Rice cooker steam hand burn in the pediatric patient

A characterization of home maintenance equipment-related hand and lower arm injuries

BACKGROUND

Thousands of Americans sustain injuries from various household appliances each year, though injury patterns have not been well characterized. We thus sought to determine the incidence, characteristics, and trends of household appliance-related hand injuries over the past decade.

METHODS

The National Electronic Injury Surveillance System database (NEISS) was queried from 2010 through 2019. Our analysis grouped patients into 10-year age groups. We defined types of appliances and injuries Chi-square tests were used to compare the most common injury mechanisms by age group.

RESULTS

Between 2010 and 2019, 30,336 total cases of home workshop equipment-related upper extremity injuries were recorded; 2,574 (8.48%) of these affected females, compared to 27,762 (91.52%) of the cases affecting males. Across all age groups, males were between 6 and 13 more times likely to be injured than females (p < 0.001). Between 2010 and 2019, we recorded a decline in total injuries from 168,795 to 147,584, with a Pearson correlation coefficient of -0.68 (p = 0.031). The appliances most likely to injure those in their 10s through 40s were mechanical tools such as screwdrivers. Meanwhile, those in their 50s through 70s were most likely to be injured by saws. Both amputations and avulsions were found to significantly increase with age (p = 0.038, p = 0.027, respectively). Most injuries result from manual tools and saws.

DISCUSSION

Males are significantly more likely to incur injuries than females from maintenance equipment, and risk of avulsions and amputations increase significantly with age. This aligns with previous research which also suggested that older saws were most likely to injure older individuals; namely, following new regulations on saws, older adults were more likely to be affected. This is especially worrisome in light of recent research showing that older adults with amputations are less likely to be offered replantations. Overall, these results can continue to guide and optimize community interventions on an epidemiological basis.

Cutaneous steam burns and steam inhalation injuries: a literature review and a case presentation

Abstract

Scald is one type of burn that s often mentioned alone and occurs mostly in the paediatric population. Inhaled steam is mostly cooled off in the airways, why thermal damage is rarely seen. A sudden exposure to hot steam/inhalation can cause a thermal inhalation injury. A scoping review was performed, with the aim to summarize all published papers in English, about steam-related injuries. The search was conducted using the PubMed® and Cochrane libraries on 19th of May 2021, without a set time period. Out of a total of 1186 identified records, 31 were chosen for review. Burns related to the contact with steam are generally rare and can be both minor and severe. The more severe cases related to steam exposure are mostly workplace accidents and the minor injuries reported in the literature are often related to steam inhalation therapy, especially in the paediatric population. This review describes the challenges that can be found dealing with patients suffering from cutaneous steam burns and/or steam inhalation injuries. A steam injury to the airways or the skin can be directly life-threatening and should be treated with caution. This type of injury can lead to acute respiratory insufficiency and sometimes death. A case of a male patient with extensive cutaneous steam burns and a steam inhalation injury who passed away after 11 days of treatment is also presented to illustrate this review.

Level of evidence: Level V, Therapeutic; Risk/Prognostic Study.

Pediatric Hand Trauma: An Analysis of 3,432 Pediatric Hand Trauma Cases Over 15 Years

PurposePediatric hand trauma is common and sometimes causes deformity or disability. The incidence and etiologies of hand trauma in children are different from those in adults. This study analyzed the characteristics of pediatric hand trauma cases and patients over a 15-year period. MethodsWe conducted a retrospective medical record review of 3,432 children (2,265 boys, 1,167 girls, under 18 years of age) with hand injuries from January 2005 to December 2019. We evaluated the sex distribution and injury etiologies. Injuries were classified by type as burns, amputations, crushing injuries, lacerations, extensor and flexor tendon injuries, open and closed fractures, and nerve injuries. ResultsAmong the pediatric hand injury patients, males were predominant (1.94:1). Simple lacerations (58.4%) were the most common injury type, followed by fractures (22.8%). Lacerations and burns tended to be common in younger age groups, while tendon injuries, nerve injuries, and crushing injuries were more frequently encountered in older age groups. ConclusionsHand trauma prevention strategies should be established considering the frequent trauma etiologies in specific age groups. An awareness of age-specific characteristics of pediatric hand trauma patients will be helpful to prevent hand trauma.

