A comparative study of paediatric thermal burns treated with topical heparin and without heparin.

Abstract

Following reports of heparin use in burn treatment, an ethics-committee-approved prospective randomized study with controls compared results obtained using traditional usual burn treatment without heparin with results in similar patients similarly treated with heparin added topically. The subjects were 100 consecutive burn patients (age <15years) with second-degree superficial and deep burns of 5-45% total body surface area size. Two largely similar cohort groups-a control group (C) and a heparin group (H) with 50 subjects per group-were randomly treated. The 50 control group patients received traditional routine treatment, including topical antimicrobial cream, debridement, and, when needed, skin grafts in the early postburn period. The 50 heparin group patients, without topical cream, were additionally treated, starting on day 1 postburn, with 200IU/ml sodium aqueous heparin solution USP (heparin) dripped on the burn surfaces and inserted into the blisters two to four times a day for 1-2days, and then only on burn surfaces for a total of 5-7days, before skin grafting, when needed. Thereafter, control and heparin group treatment was similar. It was found that the heparin patients complained of less pain and received less pain medicine than the control patients. The heparin group needed fewer dressings and oral antibiotics than the control group. The 50 heparin group patients had 4 skin graftings (8%), while the 50 control group patients had 10 (20%). Five control group patients died (mortality 10%). No heparin group patients died. The number of days in hospital for the heparin group versus control group was significantly less (overall P < 0.0001): 58% of heparin group patients were discharged within 10days versus 6% of control group patients; 82% of heparin group patients were out in 20days versus 14% of control group patients; 98% of the heparin group versus 44% of the control group were out in 30days; and while 100% of heparin group patients were discharged by day 40, 56% of the control group required up to another 10days. Burns in heparin group patients healed on average in 15days (maximum period 37days) versus an average of 25days (maximum >48days) in control group patients (P < 0.0006). Procedures and costs in the heparin group were much reduced compared with the control group. Differences between the heparin and control groups are presented for the sake of comparison. It was concluded that heparin applied topically for 5-7days improved burn treatment: it reduced pain, pain medicine, dressings, and use of antibiotics; it significantly reduced IV fluids (P < 0.04), days in hospital (P < 0.0001), and healing time (P < 0.0006); and it reduced skin grafts, mortality, and costs.