatment is known to result in significant burns and has led to mandatory labeling requirements on hot water bottles in Australia. Despite this, few published studies have documented the incidence and nature of burns sustained through their use. This study aimed to assess the incidence, causation and outcome of hot water bottle burns presenting to a major burn trauma unit in Sydney (Australia).
  
  
  METHODS
  The New South Wales Agency for Clinical Innovation Statewide Burn Injury database and admission data to the Concord Hospital Burns Injury Unit (major treatment unit) provided information on hot water bottle burns occurring between 2005 and 2013. Demographic details, cause of burn, burn depth, total burn surface area (%TBSA), and outcome of burn were ascertained. In order to assess the burn potential of hot water bottles, a separate study examined the thermic properties of hot water bottles in 'real life' scenarios.
  
  
  RESULTS
  There were 155 hot water bottle burn presentations resulting in 41 admissions and 24 grafts. The majority of patients were female, and most burns resulted from appliance rupture when used for local pain relief. Patients had an average TBSA of 2.4%. Burns patients were slightly more likely to reside in areas with greater socio-economic disadvantage. In real life scenarios, hot water bottles were shown to retain heat over 50°C for at least 3 hours (h).
  
  
  CONCLUSIONS
  Hot water bottles are a source of common and preventable burns in the community, with women being more at risk than men. Hot water bottles may retain harmful levels of heat over an extended period of time. Additional labeling requirements pertaining to the longevity of hot water bottles and their use among people especially at risk of burns (i.e. children, the elderly, patients who have undergone recent surgery and/or those with conditions associated with sensory impairment) may further reduce the incidence and severity of hot water bottle burns in the community.
authors.affiliation: Burns Unit, Concord Repatriation General Hospital, Concord, NSW 2130, Australia; Sydney Medical School, The University of Sydney, NSW 2006, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Goltsman
authors.affiliation: Burns Unit, Concord Repatriation General Hospital, Concord, NSW 2130, Australia; Sydney Medical School, The University of Sydney, NSW 2006, Australia.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Li
authors.affiliation: Geocoastal Research Group, School of Geosciences, Madsen Building F09, University of Sydney, NSW 2006, Australia.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Bruce
authors.affiliation: New South Wales Agency for Clinical Innovation, Statewide Burn Injury Service, Australia.
authors.forename: Anne
authors.initials: A
authors.lastname: Darton
authors.affiliation: Burns Unit, Concord Repatriation General Hospital, Concord, NSW 2130, Australia.
authors.forename: Kelly
authors.initials: K
authors.lastname: Thornbury
authors.affiliation: Burns Unit, Concord Repatriation General Hospital, Concord, NSW 2130, Australia; Sydney Medical School, The University of Sydney, NSW 2006, Australia.
authors.forename: Peter K M
authors.initials: PK
authors.lastname: Maitz
authors.affiliation: Burns Unit, Concord Repatriation General Hospital, Concord, NSW 2130, Australia; Sydney Medical School, The University of Sydney, NSW 2006, Australia. Electronic address: pkennedy@lexicon.net.
authors.forename: Peter
authors.initials: P
authors.lastname: Kennedy
mesh_terms: D000061:Accidents, Home / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002056:Burns / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006358:Hot Temperature / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D055815:Young Adult
keywords: Alleviation of local pain; Contact burns; Hot water bottle rupture; Scalds