Children With Facial Burns Treated in United States Emergency Departments, 2000 to 2018

OBJECTIVE

To investigate the characteristics and trends of facial burns among children.

METHODS

Data from the National Electronic Injury Surveillance System database were retrospectively analyzed for children <20 years old treated in United States (US) emergency departments (EDs) from 2000 to 2018 and national facial burn estimates were calculated.

RESULTS

During 2000 to 2018, there were an estimated 203,180 children <20 years old treated in US EDs for facial burns, averaging 10,694 burns or 130 burns per million children annually. Boys accounted for 66.4% of cases, and 41.9% were patients <5 years old. The most common type of burn was thermal (51.9%), followed by scalds (30.7%). The 2 most common injury mechanisms were light/lit (22%) and spilled/splashed (15.1%). Fuels and fuel burning equipment (13.1%) were most commonly associated with burns. Overall, the number of facial burns decreased significantly by 53.1% during the 19-year study period with 6525 cases treated in 2018. Although the number of thermal and radiation burns decreased significantly by 69.6% and 63.5%, respectively, the number of scald burns remained relatively constant.

CONCLUSIONS

Although the number of children treated in US EDs for facial burns decreased significantly from 2000 to 2018, these injuries remain common. Contrary to the observed decline in thermal and radiation burns, scald burns did not demonstrate a significant temporal trend. These findings indicate a need for increased prevention efforts, especially focused on scalds. Because the type of burn, mechanisms involved, and consumer products associated with facial burns vary by age group, prevention strategies should be developmentally tailored.

Children Younger Than 18 Years Treated for Nonfatal Burns in US Emergency Departments

This study investigated children <18 years old treated for burns in United States (US) emergency departments from 1990 to 2014 using data from the National Electronic Injury Surveillance System. There were 2 548 971 children treated for burns during the study period, averaging 101 959 annually. The number and rate of burns decreased by 30.0% and 38.9%, respectively, (both P < .001) during the study. Most patients (58.4%) were boys, 64.0% were <6 years old, and 7.4% were admitted to the hospital. Thermal burns accounted for 60.2% of injuries. The hand/fingers were most commonly injured (37.1%), followed by head/neck (19.6%). The most common specified mechanism of injury was grabbing/touching (18.4%), followed by spilling/splashing (16.4%). Although the number of children treated for burns has decreased, it remains an important source of pediatric injury, demonstrating the need to increase prevention efforts, especially among young children. This is the first study to use a nationally representative sample to investigate burn mechanisms.

Is there any place for spontaneous healing in deep palmar burn of the child?

Child palm burns arise by contact and are often deep. The singular difficulty of such a disease comes from the necessity of the child growth and from the potential occurrence of constricted scars. In order to avoid sequelae, the actual gold standard is to practice an early excision of the burn, followed by a skin graft. The aim of this study is to evaluate the results of spontaneous healing combined with rehabilitation versus early skin grafting and rehabilitation concerning the apparition of sequelae. We performed a retrospective study in two burn centers and one rehabilitation hospital between 1995 and 2010. Eighty-seven hands have been included in two groups: one group for spontaneous healing and the other group for excision and skin grafting. Every child benefited from a specific rehabilitation protocol. The two main evaluation criteria were the duration of permanent splint wearing and the number of reconstructive surgery for each child. The median follow-up duration is about four years. The two groups were comparable. For the early skin grafting group, the splint wearing duration was 1/3 longer than for the spontaneous healing group. Concerning the reconstructive surgery, half of the grafted hands needed at least one procedure versus 1/5 of spontaneous healing hands. Our results show the interest of spontaneous healing in palmar burn in child, this observation requires a specific and intense rehabilitation protocol.

Analysis of 344 Hand Injuries in a Pediatric Population

Background

The purpose of this study was to identify comprehensive hand injury patterns in different pediatric age groups and to assess their risk factors.

Methods

This retrospective study was conducted among patients younger than 16-year-old who presented to the emergency room of a general hospital located in Gyeonggi-do, Republic of Korea, and were treated for an injury of the finger or hand from January 2010 to December 2014. The authors analyzed the medical records of 344 patients. Age was categorized according to five groups.

