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Demir Yiğit Y, Yiğit E. Pediatric Craniofacial and Neck Burns. Indian J Otolaryngol Head Neck Surg 2023; 75:3216-3220. [PMID: 37974824 PMCID: PMC10646003 DOI: 10.1007/s12070-023-03926-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 05/31/2023] [Indexed: 11/19/2023] Open
Abstract
This study aimed to determine the epidemiological features, risk factors, current management trends and prognosis associated with injury severity in paediatric craniofacial and neck burn injuries. In the study conducted between January 2016 and January 2022, the data of 204 paediatric patients with head and neck burns hospitalised in Gazi Yaşargil Training and Research Hospital Burn Centre were scanned from medical records in a hospital computer. Of the total 204 patients, 114 (55.9%) were boys and 90 (44.1%) were girls. The age group most affected by burn trauma was the 1-4 age group at 55.4%. Scald burns were the most common cause in all age groups. Electrical, chemical and sunburns were rare causes. Among the patients, 97 (47.5%) developed acute conjunctivitis due to burns. Among the patients, 91 (44.6%) lived in rural areas and 113 (55.4%) in urban areas. The wound culture results of the patients were 24% positive, and the most common bacteria were Staphylococcus hominis (5.4%) and Staphylococcus aureus (4.9%). During follow-up, neck contracture developed in six (2.94%) patients with neck burns. Four (1.96%) patients died because of sepsis. The mean hospital stay was 5.49 ± 4.14 days. Craniofacial and neck burns in the paediatric population are complex and leave sequelae after burns, often requiring advanced care. Children are at risk for injury by liquid, kitchen and chemical products, which serve as common caustic injury mechanisms.
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Affiliation(s)
- Yasemin Demir Yiğit
- Department of Pediatrics, Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
| | - Ebral Yiğit
- Department of General Surgery, Gazi Yasargil Training and Research Hospital, 21090 Diyarbakır, Turkey
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De Decker I, De Graeve L, Hoeksema H, Monstrey S, Verbelen J, De Coninck P, Vanlerberghe E, Claes KEY. Enzymatic debridement: past, present, and future. Acta Chir Belg 2022; 122:279-295. [PMID: 35440290 DOI: 10.1080/00015458.2022.2068746] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Early surgical debridement of the deep second and third-degree burns is still the standard of care (SOC) to prepare the wound bed for skin grafting. However, this technique has some drawbacks that explain the growing interest in enzymatic debridement as an alternative. In this article, we provide a historic overview as well as the current state-of-the-art and future prospective of this type of non-surgical debridement. MATERIALS AND METHODS A narrative review of the available literature was conducted using a systematic search. RESULTS A total of 32 articles were included. The only enzyme mixture still used nowadays for burn eschar removal is bromelain-based. There is increasing evidence that this type of enzymatic debridement is a powerful tool to selectively remove the eschar in deep burns, thereby reducing the need for autologous skin grafting compared to surgical SOC. Moreover, off-label use of enzymatic debridement with NexoBrid® (facial, pediatric, and >15%TBSA burns) has proven to be effective and safe. CONCLUSION There is increasing evidence that bedside administered NexoBrid®, preferably under regional anesthesia, is a powerful tool for selective burn eschar removal. However, the clinical wound bed evaluation post-NexoBrid® procedure in relation to the optimal treatment decision-conservative treatment vs. surgery-is not yet completely elucidated. More high-quality prospective clinical trials are necessary to compare enzymatic debridement of objectively confirmed deep burns with the current standard treatment and assess the effectiveness of the eschar removal, the need for surgery, the healing time of such wounds, and the long-term scar quality.
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Affiliation(s)
| | - Liesl De Graeve
- Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Henk Hoeksema
- Burn Center, Ghent University Hospital, Ghent, Belgium
- Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Stan Monstrey
- Burn Center, Ghent University Hospital, Ghent, Belgium
- Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
| | | | | | | | - Karel E. Y. Claes
- Burn Center, Ghent University Hospital, Ghent, Belgium
- Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
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Purcell LN, Banda W, Akinkuotu A, Phillips M, Hayes-Jordan A, Charles A. Characteristics and predictors of mortality in-hospital mortality following burn injury in infants in a resource-limited setting. Burns 2022; 48:602-607. [PMID: 34284937 PMCID: PMC8755851 DOI: 10.1016/j.burns.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 06/17/2021] [Accepted: 07/07/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE Burn outcome data in infants is lacking from sub-Saharan Africa. We, therefore, sought to assess the characteristics and predictors of in-hospital burn mortality in a resource-limited setting. METHODS We performed a retrospective study of the prospectively collected Burn Injury Surveillance database from June 2011 to December 2019. We performed bivariate analysis and Poisson regression to assess risk factors for mortality in our infant burn population. RESULTS 115 (7.3%) infants met inclusion criteria. The median age of 8 months (IQR: 6-10) and primarily male (n = 67, 58.8%). Most burns were from scald (n = 62, 53.9%). Infant burn mortality was 12.2%. Poisson multivariable regression to determine burn mortality risk in infants showed that increased %TBSA burns (RR 1.04, 95% CI 1.01-1.07) and flame burns (RR 3.08, 95%CI 1.16-8.16) had a higher risk of mortality. Having surgery reduced the relative risk of death for infants with burns. CONCLUSION We show that factors that increase infant burn mortality risk include percent total body surface area burn, flame burn mechanism, and lack of operative intervention. Increasing burn operative capability, particularly for infants and other children, is imperative.
