Pediatric Burn Patients Research Articles

EVALUATION OF ETIOLOGY AND OUTCOMES OF PAEDIATRIC BURNS UNDER THE AGE OF ONE YEAR.

Between March 2012 and March 2022, 138 paediatric burns patients under the age of one year were hospitalized and managed at Department of Burns and Plastic surgery at Pandit Dindayal Upadhyay Civil Hospital, Rajkot, Gujarat, India. Out of these patients, 61.59% (n=85) were males and 38.40%(n=53) were females. Aetiology of burns was mostly ame burns, scald burns from water and milk and electrical burns. TBSA (total body surface area) percentage sustained from burn trauma ranged from 1% to 95 %. Flame burns and water scald burns contributed to higher percentage of burns as compared to milk scalds and electrical burns. Total mortality was 23.91% (n=33). Flame burns resulted in 16 mortalities and scald burns lead to 14 deaths. These results show that mortality in infant is higher than other paediatric age groups. Infants represent a specic vulnerable group because they are essentially non-walkers and entirely dependent on their parents. More often than not these burns are due to negligence on the part of parents. These burns can be prevented by awareness campaigns targeting education of parents and care givers.

The Efficacy of Anterior Capsulotomy and Basal Capsulectomy Adherent to Expanded Scalp Flap During Alopecia Reconstruction in Pediatric Burned Patients.

Scalp expansion is an optimal treatment for alopecia resulting from burn injuries, especially in the pediatric population through providing highly vascularized adjacent local tissues with optimal hair density, color matching, texture, and hair-bearing characteristics. The aim of this study was to evaluate the efficacy of anterior capsulotomy and basal capsulectomy adherent to expanded scalp flap during alopecia reconstruction with scalp expansion in pediatric burned patients. The study was conducted on 127 patients with an age range of 5 to 19 years who presented with postburn alopecia accompanied by hairline loss. The patients were divided into 2 groups: group I consisted of 58 patients who were operated on using conventional technique, and group II consisted of 69 patients who were operated using modified technique including basal capsulectomy on the skull side and anterior capsulotomy on the expanded scalp flap. The Hairdex, a validated questionnaire of Hair-Specific Health-Related Quality of Life measures, showed that percentage of satisfaction concerning outcomes was 91.50%, psychological well-being was 95%, and self-confidence was 84.30% in group II, compared with 63%, 55.70%, and 66.20%, respectively, in group I. This significant values had a great positive effect on patient satisfaction, changing child's behavior and self-confidence. Although physiological background of tissue expansion is the same, proper flap design with anterior capsulotomy on flap undersurface and basal capsulectomy on the skull side improve results of the traditional method significantly and minimize the complication rate. These surgical modifications provide maximum benefits from expanded tissue, with restoration of the hairline and a uniform hair direction. Level III, case-control study.

Prevalence of Suicide by Self-immolation Among Children in Southern Iran.

Self-immolation is considered among the most rigorous acts of suicide. Lately, this act has increased in children. We evaluated the frequency of self-immolation among children in the largest burn referral center in southern Iran. This cross-sectional study was conducted from January 2014 to the end of 2018 at a tertiary referral burn and plastic surgery healthcare center in southern Iran. Subjects were pediatric self-immolation burn patients registered as outpatients or inpatients. The patients' parents were contacted regarding any incomplete information. Among 913 children admitted due to burn injuries, 14 (1.55%) were admitted with an impression of suicidal self-immolation. Among self-immolation patients, the ages ranged from 11 to 15 years (mean: 13.64 ± 1.33), and the average burnt percentage of total body surface area was 67.07 ± 31.19%. The male-to-female ratio was 1:1, and the majority were from urban areas (57.1%). The most frequent cause of burn injury was fire (92.9%). There was no history of family mental illness or suicide among the patients, and only one of the patients had an underlying disease of intellectual disability. The mortality percentage was 64.3%. The percentage of childhood suicidal attempts by burn injuries was alarmingly high among children aged from 11 to 15. While contrary to many reports, we reported this phenomenon to be relatively similar between genders, and also between urban and rural patients. Compared with accidental burn injuries, the self-immolation group had significantly higher age and burn percentage, and were more frequently caused by fire, occurred outdoors, and resulted in mortality.

