Pediatric Burn Injuries Research Articles

The Economics of Burn Injuries Among Children Aged 0 to 4 Years in British Columbia.

Children under the age of 5 years have the highest rate of hospitalization and mortality from burns. Studies of costs associated with pediatric burns have included a limited number of patients and focused on inpatient and complication costs, limiting our understanding of the full economic burden of pediatric burns. This study aimed to develop a costing model for burn injuries among children to estimate the economic burden of child burns in British Columbia, Canada. Costs of services and resources used by children aged 0 to 4 years old who were treated at BC Children's Hospital (BCCH) between January 1, 2014 and March 15, 2018 for a burn injury were estimated and summed, using a micro-costing approach. The average cost of burn injuries per percentage of total body surface area (%TBSA) was then applied to the number of 0 to 4 years old children treated for a burn injury across British Columbia between January 1 and December 31, 2016. Based on 342 included children, a 1-5%, 6-10%, 11-20%, and >20% burn, respectively cost an average of $3338.80, $13,460.00, $20,228.80, and $109,881.00 to society. The societal cost of child burns in BC in 2016 totaled $2,711,255.01. In conclusion, pediatric burn injuries place an important, yet preventable economic burden on society. Preventing even a small number of severe pediatric burns or multiple small burns may have considerable economic impacts on society and allow for the reallocation of healthcare funds toward other clinical priorities.

Pediatric Scald Injuries Sustained From Instant Soup and Noodle Products.

Background and Objective. Scald burns are a major cause of pediatric burn injuries. Instant soups have been identified as one source of these injuries. This study aims to quantify and characterize these injuries in pediatric patients. Methods. Ten-year query of National Electronic Injury Surveillance System (NEISS) database identified instant soup- and noodle-related scald burns in children aged 4 to 12 years. Data included patient demographics, injured body part, case narratives, and emergency department disposition. Results. A total of 4518 cases were identified, yielding an estimate of 9521 cases/year in the United States. Younger children were affected more than the older. Trunk was the most commonly burned body area. Approximately 10% of injuries required admission or transfer for further care. Conclusion. Instant soup and noodle products are a common cause of pediatric scald burns, potentially injuring 25 children per day in the United States and leading to high rates of health care utilization.

Deep Inferior Epigastric Artery Perforator Flap Reconstruction for Breast Burn Deformities.

Summary:The anterior chest wall is commonly involved in pediatric burn injuries. In women, deep thermal injuries may result in damage to the breast bud and breast skin, which can disrupt breast development and result in long-term deformities. In adulthood, the techniques frequently applied to correct these deformities focus on scar release in combination with skin grafting and implant-based procedures; however, these techniques often result in suboptimal aesthetic outcomes. In this report, we present superior outcomes from applying an autologous breast reconstruction technique to this challenging problem.

Differentiation of paediatric burn injury by household energy source in South Africa

Burn injuries remain a significant cause of death and disability in the global south, with children amongst the most vulnerable. In South Africa, burns are a critical health and economic burden in densely populated and energy-impoverished communities. This study used secondary data on burn injuries from 19 health facilities to differentiate between risk for scalds and flame burns across three household energy sources (firewood, paraffin and electricity). The sample was 2 933 cases of child burn victims, with key analytical procedures being descriptive statistics and logistic regression analysis. Results showed that 52% of burn injury admissions reported electricity as the household energy source used at the time of injury. Most burn injuries were scalds (85.3%), with infants and toddlers at greatest risk. The differentiation between wood and paraffin was associated with a threefold increase in scalds relative to flame burns, while that between paraffin and electricity indicated a sevenfold increase in scalds and nineteen times such an increase between wood and electricity. This was an indication of continued challenges for the country in addressing paediatric burns despite, and in the context of, the continued electrification of poor households. The study recommends improved regulation of electrical appliances used by low-income households, and targeted household safety education initiatives.