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Affiliation(s)
- Laura N. Purcell
- Department of Surgery, University of North Carolina at Chapel Hill
| | - Wone Banda
- Kamuzu Central Hospital, Lilongwe, Malawi
| | | | - Michael Phillips
- Department of Surgery, University of North Carolina at Chapel Hill
| | | | - Anthony Charles
- Department of Surgery, University of North Carolina at Chapel Hill,Kamuzu Central Hospital, Lilongwe, Malawi,Anthony Charles MD, MPH, UNC School of Medicine, 4008 Burnett Womack Building, CB 7228, P:9199664388, F:9199660369,
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Gallaher J, Purcell LN, Banda W, Reid T, Charles A. Re-evaluation of the Effect of Age on In-hospital Burn Mortality in a Resource-Limited Setting. J Surg Res 2020; 258:265-271. [PMID: 33039634 DOI: 10.1016/j.jss.2020.08.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/05/2020] [Accepted: 08/26/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND This global burden of burn injury is suffered disproportionately by people in low-income and middle-income countries, where 70% of all burns occur. Models based in high-income countries to prognosticate burn mortality treat age as a linearly increasing risk factor. It is unclear whether this relationship is similar in resource-limited settings. METHODS We analyzed patients from the Kamuzu Central Hospital Burn Registry in Lilongwe, Malawi, from 2011 to 2019. We examined the relationship between burn-associated mortality and age using adjusted survival analysis over 60 d, categorized into four groups: (1) younger children <5 y; (2) older children 5-17 y; (3) adults 18-40 y; and (4) older adults >40 y. RESULTS A total of 2499 patients were included. Most patients were <5 y old (n = 1444) with only 133 patients >40 y. Older adults had the highest crude mortality at 34.6% and older children with the lowest at 13%. Compared to younger children, the hazard ratio adjusted for sex, percent total body surface area, and operative intervention was 0.59 (95% confidence interval, 0.44, 0.79) for older children and 0.55 (95% confidence interval, 0.40, 0.76) for adults. Older adults were statistically similar to younger children. CONCLUSIONS We show in this cohort study of burn-injured patients in a resource-limited environment that the relationship between mortality and age is not linear and that the use of age-categorized mortality prediction models is more accurate in delineating mortality characteristics. Categorizing age based on local burn epidemiology will help describe burn mortality characteristics more accurately, leading to better-informed management strategies aimed at attenuating burn mortality for different populations.
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Affiliation(s)
- Jared Gallaher
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
| | - Laura N Purcell
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Wone Banda
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Trista Reid
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Anthony Charles
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
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Shoham Y, Krieger Y, Rubin G, Koenigs I, Hartmann B, Sander F, Schulz A, David K, Rosenberg L, Silberstein E. Rapid enzymatic burn debridement: A review of the paediatric clinical trial experience. Int Wound J 2020; 17:1337-1345. [PMID: 32445271 DOI: 10.1111/iwj.13405] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/20/2020] [Accepted: 05/05/2020] [Indexed: 01/22/2023] Open
Abstract
NexoBrid (NXB) has been proven to be an effective selective enzymatic debridement agent in adults. This manuscript presents the combined clinical trial experience with NXB in children. Hundred and ten children aged 0.5 to 18 years suffering from deep thermal burns of up to 67% total body surface area were treated with NXB in three clinical trials. Seventy-seven children were treated with NXB in a phase I/II study, where 92.7% of the areas treated achieved complete eschar removal within 0.9 days from admission. Thirty-three children (17 NXB, 16 standard of care [SOC]) participated in a phase III randomized controlled trial. All wounds treated with NXB achieved complete eschar removal. Time to complete eschar removal (from informed consent) was 0.9 days for NXB vs 6.5 days for SOC (P < .001). The incidence of surgical excision was 7.9% for NXB vs 73.3% for SOC (P < .001). Seventeen of these children participated in a phase III-b follow-up study (9 NXB and 8 SOC). The average long-term modified Vancouver Scar Scale scores were 3.4 for NXB-treated wounds vs 4.4 for SOC-treated wounds (NS). There were no significant treatment-related adverse events. Additional studies are needed to strengthen these results.