Outcomes in Pediatric Burn Patients With Additional Trauma-Related Injuries.

The addition of trauma to burn injuries may result in higher morbidity and mortality. The purpose of this study was to evaluate the outcomes of pediatric patients with a combination of burn and trauma injuries, and included all pediatric Burn only, Trauma only, and combined Burn-Trauma patients admitted between 2011 and 2020. Mean length of stay, ICU length of stay, and ventilator days were highest for the Burn-Trauma group. The odds of mortality were almost 13 times higher for the Burn-Trauma group when compared to the Burn only group (P = .1299). After using inverse probability of treatment weighting, the odds of mortality were almost 10 times higher for the Burn-Trauma group in comparison to the Burn only group (P < .0066). Thus, the addition of trauma to burn injuries was associated with increased odds of mortality, as well as longer ICU and overall hospital length of stay in this patient population.

The Use of a Polylactic Membrane in Pediatric Burns Proves to be Successful Even After Late Application.

The Polylactide membrane (PLM) is a biosynthetic dressing that mimics properties of the human epithelium. Herein we describe our experience on the use of PLM in pediatric burns. All pediatric burn patients admitted to the Pediatric Surgery Department between November 2019 and November 2021 and submitted to PLM application were selected. Clinical and demographic data were collected retrospectively. Seventy-seven patients with a median age of 1.8 years were included. The median total body surface area was 6% (2-20%), and burns were mainly mixed-partial thickness. PLM was applied at a median of 5 days post-burn (IQR 3-6), usually under sedation (43/77). After PLM application, the median healing time (HT) was 10 days (IQR 8-14). HT was significantly higher in deep-partial thickness burns vs. mixed superficial-deep (P = .015) and superficial burn areas (P = .006). No correlation was found between HT and the timing of PLM application. The grafting rate due to clinical misevaluation was 2.7%, one infection was found. The PLM is a promising way for treating partial-thickness burns, even when applied later during treatment. Shorter HT, the decreased need for dressing changes, and the potential of sparing of donor sites and pain reduction are its main advantages.

Evaluating effects of burn injury characteristics on quality of life in pediatric burn patients and caregivers

ObjectivesThe purpose of this study was to evaluate pediatric burn patients’ and caregivers’ quality of life (QoL), while identifying clinical characteristics correlated with psychological stress. MethodsPediatric burn patients at an ABA-verified institution from November 2019-January 2021 were included. Caregivers of patients 0–4 years completed the Infant’s Dermatology QoL Index (IDQOL). Patients> 4–16 years completed the Children’s Dermatology Life Quality Index (CDLQI). The Short Post-Traumatic Stress Disorder Rating Interview (SPRINT) measured caregivers’ stress. Generalized linear mixed models evaluated associations between assessment scores and burn characteristics. ResultsOverall, 27.3% (39/143) of IDQOL and 53.1.% (41/96) of CDLQI scores indicated that patients’ burns caused moderate to extremely large effects on QoL. In caregivers, 4.5% (7/159) scored> 14 on the SPRINT, warranting further PTSD evaluation. For the IDQOL, each additional 1% TBSA burn was associated with a 2.75-point increase (p = 0.05), and patients sustaining 2nd degree deep partial thickness burns scored an average of 3.3 points higher compared to 2nd degree superficial partial thickness burns (P < 0.01). CLDQI and SPRINT scores demonstrated a similar pattern. ConclusionsQoL is impacted in a substantial proportion of pediatric burn patients. Larger TBSA and increased burn depths cause significantly more psychological stress in children, and caregivers may require more extensive psychological evaluation.