Age-Based Characteristics of Pediatric Burn Injuries From Outdoor Recreational Fires.

Accidental burns from outdoor recreational activities, such as campfires, bonfires, ceremonial fires, and firepits, are not uncommon; however, few studies describe the nature of such injuries in children. The objective of this study was to examine the age-based pattern of pediatric burn injuries from outdoor fires. Children and adolescents 0 to 18 years, admitted to the Burn Center between 2008 and 2018 with acute burn injuries from outdoor fires, were included in the current study. Demographic and clinical data were obtained from the burn injury database. Patients were categorized into three age groups: 0 to 5 years, 5 to 10 years, and 10 to 18 years. One hundred and sixty-seven children were included in the data analysis, the mean age of the cohort was 6.4 (SD ± 4.9) years, and the majority (66.5%) were males. More than half (52.1%) were less than 5 years of age, they commonly sustained hand burns and frequently required inpatient burn management. Burn severity varied between age groups, and the mean total burn surface area (TBSA) was significantly higher in adolescents (10.9%). Almost half the injuries (49.7%) resulted from a fall onto a campfire, bonfire, or a firepit. In this study, we found age-specific variation in the mechanism and pattern of burn injuries. Children at least 5 years and adolescents were least common victims of burns due to outdoor fires but suffered from more serious injuries with significantly higher TBSA involvement, longer intensive care unit, and ventilator days. Raising awareness among parents, caregivers, and children about outdoor fire safety is important for the prevention of such injuries.

The Effect of Surgical Intervention on Pediatric Burn Injury Survival in a Resource-Poor Setting

IntroductionBurns are one of the most common injuries sustained globally. Low- and middle-income countries (LMICs) are disproportionately affected by burn injury morbidity and mortality; African children have the highest burn mortality globally. In high-income countries, early surgical intervention has shown to improve survival. However, when applied to burn victims in LMICs, improved survival in the early excision cohort (≤5 d) was not seen. Therefore, we aimed to determine the magnitude of the effect of surgical intervention on burn injury survival. MethodsA retrospective analysis of a prospectively collected data, utilizing the Kamuzu Central Hospital Burn Database from May 2011 to July 2019, was performed. Pediatric patients (≤12 y) were included. Patients were excluded if they underwent surgical intervention for nonacute burn care management. Bivariate analyses stratifying by type of surgical intervention was performed, comparing demographics, burn characteristics, surgical intervention, and patient mortality. Standardized estimates were adjusted using the inverse-probability of treatment weights to account for confounding. Weighted logistic regression modeling was performed to determine the odds of mortality based on if a patient underwent surgical intervention. ResultsDuring the study, 2364 patients were seen at the Kamuzu Central Hospital, 1785 (75.5%) were children ≤12 y who met inclusion criteria. In the overall cohort, 342 (19.2%) underwent operations, including split-thickness skin graft (n = 196, 57.3%), debridement (n = 116, 33.9%), escharotomy (n = 19, 5.6%), and amputation (n = 1, 0.3%). The surgery cohort was older (4.2 ± 3.1 versus 3.1 ± 2.6 y, P < 0.001) with larger percent total body surface area burns (16%, interquartile range: 10-24 versus 13%, interquartile range: 8-20, P < 0.001) than those who did not have surgery. In the propensity score–weighted logistic regression predicting survival, patients undergoing surgery after burn injury had an increased odds of survival (odds ratio: 5.24, 95% confidence interval: 2.40-11.44, P = 0.003) when compared with patients not undergoing surgery. ConclusionsIn this propensity-weighted analysis, surgical intervention following burn injury increases the odds of survival by a factor of 5.24 when compared with patients not undergoing surgical intervention. Efforts to enhance burn infrastructure to deliver surgical care is imperative to attenuate burn mortality in resource-poor settings.

Social Determinants Associated with Pediatric Burn Injury: A Population-Based, Case-Control Study.