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Affiliation(s)
- Yaron Shoham
- Plastic Surgery Department and Burn Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel
| | - Yuval Krieger
- Plastic Surgery Department and Burn Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel
| | - Guy Rubin
- Orthopaedic Department, Central Emek Hospital, Afula, Israel
| | - Ingo Koenigs
- Department of Pediatric Surgery, Pediatric Burn Unit, Plastic and Reconstructive Surgery in Children, Altonaer Kinderkrankenhaus & University Medical Center, Hamburg-Eppendorf, Germany
| | - Bernd Hartmann
- Burn Center with Plastic Surgery, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Frank Sander
- Burn Center with Plastic Surgery, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Alexandra Schulz
- Department of Plastic Surgery, Hand Surgery, Burn Center, University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Cologne, Germany
| | | | | | - Eldad Silberstein
- Plastic Surgery Department and Burn Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel
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Othman S, Sethi HK, Cohn JE, Shokri T, Davis WJ. Craniofacial and neck burns in the pediatric population. Burns 2020; 46:1225-1231. [PMID: 32173069 DOI: 10.1016/j.burns.2020.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/24/2020] [Accepted: 03/01/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Burn injuries can present with catastrophic physical and psychiatric harm with extensive, long-term sequelae. The pediatric population may especially be at-risk given this population's early neurocognitive and behavioral state of development. Innovations in treatment modalities and the development of evidence-based guidelines have helped mitigate burn morbidity and mortality in the pediatric population. Unfortunately, a surprising dearth of literature identifies risk-factors, epidemiological data, injury mechanisms, and prognostic factors within the pediatric population in the setting of craniofacial burns. METHODS An analysis of emergency department visits under the National Electronic Injury Surveillance System was conducted for the most recent 5-year period available (2014-2018). Available information includes demographical data, such as age and sex, mechanism of injury, visit circumstances, as well as visit disposition. Additionally, details surrounding the injury, including type of burn and anatomical location of injury, were compared. RESULTS After a review of results, a total of 2599 patients were included for analysis. Our study shows that infants and young children are at increased risk for grave injury 27.3% and 13% of infants and toddlers transferred or admitted, respectively, p < 0.05). 59.8% of infant burns in particular were caused by liquid or kitchen products, while 44.5% of burns in toddlers were caused by chemical products (p < 0.05 for both). Conversely, adolescents are at greater risk of burns in the setting of occupational and hobby-based activities (20.4% of adolescent burns). CONCLUSIONS Craniofacial burns in the pediatric population may present with complex pathology and sometimes necessitate advanced care. Presentations and prognoses are different dependent upon age and injury mechanism. These findings may serve as important framework in the establishment of guidelines for medical and legislative reform.
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Affiliation(s)
- Sammy Othman
- Drexel University College of Medicine, 2900 West Queen Lane, Philadelphia, PA 19129, United States.