Research progress on moderate and deep sedation during wound dressing change in pediatric burn patients

Moderate and deep sedation can effectively relieve or eliminate the pain and body discomfort during wound dressing change in pediatric burn patients, relieve anxiety, agitation, and even delirium of the children, reduce the metabolic rate of the children, make them in a quiet, comfortable, and cooperative state, which is conducive to the smooth completion of dressing change. This paper summarized the three aspects of moderate and deep sedation in pediatric burn patients, including the overview, main points of implementation, and effects, and further introduced the moderate and deep sedation medication regimens for different routes of administration, as well as the content of evaluation and monitoring. Suggestions on the prevention and management of related complications and the management of moderate and deep sedation implementation procedures were put forward, in order to provide references for the development of moderate and deep sedation for wound dressing change in pediatric burn patients in China.

Race, area deprivation index, and access to surgical burn care in a pediatric population in North Carolina

BackgroundBurns represent a leading cause of morbidity and mortality for children. This study explores the intersecting effects of social deprivation and race in pediatric burn patients. MethodsWe performed a retrospective review of all pediatric patients (<18 years old) admitted to a tertiary burn center in North Carolina from 2009 to 2019. We used bivariate analysis to compare patients based on reported race, comparing African Americans (AA) to all others. Modified Poisson regression was used to model the probability of undergoing autologous skin grafting based on AA race. ResultsOf 4227 children admitted, AA children were disproportionally represented, comprising 33.7% of patients versus a state population of 22.3%. AA patients had larger %TBSA with a median of 3% (IQR 1–6) compared to 2% (IQR 1–5, p < 0.001) and longer median length of stay at 5.8 days (SD 13.6) versus 4.9 days (SD 13.8). AA patients were more likely to have autologous skin grafting compared to other races, with an adjusted RR of 1.49 (95% CI 1.22–1.83) when controlling for Area Deprivation Index (ADI) national rank, age, %TBSA, and burn type. ConclusionsAA children were disproportionately represented and had larger burns, even when controlling for ADI. They had longer hospital stays and were more likely to have autologous skin grafting, even accounting for burn size and type. The intersection between social deprivation and race creates a unique risk for AA patients. Further investigation into this phenomenon and factors underlying surgical intervention selection are indicated to inform best treatment practices and future preventative strategies.

The research on the treatment effects of nano Berberine gel on superficial burn thickness

Objectives: To evaluate the analgesic effect of nano Berberin gel in the treatment of superficial burns.Subjective and Method: Study on 32 pediatric burn patients, treated at the Pediatric Burn Department in Le Huu Trac National Burn Hospital from 1 January 2022 to 30 April 2022. The method of study is a Prospective study, a randomized controlled trial. with comparison before-after. In the same patient, the burn was divided into 2 areas of equal area and depth. Study area: burns treated with a gel containing nano Berberine and comparison area: burns treated with 1% SSD cream. Results: 1. Having an anti-inflammatory effect: Reduction of the degree and duration of inflammation and reduced significantly the exudation on the study burn wound compared to the control area. 2. Nano Berberin gel dries wet necrosis (obvious after 2 - 3 days of using the drug). 3. Gel has the effect of preventing infection. A significant reduction in the number of positive cultures and the number of bacteria after 1 - 2 weeks of treatment, (78.33 ± 46.69 vs 105.16 ± 91.28 p &lt; 0.05). The number of infected wounds after 1 week also decreased significantly in the control area, (25% vs 61.5% in zone A; 33.3% vs 58.3% in zone B) p&lt;0.05. 4. The time for 50% epithelialization, the treatment time in the study area is also shorter than in the control area, (6.9 ± 3.6 vs 8.1 ± 4.2; p &lt; 0.05). Conclusion: Initial remarkable recognition of the treatment effect of Nano Berberin Gel on the pediatric superficial burn.

The clinical characteristics and microbiological investigation of pediatric burn patients with wound infections in a tertiary hospital in Ningbo, China: A ten-year retrospective study.