Social determinants of health (SDoH) influence risk of injury. We conducted a population-based, case-control study to identify which social determinants influence burn injury in children. Children (≤16 years of age) admitted to a Canadian regional burn center between January 1, 1999 and March 30, 2017 were matched based on age, sex, and geographic location 1:5 with an uninjured control cohort from the general population. Population-level administrative data describing the SDoH at the Manitoba Center for Health Policy (MCHP) were compared between the cohorts. Specific SDoH were chosen based on a published systematic review conducted by the research team. In the final multivariable model, children from a low-income household odds ratio (OR) (95% confidence interval) 1.97 (1.46, 2.65), in care 1.57 (1.11, 2.21), from a family that received income assistance 1.71 (1.33, 2.19) and born to a teen mother 1.43 (1.13, 1.81) were significantly associated with an increased risk of pediatric burn injury. This study identified SDoH that are associated with an increased risk of burn injury. This case-control study supports the finding that children from a low-income household, children in care, from a family that received income assistance, and children born to a teen mother are at an elevated risk of burn injury. Identifying children at increased potential risk allows targeting of burn risk reduction and home safety programs.

Pain Management for Pediatric Burns in the Outpatient Setting: A Changing Paradigm?

Childhood burns are common and distressing for children and their parents. Pain is the most common complaint and often thought to be undertreated, which can negatively influence the child's care and increase the risk of posttraumatic stress disorder. There is limited literature on the role of opioids and multimodal therapy in the treatment of pediatric outpatient burns. We sought to evaluate the current use of opioids (including the use of multimodal therapies), storage, and disposal of opioids in this patient population. Parents of burn-injured children 8 months to 18 years old, who were seen in an outpatient setting within 2 weeks of their burn injury, were queried from April to December 2019 regarding their child's pain control, opioid medication use, over-the-counter pain medication use, opioid storage, and disposal. A total of 142 parents of burn-injured children and their parents were surveyed. The median age of the burn-injured children was 2.7 years old and the majority (54.2%; 77/142) were male. The mean total body surface area (TBSA) was 1.8% and half sustained burn injuries to one or both hands. The most frequently used regimens for constant and/or breakthrough pain control were acetaminophen (62.7%) and nonsteroidal anti-inflammatory drugs (NSAIDs; 68.3%). Less than one fifth (26/142;18%) of patients were prescribed opioids and 88% filled their prescription. The median number of doses of opioids prescribed was eight doses, with a median of four doses of opioids unused. Only three patients used all of their prescribed opioids and no patient ≥12 years old used their entire prescription. Burns greater than 3% TBSA, irrespective of burn injury location, were associated with opioid prescription (P = .003). Approximately 40% (10/26) of parents who filled their child's opioid prescription stored the opioid in a locked area. Fewer than one third (7/26) of patients were educated on how to dispose of excess opioid pain medication. Overall, most pediatric outpatient burn injuries can be successfully managed with over-the-counter medications. Providers, who care for burn-injured children ≤ 12 years old with burns that cover ≥3% TBSA in the outpatient setting, should consider no more than four opioid doses for initial pain control. This guideline, coupled with family and provider-centered education on multimodal therapy at the time of initial presentation and safe use of opioids, are important first steps to minimizing the use of opioids in the management of small area burns in children.

Parents' perceptions of unintentional paediatric burn injuries - A qualitative study.

