424 Safety of Outpatient Management of Pediatric Hand Burns in an Urban Burn Center

Abstract

The inquisitive nature of pediatric patients places them at risk for burn injuries of the hand. While there is literature to guide management of these burns, studies of outpatient management, specifically rates of surgical intervention and infection are lacking. Current studies in the literature estimate up to 20% of all pediatric hand burns are admitted. The goal of this study was to profile pediatric hand burns presenting to our clinic and determine rates of admission, surgical intervention, and adverse outcomes. We hypothesized that outpatient management is safe and effective, with low rates of unplanned admission, infection, and surgical intervention. We performed a single-center retrospective analysis of outpatient records at an ABA-verified burn center serving adult and pediatric populations. We identified pediatric patients under 18 years of age with a burn injury to the hand or wrists that were seen in the outpatient clinic from 1/2014 - 11/2016. Patients with superficial, first-degree burns, or minimal burn injury (TBSA </=.1%) were excluded. Descriptive analysis was performed to identify patient demographics, injury characteristics, treatment patterns, and outcomes. A total of 198 patients met inclusion and exclusion criteria. Median age was 2 years (IQR 1-9). Median TBSA was 0.5%; 149 patients (75%) had burns isolated to the hand with 5 patients (3%) having full thickness burns. Contact burn was the most common etiology (49%) followed by scald burn (37%). 114 patients (58%) were seen during regular clinic hours. 175 patients (88%) were initially prescribed a topical antibiotic ointment with a petrolatum-based gauze. 51 patients (33%) were prescribed compression therapy. Median number of total visits were 2 (IQR 2-3) and median length of followup was 11 days. 11 patients (6%) were admitted at initial visit and 9 patients (5%) required split-thickness skin grafting. One patient was admitted unexpectedly and one patient developed a wound infection. The incidence of outpatient pediatric patients with a thermal injury to the hand requiring admission or surgical intervention is low. Unexpected admissions and complications including wound infection were rare in patients with both partial and full thickness burn. This finding suggests that pediatric patients with thermal injuries to the hand can be safely managed in an outpatient setting with appropriate care.