51 Negative Pressure Wound Therapy for Small-to-medium-sized Paediatric Thermal Burns: A Randomized Controlled Trial (SONATA in C)

Abstract

Abstract Introduction In the setting of burns, negative pressure wound therapy (NPWT) has been widely adopted as a means of wound bed preparation prior to skin grafting and graft immobilization. Its role in the treatment of acute burns has been less well-studied, although there is limited evidence to suggest that it might facilitate physiological healing. This study aimed to assess its efficacy in the management of acute burns in children with small-to-medium-sized thermal injuries. Methods In this single-center, two-arm, parallel, randomized, controlled clinical trial, we assigned patients under 17 years of age with acute thermal burns covering < 5% of their total body surface area to either an active control (nanocrystalline silver dressings) or an experimental treatment combining standard dressings with NPWT. Patients were excluded if their burn occurred >7 days prior to presentation, affected the face, or was deemed by clinicians to be trivial. The primary outcome was time to re-epithelialization. Secondary outcomes included scarring, grafting, pain, ease of management, and adverse events. Results A total of 114 children underwent randomization. The median time to re-epithelialization was 8 days (interquartile range (IQR) 7–10) for the NPWT group and 10 days (IQR 8–12.25) for the control group (hazard ratio, 1.515; 95% confidence interval (CI) 1.003 to 2.289; P=0.048). Children administered NPWT within 48 hours of their injury (n=16) re-epithelialized in a median of 7 days (IQR 5–8; HR, 2.129; 95% CI 1.155 to 3.922; P=0.015). The proportion of children referred to scar management was 8.7% for the experimental group and 25.9% for the control group (odds ratio, 0.27; 95% CI 0.08 to 0.90; P=0.032). There were no significant differences in grafting (2.2% vs. 7.4%; odds ratio, 0.28; 95% CI 0.03 to 2.58; P=0.260), pain during dressing changes (P=0.946), or at-home pain between dressing changes (P=0.592). NPWT was associated with a greater treatment burden (P< 0.001) and incidence of adverse events, which included minor blistering and wound maceration. Conclusions In children with small-to-medium-sized thermal burns, NPWT accelerated re-epithelialization and decreased the need for long-term scar management. Applicability of Research to Practice This study found NPWT to be a promising adjunct to standard care in the treatment of pediatric thermal burns. (Clinical Trials Registry number, ACTRN12618000256279.)