Burn injuries disproportionally affect the world's poorest populations. However, there has been a lack of research that has investigated the social, cultural or contextual factors associated with this injury mechanism in these areas. As a result, there is a scarcity of information from which to develop culturally appropriate and targeted burn prevention initiatives. A community survey was used to identify households to take part in this qualitative study. Semi-structured interviews were conducted with 32 parents from four different villages in Malawi to discuss their experiences of burn injuries sustained by children in the household as well as any existing preventative strategies used. In addition, 29 of the study households took part in an observation exercise to identify and discuss burn hazards present around the home environment. Transcripts and observations were recorded and transcribed verbatim. A thematic approach was used to analyse the data. The final themes could be categorised into three key areas: parental perception of hazards around the home; socio-cultural and developmental factors associated with burn injuries; and parental perception of burns prevention. Factors associated with unintentional burn injuries, as perceived by parents, included: increased exposure to hazards, children's play and development activities, increased fire use during the morning hours and the children's household roles and responsibilities. Although some parents identified possible burns prevention strategies numerous barriers to prevention were highlighted including: poverty, poor housing infrastructure and restrictions, knowledge deficit, inability to provide adequate supervision and the child's behaviour. Parents recognise that there are a number of burn hazards and risks present around the home however factors that prevented them acting included: a lack of knowledge about injury prevention, a lack of household safety equipment, a lack of control to make alternations to their housing and an inability to adequately supervise their children. In the future it is crucial that the local context and community are consulted in the development of any future burn injury prevention strategies to ensure that they are appropriate, accepted and effective.

754 Social Determinants Associated with Paediatric Burn Injury: A Population Based, Case-control Study

Abstract Introduction Children are disproportionately represented as victims of burn injury compared to adults. Life-long sequelae post-burn manifest as increased rates of mental and physical illness, substance abuse, and suicide. Social determinants of health (SDoH) influence risk of injury, however the extent and influence of SDoH on burn injury is less clear. To determine which social determinants influence burn injury in children, a retrospective case-control study was conducted. Methods Children (&amp;lt; 17 years of age) admitted to a regional burn centre between January 1 1999 and March 30 2017 were matched based on age, sex and geographic location 1:5 with an uninjured cohort. Population level administrative data describing the SDoH, at the regional administrative multifaceted data repository were compared between the cohorts. Thirteen SDoH were chosen based on a systematic review conducted by the research team. Results No significant differences existed in descriptive statistics between the burn and control cohorts. Mean age at burn injury = 5.46 (± 5.23), average TBSA (%) = 10.5 (± 13.4). The most common mechanism of burn injury was scald (42.03%) Upon multivariable logistic regression, children: from a low-income household (O.R. 1.97 (1.46, 2.65)); in foster care (O.R. 1.57 (1.11, 2.21)); from a family that received income assistance (O.R. 1.71 (1.33, 2.19)); or born to a teen mother (O.R. 1.43 (1.13, 1.81)) were associated with an increased risk of burn injury. Conclusions This study identified SDoH associated with an increased risk of burn injury. This case-control study supports the finding that children from a low-income household, children in care, from a family that received income assistance, and children born to a teen mother are at an elevated risk of burn injury. Applicability of Research to Practice Identifying children at increased potential risk provides an opportunity to prevent burn injuries, bypassing the associated long-term physical disfigurement, life-long mental health consequences and mortality. This study also has merit in maximizing the efficiency of a burn prevention budget through targeted burn safety and risk reduction programs.

