57 Cool Running Water First Aid Decreases Skin Grafting Requirements in Pediatric Burns: A Cohort Study of 2495 Children

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Abstract Introduction First-aid guidelines recommend the administration of cool running water in the early management of thermal injury. Our objective was to analyze the associations between first aid and skin grafting requirements in children with burns. Methods This cohort study utilized a prospectively collected registry of patients managed at a tertiary children’s hospital. Multivariate logistic regression models were used to evaluate the relation ship between first aid and the requirement for skin grafting. Secondary outcomes included time to re-epithelialization, wound depth, hospital admission and length of stay, and theater interventions. Adequate first aid was defined as 20 minutes of cool running water within three hours of injury. Results In our cohort of 2495 children, 2259 (90.6%) received first aid involving running water, but only 1780 (71.3%) were given the adequate duration. A total of 236 (9.5%) children required grafting. The odds of grafting were decreased in the adequate first aid group (OR 0.6, 95% CI 0.4 to 0.8). The provision of adequate running water was further associated with reductions in the full-thickness depth (OR 0.4, 95% CI 0.2 to 0.6), hospital admission (OR 0.7, 95% CI 0.5 to 0.9) and theater operations (OR 0.7, 95% CI 0.5 to 0.9), but not hospital length of stay (HR=0.9, 95% CI 0.7 to 1.2, p=0.48). Conclusions Burn severity and clinical outcomes improved with the administration of cool running water. Adequate first aid must be prioritized by pre-hospital and emergency services in the preliminary management of pediatric burns. Applicability of Research to Practice Although children are at particularly high risk of burn injuries there was a paucity of literature addressing the relationship between burn first aid and clinical outcomes in pediatric populations. Due to differences in volume, surface area and skin thickness it was unknown whether benefits in adults applied to children. This study supports the prioritization of the administration of cool running water for 20 minutes to be adhered to immediately after a pediatric burn to decrease the severity and improve patient outcomes.