| | - Harleen K Sethi
- Department of Otolaryngology-Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, 4190 City Line Avenue, Philadelphia, PA 19131, United States
| | - Jason E Cohn
- Department of Otolaryngology-Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, 4190 City Line Avenue, Philadelphia, PA 19131, United States
| | - Tom Shokri
- Department of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center, 500 University Drive, Hershey, PA 17033, United States
| | - Wellington J Davis
- Chief of Pediatric Plastic Surgery, Lehigh Valley Health Network, Allentown, PA 18103, United States
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Al Ashry HS, Mansour G, Kalil AC, Walters RW, Vivekanandan R. Response to Letter to the Editor regarding "Incidence of ventilator associated pneumonia in burn patients with inhalation injury treated with high frequency percussive ventilation versus volume control ventilation: A systematic review". Burns 2017; 43:689-690. [PMID: 28169077 DOI: 10.1016/j.burns.2017.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 01/05/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Haitham S Al Ashry
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
| | - George Mansour
- Division of Hospital Medicine, Department of Medicine, Washington University School of Medicine, Saint Louis, MO 63108, USA
| | - Andre C Kalil
- Division of Infectious Diseases, Department of Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Ryan W Walters
- Division of Clinical Research and Evaluative Sciences, Department of Medicine, Creighton University Medical Center, Omaha, NE 68131, USA
| | - Renuga Vivekanandan
- Division of Infectious Diseases, Department of Medicine, Creighton University Medical Center, Omaha, NE 68131, USA
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Maghsoudi H, Pourzand A, Azarmir G. Etiology and Outcome of Burns in Tabriz, Iran an Analysis of 2963 Cases. Scand J Surg 2016; 94:77-81. [PMID: 15865123 DOI: 10.1177/145749690509400118] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background and aims: Burn injuries still produce a significant morbidity and mortality in Iran. A 3-year retrospective review of burn victims hospitalized at a major burn center was conducted to determine the etiology and outcome of patients in Tabriz. Material and Methods: Two thousand nine hundred sixty + three patients were iden tified and stratified by age, sex, burn size, presence or absence of inhalation injury, cause of burn. There is one burn center in the East Azarbygan province serving 3.3 million people over an area of 47,830 sq.km. Results: The overall incidence rates of hospitalization and death were 30.5 % and 5.6 % per 100000 person years. The mean patient age was 22 years, and the male: female ratio was 1.275. There were 555 deaths altogether (18.7 %). The highest incidence of burns was in the 1–9 age group (29.2 %). Patients with less than 40 percent of burned surface constituted 79.8 % of injuries. The most common cause of burns was kerosene accident in adults and scald injuries in children. The mean length of hospitalization was 13 days. The mean body surface area burned was larger with higher mortality in females than in males (p < 0.001). Inhalation injuries were strongly associated with large burns and were present in all flame-burn fatalities. Conclusion: In our opinion, social factors are the main drive leading to an unacceptably high rate of burn injuries in our societies. Most of the burn injuries were caused by domestic accidents and were, therefore, preventable; educational programs might reduce the incidence of burn injuries.
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Affiliation(s)
- H Maghsoudi
- Department of Surgery, Tabriz University of Medical Sciences, Faculty of Medicine, Tabriz, Iran.
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Cox S, Rode H, Darani A, Fitzpatrick-Swallow V. Thermal injury within the first 4 months of life. Burns 2011; 37:828-34. [DOI: 10.1016/j.burns.2011.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 12/17/2010] [Accepted: 02/03/2011] [Indexed: 10/18/2022]
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Hosseini SN, Mousavinas SN, Shoghli A, Rahmanpour H. Xenoderm Versus `Conventional` Treatment in Pediatrics Burns. INT J PHARMACOL 2007. [DOI: 10.3923/ijp.2008.46.50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Uba AF, Edino ST, Yakubu AA. Paediatric burns: management problems in a teaching hospital in north western Nigeria. Trop Doct 2007; 37:114-5. [PMID: 17540101 DOI: 10.1177/004947550703700223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The records of 168 children managed for burns in a teaching hospital in northwestern Nigeria, between April 1998 and March 2003, were assessed to determine the factors that are responsible for high rates of morbidity and mortality in paediatric burns. The causes of burns were hot water in 86 cases (51.2%), flame in 45 (26.8%), hot soup in 32 (19%) and electricity in five (3%). The main complications were wound infections in 109 (64.9%) patients, anaemia in 68 (40.5%), malnutrition in 54 (32.1%), contracture in 50 (29.8%), persistent hypothermia in 27 (16.1%), tetanus in 14 (8.3%) and one case (0.6%) of massive upper gastrointestinal bleeding, possibly as a result of Curling's ulcer.
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Affiliation(s)
- A F Uba
- Paediatric Surgery Unit, Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria.
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Thombs BD, Singh VA, Milner SM. CHILDREN UNDER 4 YEARS ARE AT GREATER RISK OF MORTALITY FOLLOWING ACUTE BURN INJURY. Shock 2006; 26:348-52. [PMID: 16980880 DOI: 10.1097/01.shk.0000228170.94468.e1] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
It is important to have an accurate understanding of mortality risk in children to make sound treatment decisions and to advise parents and families. Several studies have found that children younger than 4 years are at greater risk for mortality from burn injury than older children, although other studies have found no difference. All of these studies, however, have been limited by small sample sizes from single burn centers. The objective of this study was to assess age-related mortality risk in a sample of more than 12,000 children from a national burn registry who were admitted to 43 burn centers in the United States from 1992 to 2002. The study showed that, compared with older children, children younger than 4 years were significantly more likely to be admitted with scalds rather than flame burns, had smaller burn injuries, and were less likely to have an inhalation injury. Logistic regression analysis was used to assess age-related mortality risk. After adjusting for sex, burn size, inhalation injury, and type of burn (flame versus scald), the risk of mortality was substantially higher for children aged 0 to 1.9 years (odds ratio, 2.70; P<0.001) and for children aged 2.0 to 3.9 years (odds ratio, 2.00; P<0.01) as compared with children aged 4 years or older. This study provides strong evidence that when comparing children based on burn injuries of similar size and etiology, children younger than 4 years are at substantial risk for death as compared with older children.