551 Mixed Methods Assessment of Pediatric Scald Burns

Abstract Introduction CDC estimated more than 87,000 fire/burn injuries in 2017 among children 0–15 years old. Scald burns are the most common form of burn injury for children in the United States and are estimated to cost $44 million annually. Understanding the circumstances surrounding burn incidents and caretakers’ responses to them are needed to better guide prevention and education offerings. Methods We used a mixed methods approach to better understand pediatric scald burn mechanisms along with caregivers’ general knowledge, first aid responses and ability to accurately report characteristics of their child’s injury. Caregivers of children &amp;lt; 15 year old attending a burn follow up clinic with their child were recruited. Participants completed a 39-item, iPad-based survey that captured information about the circumstances, location and cause of the scald burn, whether first aid was provided, and caregiver/child demographics. With permission of the caregiver, the child’s medical record was accessed to collect burn descriptors (e.g., burn severity, total body surface area (TBSA), etc) to compare with parent self-report. Data collection occurred between May 2018 - May 2019. The study was approved by our institutional review board. Results Surveys were completed by 55 parents; 75% agreed to medical record review. The typical respondent was the female caregiver (80%) with more than a high school education (67%). The typical burn incident occurred in the kitchen (60%) of the family’s home (80%) and in the presence of the caregiver (71%). Seventy percent of respondents reported applying first aid; among those, 50% administered the proper first aid (using cool water on the burn) despite most (44%) reporting feeling “not confident” in the ability to do so. More than half (53%) didnot know their child’s TBSA; of those who did, self-reported TBSA ranged from 1 to 50%. Medical record review revealed that only 5 participants accurately reported their child’s TBSA. Conclusions Our data reveal that most scald burns occurred in the kitchen, of the child’s home, and in the presence of a caretaker. Half received incorrect first aid and few parents could accurately report their child’s TBSA. These results support the need to strengthen primary prevention offerings and improve parents’ understanding of their child’s burn injury. Applicability of Research to Practice The results of this research can help guide education efforts for primary prevention programs related to pediatric scald burn injuries. Furthermore, results can guide education practices for caregivers of children being treated for a scald burn injury.

548 The Economics of Burn Injuries Among Children Aged 0–4 Years

Abstract Introduction Children under the age of five years are particularly vulnerable to scalds and contact burns and have the highest rate of hospitalization and mortality from burns. Studies of costs associated with pediatric burns have included a limited number of patients and focused on inpatient and complication costs, limiting our understanding of the full economic burden of pediatric burns, including costs incurred through outpatient care and caregivers’ productivity loss. This study aimed to develop a societal costing model for burn injuries among children aged 0 to 4 years. Methods Children aged 0 to 4 years identified through the local Burn Registry with a burn injury between January 1, 2014 and March 15, 2018 were included in this study. Patients with inhalation injury, electrical, chemical and friction burns were excluded. An incidence-based cost-of-illness analysis with a human capital approach was used to quantify the cost of partial and full-thickness burns according to the percentage of total body surface area (%TBSA) involved. The cost of a burn injury was assessed from a societal perspective through the following cost categories: emergency department visits, inpatient, outpatient dressing changes, outpatient burnbaths, day surgeries, clinic visits and caregiver productivity losses. A list of resource items for each category were extracted from patient chart review, the local Burn Registry, and the local Hospital Finance Database, and assigned unit prices. Costs were discounted to a present value in 2017 dollars at 1.5% per annum. Results Burn injuries were observed for 342 children, of which 249 (73%) had their burn severity classified (%TBSA and partial/full thickness) and were included in this study. Burn severity categories (1–5%, 6–10%, 11–20%, and &amp;gt;20%) were developed based on the differential distribution of the costs allocated to each burn incident. The majority of children (60.8%) suffered from a 1–5% burn. A 1–5%, 6–10%, 11–20%, and &amp;gt;20% burn respectively cost an average of $2,229, $8,653, $13,663, and $98,634 to society. Costs incurred by the 1–5% burns were related mostly to emergency department visits and dressing changes, while costs incurred by the &amp;gt;20% were related mostly to inpatient and clinic visits (garments) costs. Conclusions This costing approach raises awareness about the important, yet preventable economic burden that pediatric burn injuries place on society. Applicability of Research to Practice This evidence may persuade policymakers and clinicians to invest in pediatric burns prevention programs in order to decrease pediatric burns costs allowing for the allocation of funds towards other clinical initiatives. This costing model may also facilitate cost-effectiveness analyses of burn prevention programs in the coming years.

