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Javaid AA, Johnson E, Hollén L, Kemp AM. Influence of agents and mechanisms of injury on anatomical burn locations in children <5 years old with a scald. Arch Dis Child 2021; 106:1111-1117. [PMID: 33727239 DOI: 10.1136/archdischild-2020-320710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To demonstrate how the mechanism and agent of injury can influence the anatomical location of a scald. DESIGN Prospective multicentre cross-sectional study. SETTING 20 hospital sites across England and Wales including emergency departments, minor injury units and regional burns units. PATIENTS Children aged 5 years and younger who attended hospital with a scald. MAIN OUTCOME MEASURES Primary outcome: a descriptive analysis of the mechanism, agent and anatomical location of accidental scalds. Secondary outcome: a comparison of these factors between children with and without child protection (CP) referral. RESULTS Of 1041 cases of accidental scalds, the most common narrative leading to this injury was a cup or mug of hot beverage being pulled down and scalding the head or trunk (132/1041; 32.9% of cases). Accidental scalds in baths/showers were rare (1.4% of cases). Accidental immersion injuries were mainly distributed on hands and feet (76.7%). There were differences in the presentation between children with accidental scalds and the 103 who were referred for CP assessment; children with scalds caused by hot water in baths/showers were more likely to get referred for CP assessment (p<0.0001), as were those with symmetrically distributed (p<0.0001) and unwitnessed (p=0.007) scalds. CONCLUSIONS An understanding of the distributions of scalds and its relationship to different mechanisms of injury and causative agents will help clinicians assess scalds in young children, particularly those new to the emergency department who may be unfamiliar with expected scald patterns or with the importance of using appropriate terminology when describing scalds.
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Affiliation(s)
- Assim Ali Javaid
- Department of Population Health, Cardiff University, Cardiff, UK
| | - Emma Johnson
- Paediatric Department, New Cross Hospital, Wolverhampton, UK
| | - Linda Hollén
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Alison Mary Kemp
- Division of Population Medicine, Department of Child Health, Cardiff, UK
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Storey K, Kimble RM, Holbert MD. The Management of Burn Pain in a Pediatric Burns-Specialist Hospital. Paediatr Drugs 2021; 23:1-10. [PMID: 33447938 DOI: 10.1007/s40272-020-00434-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
Appropriate pain management for children who have experienced an acute burn injury is critical to improve patient outcomes and reduce potential morbidities. With 60% of our patients being under the age of 4 years, pain management is crucial in reducing pain and anxiety in both patients and parents. It is imperative that appropriate pain relief is commenced from initial contact with healthcare workers as this will affect the success or failure of future wound procedures. Uncontrolled pain can negatively affect a patient, both short and long term. It may cause anticipatory anxiety for future medical procedures, increased pain and anxiety can decrease wound re-epithelialization which can lead to long-term consequences for growth and mobility, and increased pain can also influence the possibility of patients and families displaying signs of post-traumatic stress disorder. Pain management in the form of pharmaceuticals is imperative during burn wound treatment and should incorporate pain relief targeted at both background and procedural pain. It also requires a multimodal, individualized, and targeted approach combining both pharmaceutical and nonpharmaceutical techniques, including cold running water, multimodal distraction devices, hypnotherapy, and bubbles. We discuss the research and knowledge that our center has gained through treating pediatric patients with burns over the last 20 years.
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Affiliation(s)
- Kristen Storey
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, South Brisbane, QLD, Australia. .,Pegg Leditschke Paediatric Burns Centre, The Queensland Children's Hospital, South Brisbane, QLD, Australia. .,Queensland University of Technology, Brisbane, QLD, Australia. .,Children's Health Queensland Hospital and Health Service, Queensland Children's Hospital, 501 Stanley Street, South Brisbane, QLD, 4101, Australia.
