Abstract
Reported advantages of early excision for larger burn injuries include reduced morbidity, mortality, and hospital length of stay for adult burn patients. However, a paucity of evidence supports the best option for paediatric burns and the advantages of non-excisional (mechanical) debridement. Procedural sedation and analgesia in the emergency department is a popular alternative to debridement in operating theatres under general anaesthesia. This study aims to evaluate the association between early (< 24 h post-injury) non-excisional debridement under general anaesthesia with burn wound re-epithelialisation time and skin graft requirements. Cohort study of children younger than 17 years who presented with burns of five percent total body surface area or greater. Data from January 2013 to December 2019 were extracted from a prospectively collected state-wide paediatric burns’ registry. Time to re-epithelialisation was tested using survival analysis, and binary logistic regression for odds of skin graft requirementto analyse effects of early non-excisional debridement in the operating theatre. Overall, 292 children met eligibility (males 55.5%). Early non-excisional debridement under general anaesthesia in the operating theatre, significantly reduced the time to re-epithelialisation (14 days versus 21 days, p = 0.029)) and the odds of requiring a skin graft in comparison to paediatric patients debrided in the emergency department under Ketamine sedation (OR: 6.97 (2.14–22.67), p < 0.001. This study is the first to demonstrate that early non-excisional debridement under general anaesthesia in the operating theatre significantly reduces wound re-epithelialisation time and subsequent need for a skin graft in paediatric burn patients. Analysis suggests that ketamine procedural sedation and analgesia in the emergency department used for burn wound debridement is not an effective substitute for debridement in the operating theatre.
Highlights
This study aims to evaluate the effect of non-excisional, mechanical debridement within 24 h of paediatric burns injuries greater than or equal to 5% TBSA, under general anaesthesia in the operation theatre on wound re-epithelialisation and skin graft requirements
No significant differences were found between the emergency department (ED) Ketamine procedural sedation and analgesia (PSA), Other Setting, or the OT < 24hrs for first aid, gender, age, or time to debridement
Children in the Ketamine PSA group had almost seven times the odds of requiring a skin graft compared to those receiving non-excisional debridement under general anaesthesia within 24 h of injury (Odds Ratio = 6.97, 95% CI 2.14–22.67, p < 0.001), even after controlling for variables known to influence rates of grafting such deep partial thickness burn depth and TBSA% (Table 3)
Summary
The objectives of this study were as follows.1. Primary The effect of timing, setting and analgesia for non-excisional debridement of acute, medium to large (≥ 5% TBSA), paediatric burn injuries on time to re-epithelialisation.2. The objectives of this study were as follows. 1. Primary The effect of timing, setting and analgesia for non-excisional debridement of acute, medium to large (≥ 5% TBSA), paediatric burn injuries on time to re-epithelialisation. 2. Secondary The effect of timing, setting and analgesia for non-excisional debridement of acute, medium to large (≥ 5% TBSA), paediatric burn injuries on skin graft requirements
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