700 A Comparison of Pediatric Burn Injuries Based on Cultural Environment

Abstract Introduction The Amish maintain cultural customs that preserve their identity minimizing assimilation into American culture and selectively use technology. Cultural beliefs and environmental situations can predispose the Amish, especially children to burn injuries. As a burn center it is important to examine demographics, incidence and causes of burn injury to bring awareness for prevention efforts. The purpose of this study was to determine if burns in Amish children are associated with greater severity when compared to non-Amish children. Methods A retrospective analysis of the burn registry at a verified burn center collected data on inpatient children &amp;lt; 14 years with an acute burn injury from 2012 through 2018. Children with frostbite and non-accidental burn trauma were excluded. Results Of the 273 children, 16 (5.9%) Amish children were similar to the 257 (94.1%) non-Amish children in age (mean age 4.8y, SD=3.8 vs. 4.0y, SD=3.7), male gender (63% vs. 59%) and percent needing surgery (44% vs. 26%, p=0.14). However, Amish children had a greater median injury severity score (ISS) (9.0, IQR [1, 25] vs. 1.0, [1, 4], p&amp;lt; 0.0001), median TBSA (19.5% [5.2, 52] vs. 4.0 [1.7, 7], p&amp;lt; 0.0001), median length of stay (LOS) (10.5 days [4, 50] vs. 2.0 days [1, 8], p&amp;lt; 0.0001), and median number of surgeries (0.5 [0, 6.5] vs. 0 [0, 1], p&amp;lt; 0.0074). Complications of ARDS (25%), sepsis (25%), compartment syndrome (18.8%), acute renal injury/failure (12.5%) and amputation (18.8%) were more prevalent among Amish children (all p&amp;lt; 0.0033) and non-existent in the non-Amish group. Amish children had a higher incidence of fire/flame burn (43.8% vs. 19.5%) and need for rehabilitation (37.5% vs. 0.8%). Conclusions In this study, Amish children had greater burn area, severity, longer LOS, more surgical interventions and complications than non-Amish children. Applicability of Research to Practice Culturally appropriate prevention efforts and education are needed to enhance existing care and burn or fire awareness with the Amish population.

Clinical outcome of pediatric hand burns and evaluation of neglect as a leading cause: A retrospective study.

Majority of the pediatric burns happen when an adult is nearby the child. This suggests the role of adult carelessness or neglect as a cause of burns. The aim of this study is to provide clinical data on pediatric hand burns and to draw attention to the role of neglect in pediatric burn injuries. Children admitted to a tertiary burn center between September 2017 and October 2018 were included in the study. Epidemiological data including age, sex, etiology and place of injury, presence of caregiver nearby, physical signs of neglect or abuse, clinical outcomes including burned total body surface area, length of admittance, and complications were recorded. A total of 335 pediatric burns were admitted to the burn center. Among them 89 patients with hand involvement were included in the study. Most of the patients were under the age of 6 (79.8%) and 88.8% of the burn accidents occurred indoors. Scalding was the main mechanism for hand burns. There was an adult nearby in 71.9% of the patients. Among patients with hand involvement, 19 (21.35%) were considered as neglect. All the neglect cases were under the age of 6. Pediatric burn accidents occurred mainly at home, mostly with an adult around. Habits of drinking hot beverages, dangerous cooking practices and lack of awareness are some important issues leading to burn accident. Neglect is found in 21.35% of hand burns as the etiology. In addition to general preventive measures special attention should be paid to the signs of neglect in the evaluation of patients. These burns should also be reported to official services, as they may reflect inadequate supervision or neglect by the caregiver.

The Effect of Surgical Intervention on Pediatric Burn Injury Survival in a Resource-Poor Setting

The Effect of Surgical Intervention on Pediatric Burn Injury Survival in a Resource-Poor Setting

Assessing child quality of life impairments following pediatric burn injuries: Rasch analysis of the children's dermatology life quality index.