Burn is one of the leading causes of death and disability in children worldwide, and wound infection is an excellent challenge in burn treatment. We performed a retrospective review of pediatric burn patients with wound infections to reveal their clinical data and investigate pathogens' distribution and drug resistance patterns to provide references for treatment. As a result, 330 pediatric burn patients with wound infections were identified; 65.8% (217/330) were < 2 years old. Most of the injuries were scalded and involved <10% total body surface area in size (TBSA), mainly causing II-degree burn and II + III-degree burn. Three hundred and fifty nine strains of pathogens were isolated, the primary pathogens were Staphylococcus aureus (45.4%) and Pseudomonas aeruginosa (18.7%). Both S. aureus and P. aeruginosa isolated from 2012 to 2016 were more likely to be multi-resistant than those isolated from 2017 to 2021, as they were significantly associated with resistance to ≥4 Clinical and Laboratory Standard Institute (CLSI) classes (p = 0.040 and 0.006, respectively). In conclusion, children aged <2 years old were the main pediatric burn patients with wound infections. The primary bacteria isolated from the wound were S. aureus and P. aeruginosa, with a decreasing tendency of multi-resistance.

Children's growth and motor development following a severe burn: a systematic review.

The epidemiological data on post-burn growth, body composition and motor development is ambiguous and scattered. The aim of this systematic review was therefore to summarize the current body of evidence on post-burn growth, body composition and motor development in children. A literature search was conducted in PubMed, EMBASE and Web of Science up to March 2021. We considered observational studies that reported (1) metrics on weight, height, body composition, bone mineral content, bone mineral density or motor development, in (2) paediatric burn patients and (3) published in a peer-reviewed journal. A total of 16 studies were included. Each of the included studies used quantitative methods, but with differing methodology: prospective cohort studies (n = 8), retrospective chart reviews (n = 3), case-control studies (n = 2), cross sectional studies (n = 2) and a retrospective cohort study (n = 1). When combined, the included studies represented 2022 paediatric burn patients, with a mean age of 7.7 (±3.2) years. The average burn size was 52.8% (±12.7) of the total body surface area. Identified outcome measures included weight (n = 12), height (n = 7), muscular strength (n = 4), bone mineral content (n = 5), bone mineral density (n = 5), body mass index (n = 3), fat mass (n = 5), lean body mass (n = 7) and fine and gross motor development (n = 1). Following an initial decline, patients' growth and motor development started to recover during the first or second year post-burn. Nonetheless, burns may have a profound and prolonged effect on the paediatric burn patients' muscular strength, bone mineral content and lean body mass. It should be noted that the vast majority of studies included only patients with burns covering ≥30% total body surface area. The evidence presented in this review may thus not be representative of the whole paediatric burn population.

The systemic immune-inflammation index and neutrophil-lymphocyte ratio in pediatric burned patients – a pilot study

The systemic immune-inflammation index and neutrophil-lymphocyte ratio in pediatric burned patients – a pilot study

Fire burns matter: A case-control study of severe accidental burns in pediatric patients

&lt;b&gt;Objective: &lt;/b&gt;We aimed to identify factors associated with severe accidental burns in patients ≤12 years old.&lt;br /&gt; &lt;b&gt;Materials and methods: &lt;/b&gt;We conducted a matched case-control study, in which we retrospectively reviewed the medical records of children treated in a single institution from 2014-2016. We classified the cases (patients with severe burns) and controls (patients with non-severe burns) according to the criteria of the American Burn Association. We used multivariate conditional logistic regression analysis to identify the relationship between the etiology of burns and their severity.&lt;br /&gt; &lt;b&gt;Results: &lt;/b&gt;We reviewed 180 cases and 90 controls. The most common etiology of burns was boiling water in both cases (65.6%) and controls (83.3%). Most burns occurred inside the home (84.1%) and in the afternoon (37.4%). Multivariate analysis identified that severe burns were mainly due to exposure to fire (odds ratio [OR]: 3.22, 95% confidence interval [CI]: 1.53-6.81). Similarly, these patients were more likely to live in a rural area (OR: 2.96, 95% CI: 1.17-6.19).&lt;br /&gt; &lt;b&gt;Conclusions: &lt;/b&gt;In pediatric patients ≤12 years of age severe accidental burns are more likely to be caused by fire compared to boiling water. Public health interventions should focus on populations located in rural areas.