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Affiliation(s)
- Brett D Thombs
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Ramakrishnan KM, Sankar J, Venkatraman J. Profile of pediatric burns. Burns 2005; 31:351-3. [PMID: 15774293 DOI: 10.1016/j.burns.2004.11.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2004] [Accepted: 11/07/2004] [Indexed: 10/25/2022]
Abstract
Pediatric burns admitted to the tertiary care burn facility of Kanchi Kamakoti CHILDS Trust Hospital in Chennai (India) were retrospectively analysed between 1992 and 2003. Five hundred and thirty-five burn cases were admitted during these years. These children belonged to the age group of 0-18 years (as WHO has increased the pediatric age group range to 0 to 18 years). The etiology of these burns was looked into and the outcome of these patients in respect to etiology and complications were studied. After analysis, they were classified according to age, sex, TBSA and the occurrence of infection during the course of treatment. The complications that really affected the outcome were looked into and infection ranked first in fatal cases. Inhalation burns were not very common in our group and were associated only with large flame burns, which occur when a child is burnt while the mother commits suicide, or in cases of abuse of female children in a closed room with lots of inflammable upholstery. Scalds were the most common type of burn among children under 4 years of age. Flame burns predominated the older age group. Although there were 13 deaths among the entire group, the majority occurred within the 2-4 years age group. There was no significant gender difference with respect to mortality. Large burn size and infection were the strongest predictors of mortality.
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Abstract
A 3-year prospective study of burn victims hospitalized at a major burn center was conducted to determine the etiology and outcome of pediatric burns. One thousand one hundred sixty patients under the age of 14 years identified and stratified by age, sex, burn size, presence or absence of inhalation injury, and cause of burn. The mean patient age was 2.2 years, and the male:female ratio was 1.6:1. There were 74 deaths overall (6.4%), the majority of which (44) were among children under 5 years of age. Except for burn incidence, there were no significant differences between males and females. The mean burn size was 19%, and was significantly larger for nonsurvivors than survivors (50.3% versus 16.8%; P<0.001). Inhalation injuries were strongly associated with large burns, and were present in all flame-burn fatalities. Scalds were the most common type of burn among children under 5 years of age; flame burns predominated in older children. There were 39 deaths related to scalds. Large burn size was the strongest predictor of mortality followed by the presence of inhalation injury and the length of time to intravenous access.
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Affiliation(s)
- Hemmat Maghsoudi
- Department of surgery, Faculty of medicine, Tabriz university of medical sciences, Tabriz, Iran.
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Chapman VM, Rhea JT, Sacknoff R, Novelline RA. CT of Nontraumatic Abdominal Fluid Collections After Initial Fluid Resuscitation of Patients with Major Burns. AJR Am J Roentgenol 2004; 182:1493-6. [PMID: 15149995 DOI: 10.2214/ajr.182.6.1821493] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to describe the presence and CT distribution of nontraumatic fluid collections and edema in the abdomen and pelvis after initial fluid resuscitation of patients with major (>/==" BORDER="0"> 25% total body surface area) thermal burns. CONCLUSION Awareness of the presence and expected CT distribution of nontraumatic fluid after initial fluid resuscitation in patients with major burns can assist the radiologist in differentiating such collections from those caused by mechanical trauma.