There is a need for a brief, validated measure of quality of life (QOL) for children to monitor their adjustment to burn injuries. We aimed to apply a Rasch analysis to an existing measure of QOL from the dermatology literature to a clinical sample of pediatric burn patients. The Children's Dermatology Life Quality Index (CDLQI) was administered to pediatric burn patients (N = 253) during a standard clinic visit. Rasch analysis was used to examine psychometric properties of this measure with a burn sample. The CDLQI showed an adequate fit to the Rasch model. Test difficulty is .61 logits greater than person ability. Results of item reliability and separation analyses were sufficiently strong and indicated a unidimensional latent trait. Person reliability (.74) and separation analyses (1.64) were moderate. Finally, the CDLQI was able to moderately separate the group of respondents into low and high levels of QOL impairments related to burn injuries. The Rasch model demonstrated that the CDLQI is a reliable and valid scale that adequately measures QOL impairments in children following burn injuries.

Mothers’ emotions after pediatric burn injury: Longitudinal associations with posttraumatic stress and depressive symptoms 18 months postburn

BackgroundVarious emotions are implicated in posttraumatic stress disorder (PTSD). Longitudinal studies examining temporal associations between emotions and posttraumatic stress may reveal who is at risk of chronic psychological problems. This study examined the longitudinal relationships of mothers’ trauma-related emotions with posttraumatic stress and depressive symptoms after pediatric burn injury. MethodsData from two cohort studies were used (n = 296). Mothers reported the intensity of burn-related emotions within the first month (T1) and 12 months postburn (T2). The Impact of Event Scale (IES) and the Hospital and Anxiety Depression Scale (HADS-D; depression subscale) were administered at T1 and 18 months postburn (T3). ResultsBased on two exploratory factor analyses, emotion variables were combined into acute and long-term basic emotions (fear, sadness, horror, anger) and self-conscious emotions (guilt, shame). The path model showed a positive relationship between acute and long-term basic emotions. Higher long-term basic emotions were related to persistence of posttraumatic stress and depressive symptoms. Acute self-conscious emotions showed associations with posttraumatic stress and depressive symptoms at T1 and were longitudinally related to depressive, but not posttraumatic stress, symptoms. LimitationsThe posttraumatic stress measure was not based on DSM-5 PTSD criteria and results require replication using these criteria. ConclusionsThis study suggests that mothers’ acute self-conscious and long-term basic emotions in relation to their child's burn injury are involved in the development of posttraumatic stress and depressive symptoms. Clinically, assessing and monitoring parents’ early posttraumatic stress, depressive symptoms and burn-related emotions may be useful to identify parents at risk.

First aid management of paediatric burn and scald injuries in Southern Malawi: A mixed methods study.

In sub-Saharan Africa, burn and scald injuries occur more commonly in children aged less than five years, than in any other age group, and carry a high lifetime morbidity. The optimal first aid at the time of injury includes the use of cool running water, which can reduce pain, scarring, and skin grafting. Data on the types of first aid used in Malawi is lacking, as is an in-depth understanding of the underlying factors which may influence this health behaviour. This study sought to: (a) document the types of first aid after paediatric burn and scald injuries in Southern Malawi; and (b) explore factors affecting the choice of first aid used. We conducted a sequential explanatory mixed methods study. Quantitative analysis of a prospectively collected database of all patients aged less than 17 years admitted to the only burn unit in Southern Malawi was followed by thematic analysis of semi-structured interviews with 15 adults who had witnessed a paediatric burn or scald injury. 1326 patients aged less than 17 years were admitted to the Queen Elizabeth Central Hospital between July 2009 and December 2016. Median age was 3.0 years (IQR 1.9-5.0) and male to female ratio 1:0.9. The commonest cause of injury was hot liquid (45%), followed by open fire (31%) and porridge (12%). First aid was applied in 829 patients (69%), the commonest applications used were water (31%) and egg (21%). There was a statistically significant association between the type of first aid and secondary education of the father (p = 0.009) or mother (p = 0.036); however, the type of first aid used was more likely to be egg rather than water. Analysis of qualitative interviews identified four main themes: perceived roles and responsibilities within the community, drivers of individual behaviours, availability, and trust. Participants reported using eggs as a first aid treatment, as these were readily available and were seen to reduce the occurrence of blisters and prevent peeling of the skin. By comparison, there was a strong underlying fear of using water on burn injuries due to its association with peeling of the skin. Intergenerational learning appeared to play a strong role in influencing what is used at the time of injury, and mothers were the key source of this information. This study provides the largest description of first aid use in sub-Saharan Africa, strengthening the evidence that remedies aside from water are commonly used and that higher parental education levels do not translate to increased use of water, but rather use of alternative treatments. Our qualitative findings allow improved understanding of how first aid for paediatric burns is perceived in rural Malawi communities, providing insight as to why certain first aid choices are made and the possible barriers and facilitators to the adoption of water as a first aid treatment.

