795 Factors Associated with Time to Initial Debridement in a Pediatric Burn Center

Abstract

Abstract Introduction There is sparse literature addressing the time of initial burn debridement. The purpose of this study was to describe factors associated with time to initial debridement in one American Burn Association (ABA) verified pediatric burn center. Methods Quality improvement data was prospectively collected for pediatric burn patients admitted from July 2018 through June 2019. The data included sedation method, total body surface area (TBSA) burn, mechanism of injury, and time to burn wound debridement. Adverse outcomes were also recorded. Nonparametric methods were used to evaluate associations. Medians are presented with interquartile ranges (IQR). Results There were 137 patients included in this study. The median time to initial debridement was 261 minutes (IQR: 166–321). Most patients (80%) received conscious sedation for their first debridement. The median time to debridement was significantly lower for patients receiving sedation as opposed to those without sedation, 240 minutes (IQR: 163–308) vs 338 minutes (IQR: 257–442), p=0.0004. Patients with TBSA burn > 5% (n=46) also had a significant earlier time to debridement as compared with patients with smaller burns, 183 minutes (IQR: 150–277) vs 283 minutes (IQR: 197–360), p< 0.0001. There was a significant difference in time to initial debridement based on mechanism of injury, p=0.0213. The median time to debridement for flame burns was 173 minutes (IQR: 149–308) as compared with scald burns with a median of 247 (IQR: 157–298) and contact burns, median 286 (IQR: 197–389). There were no adverse outcomes observed during the study period. Conclusions In an ABA verified pediatric burn center, conscious sedation, larger TBSA burn, and flame burns appeared to contribute to earlier time to debridement, with no adverse outcomes. Further analysis are ongoing as to whether pain scores differed for these initial burn dressings and if conscious sedation had any effects on subsequent dressings. Applicability of Research to Practice This study adds to the sparse literature regarding time to initial debridement and identifies factors associated with an earlier time to debridement. This study also raises further opportunities for investigation regarding the relationship between initial sedated debridement procedures and pain scores during subsequent dressing changes.