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Affiliation(s)
- Vernon M Chapman
- Department of Radiology, FND 216, Division of Emergency Radiology, Massachusetts General Hospital, PO Box 9657, 55 Fruit Street, Boston, MA 02114, USA
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Abstract
BACKGROUND/PURPOSE Inhalation injury, flame burn exceeding 30%, and age under 48 months all have been cited as independent risk factors for mortality; the combination of all 3 risk factors is unusual. The authors have experienced an overall reduction in mortality rate and chose to examine this high-risk group to define techniques useful in improving outcome in pediatric burns. METHODS A review was done of children with all 3 risk factors over a recent 9-year interval. All were treated with a system of care emphasizing precise fluid repletion, early wound excision and closure, and avoidance of injurious pulmonary inflating pressures and concentrations of oxygen. Data are expressed as mean +/- SD. RESULTS There were 26 children admitted with all 3 risk factors. Their average age was 2.1 +/- 1.1 years (range, 5 weeks to 3.7 years), and burn size was 61% +/- 21% (range, 30% to 98%) of the body surface. All required mechanical ventilation for an average of 28 +/- 4.5 days (range, 7 to 74 days). Two children underwent tracheostomy; all others were treated with protracted oral intubation. Inhaled nitric oxide (NO) was used in 3 children, all of whom were considered for extracorporeal membrane oxygenator (ECMO) support, although none went on to ECMO. Only 7 children (27%) never had any bacteremia. Ventilator-related pneumonia occurred in 8 children (31%). Total lengths of stay, including acute and rehabilitation hospitalizations, averaged 105 +/- 10 days (1.87 +/- 0.2; range, 0.66 to 4.8 days per percent burn). After exclusion of 1 child with a 98% third-and fourth-degree burn, pre-hospital cardiac arrest, and anoxic brain injury who had support withdrawn at 6 hours, all children survived to discharge; 23 followed up in our clinic currently are alive and well with no overt residual respiratory insufficiency. CONCLUSION A high rate of survival can be expected in young children with large burns and inhalation injury.
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Sheridan RL, Weber JM, Schnitzer JJ, Schulz JT, Ryan CM, Tompkins RG. Young age is not a predictor of mortality in burns. Pediatr Crit Care Med 2001; 2:223-224. [PMID: 12793945 DOI: 10.1097/00130478-200107000-00006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE: Conventional wisdom and recently published reports suggest that children <48 months of age have a higher mortality rate after burns than older children and adolescents with similar injuries and that young age is a predictor of mortality. This study was done to validate or refute this impression. DESIGN: Retrospective review. SETTING: Regional pediatric burn center. PATIENTS: All children (n = 1223) managed over a recent 8-yr interval (1991-1998) for acute thermal burns. INTERVENTIONS: The survival rate of children <48 months of age was compared with the survival rate of children >/=48 months of age. MEASUREMENTS AND MAIN RESULTS: Of the 1112 children with burns covering <30% of the body surface, 721 (65%) were <48 months of age. After exclusion of one child who was brain dead and became a solid organ donor, there were no deaths in this burn size group. There were 111 children admitted with burns covering >/=30% of the body surface: 47 (42%) with an average age of 2.0 yrs (range, 4 wks to 3 yrs and 11 months) were <48 months of age, and 64 (58%) with an average age of 10.9 yrs (range, 4 yrs to 17 yrs) were >/=48 months of age. There were no clinically important differences between the two groups in burn size (51.9% +/- 18.1% [range, 30%-90%] vs. 56.9% +/- 19.4% [range, 30%-97%]; p =.18) or need for mechanical ventilatory support (30/47 [63.8%] vs. 44/64 [68.8%]; p =.59). The mortality rate in the young group was 0% (0/47) and 10.9% (7/64) in the older group (p =.04). All children who died had large burns (average burn size, 82.9% +/- 11.5%) with concurrent inhalation injury. CONCLUSION: Young age is not a predictor of mortality in burns.
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Affiliation(s)
- Robert L. Sheridan
- Shriners Burns Hospital (Drs. Sheridan, Schnitzer, Schulz, Ryan, and Tompkins and Ms. Weber), the Department of Surgical Services, Massachusetts General Hospital (Drs. Sheridan, Schnitzer, Schulz, Ryan, and Tompkins), and the Department of Surgery, Harvard Medical School (Drs. Sheridan, Schnitzer, Schulz, Ryan, and Tompkins), Boston, MA
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18
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Ryan CM, Sheridan RL. Should seriously burned children who suffer cardiac arrest be subjected to cardiopulmonary resuscitation? Crit Care Med 2000; 28:592-3. [PMID: 10708217 DOI: 10.1097/00003246-200002000-00062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Jeschke MG, Herndon DN, Barrow RE. Long-term outcomes of burned children after in-hospital cardiac arrest. Crit Care Med 2000; 28:517-20. [PMID: 10708193 DOI: 10.1097/00003246-200002000-00038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Cardiopulmonary resuscitation (CPR) in severely burned patients experiencing cardiac arrest (CA) has been considered by some as futile. The objective of this article is to report predisposing factors and the outcomes of burned children experiencing in-hospital CA at our institution. DESIGN The records of 595 children admitted from 1985 to 1998 with burns covering >35% of their total body surface area were reviewed. Thirty-four children receiving CPR after in-hospital CA were studied for predisposing factors and long-term outcomes. SETTING AND PATIENTS Shriners Burns Hospital. Burned children of both genders, 0.5-19 yrs of age, who experienced in-hospital CA and received CPR. INTERVENTION Standard burn care and CPR. MEASUREMENTS AND MAIN RESULTS Predisposing factors of CA, mortality, and long-term outcomes were measured. The incidence of CA in burned children with burns on >35% total body surface area was 5.7%. No significant difference in age or burn size could be shown between long-term CA survivors (n = 17) and nonsurvivors (n = 17). CPR was successful (defined as survival for at least 1 day after CA) in 22 of 34 children (65%), with 17 of the 22 survivors (77%) experiencing long-term survival, currently from 2-14 yrs. Significant predisposing factors of CA were sepsis, identified in 53% of the nonsurvivors vs. 12% of the survivors (p<.05), and delayed fluid resuscitation (>2 hrs after burn injury), identified in 82% of the nonsurvivors vs. 6% of the survivors (p<.001). There was only one morbid long-term survivor. This survivor was diagnosed as having anoxic brain injury with persistent neurologic deficiencies. CONCLUSION In this study, 50% of the burned children experiencing CA are long-term survivors. We suggest that all burned children with CA should be afforded cardiopulmonary resuscitation.