Determination of Serum Levels of Interleukin-6, Interleukin-8, Interleukin-10, and Tumor Necrosis-Alpha and their Relationship With The Total Body Surface Area in Children.

There are few studies on the inflammatory processes and the role of cytokines involved in pediatric burn injuries. The present study aims to measure the serum levels of cytokines and their relationship with the degree of burn injury in children. Within the 48 hours of hospitalization, the serum samples were obtained to measure inflammatory cytokines (interleukin-6, interleukin-8, interleukin-10 [IL-6, IL-8, and IL-10] and tumor necrosis factor-alpha [TNF-α]). The level of all of these cytokine factors was assessed by enzyme-linked immunosorbent assay technique. The mean levels of IL-6, IL-8, IL-10, and TNF-α was 18.15 ± 4.77 pg/ml, 59.54 ± 4.59 pg/ml, 8.41 ± 2.09 pg/ml, and 1.48 ± 0.15 pg/ml, respectively, which were higher than the normal range designated for the healthy pediatrics age group. The levels of TNF-α were higher in patients with sepsis (P = .03) and deceased patients (P = .001). There was a statistically significant difference in the levels of IL-8 in patients with second- (.001) and third-degree (.001) burn injuries in comparison to the first-degree burn injuries, and the level of IL-8 was statistically significantly higher in patients with electrical burn injuries in comparison to scald burn injuries (.01). IL-10 was statistically significantly higher in patients with contact burn injuries in comparison to scald (.001) and flame (.03) burn injuries. Cytokine levels in pediatric burn patients increased after severe burn injuries. There was a significant correlation between the levels of IL-8 and the degree of burn injuries.

The Use of Dehydrated Human Amniotic/Chorionic Membrane Skin Substitute in the Treatment of Pediatric Facial Burn.

Facial burns have lasting physical and psychological effects on pediatric patients. Proper management to minimize morbidities challenges reconstructive surgeons. New technologies allowed the development of skin substitutes such as amniotic and chorionic membranes, yet the use of these skin dressings and their impact on burn outcomes have not been sufficiently studied to guide practices. The objective of this study is to report on the outcomes of dehydrated amniotic membrane as a biologic skin dressing in pediatric facial burn injury compared to cadaveric allografts. Retrospective review of data collected from our institutional burn registry from 2012 to 2016. The study population included patients younger than 16 years with facial burns. Patients between 2012 and 2014 received cadaveric allografts, whereas during 2015 to 2016 patients received dehydrated human amniotic/chorionic membrane as standard treatment. Demographic characteristics and outcome measures were compared between the 2 groups. Included 30 patients with a mean age of 3.7 years and with an average total body surface area burn of 6.8% (2%-27%). Mean injury severity scores did not significantly differ between both groups, 1.8 in amniotic group versus 2.3 in cadaveric skin group (P > 0.05). There were 4 complications (3 hypertrophic scars and 1 wound infection) in the cadaveric allografts group versus no complications in the amniotic membrane group (P < 0.05). Dehydrated amniotic/chorionic membrane wound dressings are a safe alternative to cadaveric allografts in treating pediatric partial thickness facial burns.