Effectiveness of Collagen Dressing in Second Degree Paediatric Burns: A Cross-sectional Descriptive Study

Introduction: Most common cause of burns in paediatric age group is scalds. Though intentional paediatrics burns are reported, usually they are caused by accidental spillage of hot water. Along with fluid management, major part of managing burns involves repeated dressings. Biological dressings like collagen are impervious to bacteria and create the most biological interface between the wound surface and the environment, ensuing in better healing. Aim: To determine the effectiveness of collagen dressings in second degree paediatric burns. Materials and Methods: A cross-sectional descriptive study done at Mahabhodhi Burns Center, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India, from January 2018 to December 2019, included 75 second degree paediatric burns patients. Re-epithelialisation rates, infection and progress to full thickness burns were evaluated. Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) software v.23. Results: Out of 75 children, 8 (10.7%) of children had complete re-epithelisation by seven days, 55 (73.3%) between 8 to 14 days and 4 (5.3%) between 14 to 21 days. Total 67 (89.3%) of children had complete epithialisation by 21 days, with mean of 9.5 days. Conclusion: Overall, collagen dressing helps in preventing infection, early re-epithelization, and avoids painful dressings. It minimises the psychological trauma on both patients as well as their parents.

Characteristics of pediatric burn patients in our hospital

Characteristics of pediatric burn patients in our hospital

Differences in Assessments of Total Burn Surface Area Involving Children Transferred To A Burn Center for Treatment – Experience In Southern Brazil

Purpose: To analyze discrepancies between the evaluation of total body surface area (TBSA) of burn injuries involving children performed by clinicians at hospitals and clinics in southern Brazil before patients are transferred to a Burn Care Unit (BU) and the same evaluation by trained burn specialists, in order to determine the accuracy of burn size estimation and to evaluate clinical data to inform whether efforts to increase knowledge are warranted to optimize early management and treatment of burned pediatric patients. Methods: This is an observational study in which data was analyzed involving burn patients transferred from regional hospitals and clinics for admission to Joana de Gusmão Children’s Hospital, located in the city of Florianópolis in southern Brazil, that maintains a BU for referral of pediatric patients. The analysis consists of comparisons between the estimated values of TBSA of the burn obtained from the “Transferred burnt patient form” completed by the referring clinician and values registered in patient records upon arrival at the BU. In addition, other quantitative and qualitative data, such as burn mechanism patient age, and whether resuscitation with intravenous (IV) fluids occurred, were collected to further inform management and treatment of the injuries. Results: At the early assessment, there was overestimation of TBSA burned in 76.4% of patients (n = 39), 32 of those had a TBSA of less than 15%, and the mean TBSA estimate was 291% higher (p-value 0.0001). The 1-4 age group represented the largest group of patients, 56.4% (n =29), and the most common mechanism of burn was due to heated water in 60.8% (n=31) of the cases. There was correlation (p-value 0.014) between increased length of hospitalization and burn mechanism when the burn was caused by direct contact with fire or electric shock which resulted in patients staying for 26 ± 9.35 days. In addition, 66.7% of patients included in this study had been administered IV fluids at the city of origin prior to arriving at the children’s BU. Conclusion: When the estimate of the TBSA of the burn obtained by non-specialists, was compared to the estimate after admission to a specialized burn unit, there was an overestimation in most cases and this has the potential to lead to mismanagement of pediatric burn patients.

Prognostic Factors for Mortality of Pediatric Burn Injury in a National Tertiary Referral Center

Introduction. In Indonesia, burn injuries cause about 195,000 deaths annually. Data from the Ministry of the Health Republic of Indonesia showed the incidence of burns predominated at 1-4 years old. The mortality of pediatric burn patients in a tertiary hospital was 37.26%. This study aimed to find an association between known and unknown prognostic factors of mortality in Indonesian-specific characteristics.