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Affiliation(s)
- M G Jeschke
- Shriners Hospital for Children, Galveston Burns Hospital, and the Department of Surgery, University of Texas Medical Branch, Galveston, USA
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Sedowofia K, Barclay C, Quaba A, Smith A, Stephen R, Thomson M, Watson A, McIntosh N. The systemic stress response to thermal injury in children. Clin Endocrinol (Oxf) 1998; 49:335-41. [PMID: 9861325 DOI: 10.1046/j.1365-2265.1998.00553.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Thermal injury is extremely stressful, but data characterizing the endocrine stress response to this injury in children are sparse. The objective of this study was to measure the effects of thermal injury on the levels of stress hormones in children and to assess the temporal changes associated with them. PATIENTS Twenty-three children, 13 girls and 10 boys aged between 5 months and 12 years 3 months (mean, 2 years 11 months), with burns covering 10-61% of their body surface (mean, 20.5%) were studied during the first 5 days following injury. MEASUREMENTS The levels of arginine vasopressin, angiotensin II, cortisol, adrenaline, noradrenaline and dopamine were measured in sequential blood samples obtained from thermally injured children on admission and at specified time intervals during the 5 days of the investigation. RESULTS At admission the concentrations of all the hormones were high, and varied widely between individual patients. The geometric mean and 95% confidence intervals of admission hormone levels were as follows: arginine vasopressin 18.3 (8.3-40.7) pmol/l; angiotensin II 122.0 (56.0-266.2) pmol/l; cortisol 650.6 (473.0-895.0) nmol/l; dopamine 1.0 (0.1-8.0) nmol/l; adrenaline 6.4 (3.2-12.5) nmol/l and noradrenaline 2.3 (1.3-4.3) nmol/l. Although the concentrations of arginine vasopressin and cortisol returned to normal 24 to 36 h after admission, the levels of angiotensin II, adrenaline and dopamine fluctuated and remained higher than normal throughout the study (108 h). CONCLUSIONS Thermal injury results in the release of abnormally high levels of stress hormones in children. Although there are similarities between some of the data reported here and those reported in adults, higher levels of adrenaline and lower levels of noradrenaline than reported in adults suggest important differences too. These differences may need to be taken into account in the management of burn-injured children.
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Affiliation(s)
- K Sedowofia
- Department of Child Life and Health, University of Edinburgh, UK
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Sheridan RL, Ryan CM, Petras LM, Lydon MK, Weber JM, Tompkins RG. Burns in children younger than two years of age: an experience with 200 consecutive admissions. Pediatrics 1997; 100:721-3. [PMID: 9310533 DOI: 10.1542/peds.100.4.721] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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al-Shlash S, Warnasuriya ND, al Shareef Z, Filobbos P, Sarkans E, al Dusari S. Eight years experience of a regional burns unit in Saudi Arabia: clinical and epidemiological aspects. Burns 1996; 22:376-80. [PMID: 8840037 DOI: 10.1016/0305-4179(95)00169-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A retrospective analysis of 435 consecutive admissions to a regional burns unit over an 8-year period is presented. The majority were domestic accidents, while a few were suicidal and two were due to child abuse. Scalds were commoner than flame burns, 70.6 per cent were children under 12 years, 12.4 per cent had > 40 per cent TBSA affected, 66.9 per cent were deep partial or full thickness burns, 24.4 per cent had signs of shock on admission, 13.6 per cent had smoke inhalation injury. In spite of these known adverse factors the overall outcome was satisfactory, with a case fatality rate of 7.4 per cent and a residual disability rate of 10.8 per cent. Good initial resuscitation, a low infection rate (18.4 per cent) and the ready availability of appropriate surgical intervention (35.6 per cent), with good intensive care support, could account for the satisfactory outcome.
