Fake smoke, real fire: a retrospective single-center analysis of the underestimated risk of e-cigarette explosions and the typical burn patterns.

Parallel to the increasing dissemination of electronic cigarettes (E-cigarette) in the population, increasing numbers of burn injuries caused by explosions of the devices or the rechargeable lithium-ion batteries have been observed worldwide. Several cases of E‑cigarette-related explosions have already resulted in fatalities. We report a series of 7 patients who were treated at our department between 2016 and 2022. Of the seven patients two required treatment in the intensive care unit (ICU), two further patients required normal ward and three patients could be treated as outpatients. The median age of the patients was 43 years and the female to male ratio 2:5. Most of the patients had superficial to full thickness burn injuries on their thighs and (dominant) hands; however, injuries to the genitals were also observed. The patients' burns had a median total body surface area of 4.5%. Of these patients 4 had to stay in hospital for a median of 12.5 days, 2 of them required surgical treatment and intensive care. No patient died during hospitalization. Explosions of E‑cigarettes often happen in public while the devices or rechargeable lithium-ion batteries are being carried in trouser pockets, as shown in our study. This often ignites the victim's clothing. In a crowd or on public transport, this fire could spread quickly and endanger surrounding persons. It is therefore in the public interest to raise awareness of this potential danger from E‑cigarettes.