Exploring Limited English Proficiency in the Clinical Outcomes of Pediatric Burn Patients

IntroductionLimited English proficiency (LEP) is linked to lower health care access and worse clinical outcomes. This study aims to explore the potential role of LEP on clinical outcomes of pediatric burn patients. MethodsWe conducted a single-institution retrospective study of burn patients presenting at a tertiary pediatric burn referral program between January 2016 and December 2020. Patient demographics, burn mechanism, severity, interventions, and primary patient language were abstracted from the electronic health record. Clinical outcomes (length of stay [LOS], clinic follow-up, and 30-day readmission) of patients with LEP were compared to patients with English as primary language (EPL). ResultsThirty-five (4.2%) patients with LEP were identified of 840 total patients. On univariate analysis, there was no difference in mean total body surface area (6.5% versus 6.1%), report of physical abuse (2.9% versus 8.9%), or need for grafting (14.3% versus 15.0%) comparing patients with LEP to those with EPL. Patients with LEP were more likely to have a scald burn (68.6% versus 48.9%, P = 0.025) and less likely to have a flame/fire burn (20.0% versus 37.6%, P = 0.047). On multivariate analysis, there was no difference between patients with LEP compared to patients with EPL for LOS (2.9 versus 3.5 d), 30-day readmissions (5.6% versus 5.7%), or clinic follow-up (80.6% versus 75.0%). In patients with >10% total body surface area, patients with LEP had a longer emergency department LOS (277 min versus 145 min, P = 0.06) but no difference in outcome measures. ConclusionsPediatric patients with LEP were not found to have worse burn outcomes compared to EPL patients in our patient sample. However, a true association is difficult to determine given the small sample size of LEP patients and the potential underestimation of language discordancy as recorded in the electronic medical record. Further research is needed to better explore the role of primary language and health communication as a social determinant of health in pediatric burn patients.

Does caudal analgesia improve pain control for pediatric burn surgery: A retrospective study.

Pediatric burns affect approximately 15-20 patients per 100 000 hospital admissions, but unfortunately there is a lack of evidence to guide optimal strategies for acute pain control. The aim of this study was to evaluate whether caudal analgesia with single injection of local anesthetics reduced pain medication consumption in pediatric patients who required surgical intervention for burn injuries. Retrospective data from patients <7 years old who had burn surgery in the operating rooms at a single regional burn center from 2013 to 2021 was obtained and analyzed. A 1:1 propensity-score matching method using nearest neighbor matching without replacement was utilized to create matched cohorts. Primary outcome was opioid consumption, which is presented as opioid equivalents divided by patient weight in kilograms, at 24 h after surgery. Comparing propensity-score matched groups, there were no statistically significant differences in adjusted morphine equivalents received by the caudal group (0.122 [0.0646;0.186]) and the no caudal group (0.0783 [0.0384;0.153]) at 24 h after surgery (p=0.06). This is the first study to the best of our knowledge of the association of caudal analgesia in pediatric burn patients with postoperative pain control. The data showed an increase in pain medication consumption postoperative at 24 h and intraoperative for patients who received single injection caudal blocks, but when adjusted using propensity-score matching, the difference was no longer statistically significant.

Medical and Surgical Care of Critical Burn Patients: A Comprehensive Review of Current Evidence and Practice.

Critically ill burn patients pose several unique challenges to care providers. The concepts of fluid resuscitation, nutritional management, organ support and wound care are rapidly evolving. There is a pressing need to review emerging evidence and incorporate these into practice for the effective management of burn patients.We have searched the PubMed and Google Scholar databases to review the current evidence on the acute care management of adult as well as paediatric burn patients. The rationales for current practices have been integrated into the review. The management of critically ill burn patientsrequires an in-depth knowledge of the pathophysiology of burn injury, a tailored approach for timely resuscitation, timely diagnosis oforgan specific problems, andcomprehensive wound care. This review will help the doctors and healthcare providers involved in the management of critical burn patients in their day-to-day practice.