| | - Roy M Kimble
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, South Brisbane, QLD, Australia.,Pegg Leditschke Paediatric Burns Centre, The Queensland Children's Hospital, South Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Queensland University of Technology, Brisbane, QLD, Australia
| | - Maleea D Holbert
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, South Brisbane, QLD, Australia.,Pegg Leditschke Paediatric Burns Centre, The Queensland Children's Hospital, South Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Mullen S, Begley R, Roberts Z, Kemp AM. Fifteen-minute consultation: Childhood burns: inflicted, neglect or accidental. Arch Dis Child Educ Pract Ed 2019; 104:74-78. [PMID: 29934360 DOI: 10.1136/archdischild-2018-315167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/15/2018] [Accepted: 05/16/2018] [Indexed: 11/03/2022]
Abstract
Burns are a relatively common injury in children accounting for over 50 000 emergency department attendances each year. An estimated 1 in 10 of these are due to maltreatment. These may present in the form of physical abuse or neglect with a reported ratio of 1:9. A burn associated with maltreatment may be a marker for future abuse or neglect and it is paramount that concerns are identified and addressed at the initial visit. Paediatricians need to be confident to identify safeguarding concerns specific to childhood burns and investigate accordingly. In this review, key variables that may aid in differentiating maltreatment from accidental burns are discussed in a case-based format, utilising up-to-date evidence to support the recommendations. Despite a proportion of burns resulting from physical abuse, the rate of child protection investigations in these patients are significantly lower than for children who present with other forms of physical injuries despite a similar proportion of positive findings. Our objective is to review the available evidence to support the safe assessment and management of children presenting with scalds or contact burns.
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Affiliation(s)
- Stephen Mullen
- Paediatric Emergency Department, Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland
| | - Roisin Begley
- Paediatric Emergency Department, University Hospital of Wales, Cardiff, UK
| | - Zoe Roberts
- Paediatric Emergency Department, University Hospital of Wales, Cardiff, UK
| | - Alison Mary Kemp
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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Mathias E, Srinivas Murthy M. Pediatric Thermal Burns and Treatment: A Review of Progress and Future Prospects. MEDICINES (BASEL, SWITZERLAND) 2017; 4:medicines4040091. [PMID: 29232903 PMCID: PMC5750615 DOI: 10.3390/medicines4040091] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 12/07/2017] [Accepted: 12/08/2017] [Indexed: 05/17/2023]
Abstract
Burn injuries are a devastating critical care problem. In children, burns continue to be a major epidemiologic problem around the globe resulting in significant morbidity and death. Apparently, treating these burn injuries in children and adults remains similar, but there are significant physiological and psychological differences. The dermal layer of the skin is generally thinner in neonates, infants, and children than in adults. Enhanced evaporative loss and need for isotonic fluids increases the risk of hypothermia in the pediatric population. The pain management of the children with major burns challenges the skills of the personnel of every unit. Managing these wounds requires intensive therapeutic treatment for multi-organ dysfunction, and surgical treatment to prevent sepsis and other complications that further delay wound closure. Alternatives to the practice of donor site harvest and autografting for the treatment of severe burns and other complex skin defects are urgently needed for both adult and pediatric populations. This review article focuses on thermal burn pathophysiology and pain management and provides an overview of currently approved products used for the treatment of pediatric burn wounds. A new promising approach has been presented as a first-line therapy in the treatment of burns to reduce surgical autografting in pediatric patients.
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Affiliation(s)
- Elton Mathias
- Department of Clinical Research, Mallinckrodt Pharmaceuticals, Bedminster, NJ 07921, USA.
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Choudhry IK, Kyriakedes J, Foad MB. Iatrogenic burn caused by an operating microscope: case report. J Hand Surg Am 2013; 38:545-7. [PMID: 23337461 DOI: 10.1016/j.jhsa.2012.11.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 11/08/2012] [Accepted: 11/09/2012] [Indexed: 02/02/2023]
Abstract
We present a patient who experienced a burn from an operating microscope during surgery for a brachial plexus birth palsy, a literature review, and recommendations on how to avoid such injuries.
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Affiliation(s)
- Imran K Choudhry
- Department of Orthopaedics, University of Cincinnati, Cincinnati, OH 45267-0212, USA.
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