Results

A total of 391 injury sites of 344 patients were evaluated for this study. Overall and in each group, male patients were in the majority. With regard to dominant or non-dominant hand involvement, there were no significant differences. Door-related injuries were the most common cause in the age groups of 0 to 3, 4 to 6, and 7 to 9 years. Sport/recreational activities or physical conflict injuries were the most common cause in those aged 10 to 12 and 13 to 15. Amputation and crushing injury was the most common type in those aged 0 to 3 and 4 to 6 years. However, in those aged 10 to 12 and 13 to 15, deep laceration and closed fracture was the most common type. With increasing age, closed injuries tended to increase more sharply than open injuries, extensor tendon rupture more than flexor injuries, and the level of injury moved proximally.

Conclusions

This study provides a comprehensive overview of the epidemiology of hand injuries in the pediatric population.

The use of split-thickness versus full-thickness skin graft to resurface volar aspect of pediatric burned hands: A systematic review

OBJECTIVE

The aim of this systematic review was to discuss the comparison of split-thickness skin graft (STSG) and full-thickness skin graft (FTSG) use as the treatment for volar digital and palmar burns in children.

METHODS

We conducted PubMed and Cochrane Library searches using keywords "hand injuries", "contracture" and "skin transplantation". The search was limited to studies published from 1st January 1980 until 31st December 2013 and used English language. We selected the studies based on specific inclusion and exclusion criteria. We assessed the quality of the studies by using Newcastle-Ottawa Scale (NOS) for cohort studies.

RESULTS

We included eight articles in our systematic review. One of those studies is a prospective cohort study and the others are retrospective cohort studies. Based on combined range of motion (ROM) evaluation in three studies, STSG group yielded poorer functional outcomes than FTSG group. However, there is no study which can fairly show that FTSG was significantly superior to STSG to achieve good functional outcomes.

CONCLUSION

Currently, there is no strong, high-quality evidence to prove that FTSG is superior to STSG to cover pediatric palmar burns. Either FTSG or STSG can be utilized with consideration of several influential factors especially splinting and physiotherapy.

Neglected post burns contracture of hand in children: Analysis of contributory socio-cultural factors and the impact of neglect on outcome

BACKGROUND

No study has ever evaluated the causes and effect of neglect on the outcome of post burns contractures of hand in children.

METHODS

66 hands in 61 children (mean age 12.22 years) with a mean neglect of 11.6 years (range 5-17 years) were assessed for the causes of neglect and the outcome of surgery. Average follow up was 6.6 years. The results were assessed in two groups of 5-10 years neglect as group I and >10 years neglect as group II.

RESULTS

In a total number of 134 contracted rays in 66 hands, the surgical procedures included local Z/V-Y flap (51 rays), cross finger flap (48 rays), full thickness graft (35 rays). Additional external fixator with a distracter was used in 3 patients treated at a delay of 14, 16 and 17 years. 50 (81.96%) patients belonged to rural and slum areas. The reasons for delayed treatment included poverty - 33 patients, lack of awareness of surgical treatment - 16 patients; and indifference of parents - 12 patients. 44 (72.13%) children were illiterates. With treatment the average DASH score improved from 65.10 to 36.90 (p < .000) and from 68.14 to 45.93 (p < .000) in group I and II respectively. The results were significantly superior in group I (p < .000).

CONCLUSION

The main factors for neglect in treatment of post burns contracture include poverty, lack of awareness and illiteracy. All the patients showed significant improvement in function after the surgery. Contractures with higher neglect had significantly inferior outcome.

Palmar crease release and secondary full-thickness skin grafts for contractures in primary full-thickness skin grafts during growth spurts in pediatric palmar hand burns