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Affiliation(s)
- S al-Shlash
- North West Armed Forces Hospital Programme, Tabuk, Saudi Arabia
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24
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Abstract
A 6-year retrospective review of burn victims hospitalized at a major burn center was conducted to determine the etiology and outcome of pediatric burns. Four hundred forty-nine patients under age 16 years were identified and stratified by age, sex, burn size, presence or absence of inhalation injury, cause of burn, and county of residence. The mean patient age was 4.3 +/- 0.2 years, and the male:female ratio was 1.9:1. There were 21 deaths overall (4.7%), the majority of which (18) were among children under 4 years of age. With respect to large burns, defined as > and = 30% total body surface area (TBSA), the mortality rate for children under age 4 was significantly higher than that for older children (46.9% v 12.5%; P < .01), despite the nearly identical mean burn size of the two groups. Except for burn incidence, there were no significant differences between males and females. The mean burn size was 15.1% +/- 0.7%, and was significantly larger for nonsurvivors than survivors (55.3% +/- 5.7 v 13.1% +/- 0.5%; P < .01). Inhalation injuries were strongly associated with large burns and were present in all 15 flame-burn fatalities. Scalds were the most common type of burn among children under 4 years of age; flame burns predominated in older children. There were 6 deaths related to scalds, all of which occurred in children under 4. Burn type, size, and mortality rate did not differ between children from urban and rural counties. Large burn size was the strongest predictor of mortality, followed by (in order) age less than 4 and the presence of inhalation injury. Infants and young children have the highest risk of death from burn injury. Burns smaller than 30% TBSA without an inhalation injury (such as small scald injuries) occasionally are lethal in infants and small children, despite modern therapy.
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Affiliation(s)
- S E Morrow
- Department of Surgery, University of North Carolina at Chapel Hill, NC 27599-7210, USA
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Reynolds EM, Ryan DP, Sheridan RL, Doody DP. Left ventricular failure complicating severe pediatric burn injuries. J Pediatr Surg 1995; 30:264-9; discussion 269-70. [PMID: 7738749 DOI: 10.1016/0022-3468(95)90572-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE Despite improvements in the overall survival rates for critically burned children, failed resuscitation may account for 54% of deaths following burn injuries. Clinical and experimental studies have implicated failure of the right side of the heart in adults, biventricular failure in elderly patients, and inadequate resuscitation as causes of refractory burn shock. This retrospective study of resuscitation at a tertiary pediatric burn center showed that myocardial depression is a complicating factor in the treatment of the pediatric burn victim. METHODS From 1989 to 1992, 28 critically burned children (> or = 60% total burn surface area) were resuscitated primarily at our center (admission within 24 hours of injury). Twenty-seven children had central lines, nine of whom underwent pulmonary artery catheterization for intensive hemodynamic monitoring because standard resuscitative therapy had failed. The average amount of fluid received at 8 and 24 hours after injury was within 10% of the calculated volume based on the Parkland formula. RESULTS Indexes of a failing rescue attempt included respiratory distress (PaO2/FlO2 < or = 200), central venous pressure of greater than 10 mm Hg, and urine output of less than 1 mL/kg/h. Filling pressures were found to be normal or elevated in all children, indicating adequate volume replacement. Evaluation of cardiac function was performed using a thermodilution technique and showed that 100% of the study group had depressed left ventricular function, with an average left ventricular stroke work index (LVSWI) of 19.9 g.m/m2 (normal, 44 to 68 g.m/m2), whereas only 38% had concomitant right ventricular failure. This left-sided dysfunction persisted throughout the acute resuscitation period but was improved after appropriate modification of fluid resuscitation and initiation of vasopressors (average final LVSWI, 38.0 g.m/m2). There were no complications from placement of the Swan-Ganz catheters in this group. CONCLUSION Cardiogenic failure is a major determinant of a failing pediatric burn resuscitation, and, contrary to the adult burn patient, the myocardial depression is predominantly left-sided. Information from pulmonary artery catheters can help direct therapy by providing indications for vasopressors and modifying fluid resuscitation.
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Affiliation(s)
- E M Reynolds
- Pediatric Surgical Services, Massachusetts General Hospital, Boston 02114, USA
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