Pediatric palmar hand burns are a difficult problem because of the serious hand deformity, with functional impairment resulting from rapid growth. In cases of severe pediatric palmar hand burns, a secondary full-thickness skin graft after a primary full-thickness skin graft offers a reliable way of obtaining the required functional and aesthetic outcomes.This study retrospectively evaluated 28 children who required palmar crease releases and secondary full-thickness skin grafts during the past 12 years. The case records were reviewed for sex and age distributions, injury mechanism, and time interval between the primary and secondary full-thickness skin grafts. Surgical procedures included secondary full-thickness skin grafts and incisional releases of grafted skin on the involved creases. There were 19 men and 9 women. The mean age at the time of the burn injury was 10.1 months (range, 5-19 months). The mean age at the time of the secondary full-thickness skin graft was 8.3 years (range, 3-17 years). The most common mechanism of burn injury was steam (n = 24). The median time interval from the primary to the secondary full-thickness skin graft was 67 months (range, 8-156 months). The number of released creases was 81. The number of palmar web contractures in 23 patients was 52. A secondary full-thickness skin graft was more frequently necessary in patients with a primary full-thickness skin graft in the proximal digital crease and palmar web areas. All patients achieved adequate digital length and palmar web contour after surgery. Our patients should be observed until the rapid pubertal growth period.

Shower steamer burns in a toddler: case report and brief review of steam burns in children

Commercial "shower-steamers" are relatively new devices used to produce a sauna-like effect in standard showers. These devices produce superheated steam to temperatures greater than 100 degrees C. The steam-head is installed 12 in. above the shower floor or 8 in. above the tub edge, making accidental burn injury to children a real possibility, as in our case report. To our knowledge, there are no previously documented cases in the literature or on the Consumer Products Safety Commission Web site of thermal injuries from this device. Physicians need to be aware of the possible injury from such steamers, and public education to prevent further incidents is warranted.

Burns in epilepsy: seven years of experience from the Hallym Burn Center in Korea

The objective of this retrospective epidemiological study was to identify the characteristics of burn injuries of seizure disorder patients in Korea, with the goal of developing programs to prevent or reduce the frequency and morbidity of such injuries. We reviewed the medical records of 34 acutely burned, epileptic-seizure patients who were admitted to a single regional burn center unit during the 7 years between January 1997 and April 2003, all of whom had been burned during an epileptic seizure. The most commonly associated seizure type was generalized tonic-clonic, followed by absence and complex partial. Females predominated in all age groups. There were more seizures in the morning hours between 3 and 10 am. The mean age was 43 +/- 16 years. Seizures occurred at home, while the patient was conducting daily household chores. Scalding was the most common injury, leaving small-but-deep wounds that required a mean hospital stay of 37 +/- 27 days. Typically, upper limbs and trunk were affected. To implement a successful burns injury-prevention program, patients with epilepsy should be better recognized as a high-risk group. Specific passive as well as active recommendations are suggested based on the epidemiologic features of seizure disorder patients in Korea.

Specifically designed external fixators in treatment of complex postburn hand contractures

External fixators designed specifically for severe, late postburn contractures of hand and wrist have been used in five patients between 1993 and 1997 with follow up for an average of 30.2 months. The mean age of patients at operation was 16.6 years ranging from 14 to 20 years. They had a number of failed operations. There were fixed joint contractures beside severe soft tissue contractures. There was total loss of hand functions in four patients. After reconstructive operations, at least one hand function was attained. We have found the external fixator method to be helpful in treating severe, fixed and complex postburn contractures of hand where previous surgery had failed. This study indicates the uses and benefits of external fixators as a soft tissue lengthener when correcting progressively complex burn contractures of hand.

Acute management of exercise treadmill-associated injuries in children

BACKGROUND

Exercise treadmills have grown in popularity in the past few years. The addition of this type of equipment in the home offers opportunity for injury, particularly in children.

METHODS

Patients were identified both prospectively and retrospectively by review of the trauma registry and medical records. Patient data, medical treatment, and hospital costs were obtained from medical records. Functional outcome was assessed by the modified Michigan Hand Outcomes Questionnaire.

RESULTS

Nine patients were observed with 14 injuries. The average age was 3.4 years, with average clinical follow-up of 9.1 weeks. The primary injury was friction burn (eight of nine), with one patient sustaining a thumb distal tuft fracture. Two patients required operations and all patients had a good functional outcome (124.5 of 125 on the Michigan Hand Outcomes Questionnaire).

CONCLUSION

Treadmill-associated injuries primarily involve hand injury in children. These injuries usually do not require surgical intervention and are preventable. Prevention modalities include additional manufacture safety features, warning labels, and parental education.