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Nassar JY, Al Qurashi AA, Albalawi IA, Nukaly HY, Halawani IR, Abumelha AF, Osama Al Dwehji AM, Alhartani MM, Asaad A, Alnajashi A, Khojah IM. Pediatric Burns: A Systematic Review and Meta-Analysis on Epidemiology, Gender Distribution, Risk Factors, Management, and Outcomes in Emergency Departments. Cureus 2023; 15:e49012. [PMID: 38111412 PMCID: PMC10726077 DOI: 10.7759/cureus.49012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 12/20/2023] Open
Abstract
Pediatric burns pose a significant public health concern, ranking as the fifth most common nonfatal injury globally. This review consolidates data on the epidemiology, outcomes, and management of pediatric burns presenting to emergency departments. A systematic review was conducted across multiple databases, yielding 22 articles from 1992 to 2020. Utilizing the methodological index for non-randomized studies (MINORS) instrument, non-comparative studies scored from 2 to 11 with an average of 6.87, while comparative studies ranged from 12 to 16, averaging 13.67. The review included a total of 828,538 pediatric patients who were evaluated in the systematic review. Predominantly male victims ranged from 53% to 83%. The youngest victims were aged between 0 to 4 years. Burn etiology was largely attributed to scalds. A majority suffered from second-degree burns, with some studies reporting up to 89%. Limited data on total body surface area (TBSA) were documented, with only 2.5% requiring hospitalization. Common interventions included immediate resuscitation and skin grafting. Essential areas for future research are identified, including household risks, pre-treatment decisions, and the significant role of family dynamics in burn injury recovery. Pediatric burns remain a considerable concern, particularly among males and in household environments. The data underline the imperative for prevention strategies and optimized emergency care to positively influence outcomes for burn victims. Future research areas range from evaluating pre-treatment decisions to assessing community awareness regarding burn first aid.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Alanoud Asaad
- Medicine, Alfaisal University College of Medicine, Riyadh, SAU
| | - Arwa Alnajashi
- Medicine, Alfaisal University College of Medicine, Riyadh, SAU
| | - Imad M Khojah
- Emergency Medicine, King Abdulaziz University, Jeddah, SAU
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Auh E, Kistamgari S, Yang J, Smith GA. Children With Facial Burns Treated in United States Emergency Departments, 2000 to 2018. Acad Pediatr 2020; 20:540-548. [PMID: 32044467 DOI: 10.1016/j.acap.2020.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/28/2020] [Accepted: 02/01/2020] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Edel Auh
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital (E Auh, S Kistamgari, J Yang, and GA Smith), Columbus, Ohio; Geisel School of Medicine, Dartmouth College (E Auh), Hanover, NH
| | - Sandhya Kistamgari
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital (E Auh, S Kistamgari, J Yang, and GA Smith), Columbus, Ohio
| | - Jingzhen Yang
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital (E Auh, S Kistamgari, J Yang, and GA Smith), Columbus, Ohio; Department of Pediatrics, The Ohio State University College of Medicine (J Yang and GA Smith), Columbus, Ohio
| | - Gary A Smith
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital (E Auh, S Kistamgari, J Yang, and GA Smith), Columbus, Ohio; Department of Pediatrics, The Ohio State University College of Medicine (J Yang and GA Smith), Columbus, Ohio; Child Injury Prevention Alliance (GA Smith), Columbus, Ohio.
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Lim KBL, Laine T, Chooi JY, Lye WK, Lee BJY, Narayanan UG. Early morbidity associated with fasciotomies for acute compartment syndrome in children. J Child Orthop 2018; 12:480-487. [PMID: 30294372 PMCID: PMC6169567 DOI: 10.1302/1863-2548.12.180049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Acute compartment syndrome (ACS) requires urgent fasciotomy to decompress the relevant muscle compartment/s prior to onset of irreversible myonecrosis and nerve injury. A fasciotomy is not a benign procedure. This study aims to describe and quantify early morbidity directly associated with fasciotomies for ACS in children. METHODS Clinical charts of 104 children who underwent 112 fasciotomies over a 13-year period at a tertiary children's hospital were reviewed. The following were analyzed: ACS aetiology, fasciotomy site, number of subsequent procedures, method of wound closure, short-term complications and length of hospital stay. RESULTS Short-term complications included wound infections (6.7%) and the need for blood transfusion (7.7%). Median number of additional operations for wound closure was two (0 to 10) and median inpatient stay was 12 days (3 to 63; SD 11.7). After three unsuccessful attempts at primary closure, likelihood of needing skin grafting for coverage exceeded 80%. Analyses showed that fasciotomy-wound infections were associated with higher risk for four or more closure procedures. Number of procedures required for wound closure correlated with longer inpatient stay as did ACS associated with non-orthopaedic causes. CONCLUSION Fasciotomy is associated with significant early morbidity, the need for multiple closure operations, and prolonged hospital stay. The decision for fasciotomy needs careful consideration to avoid unnecessary fasciotomies, without increasing the risk of permanent injury from missed or delayed diagnosis. Skin grafting should be considered after three unsuccessful closure attempts. Less invasive tests or continuous monitoring (for high-risk patients) for compartment syndrome may help reduce unnecessary fasciotomies. LEVEL OF EVIDENCE Level IV, Case series.
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Affiliation(s)
- K. B. L. Lim
- Department of Orthopaedic Surgery & Division of Surgery, KK Women’s & Children’s Hospital, Singapore, Singapore, Correspondence should be sent to K. Lim, Division of Surgery, Executive Office, KK Women’s & Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore. E-mail:
| | - T. Laine
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska University Hospital and Sahlgrenska Academy, Gothenburg, Sweden
| | - J. Y. Chooi
- Duke-NUS Medical School, Singapore, Singapore
| | - W. K. Lye
- Duke-NUS Medical School, Singapore, Singapore,Centre for Quantitative Medicine, Office of Clinical Sciences, Duke-NUS Medical School, Singapore, Singapore
| | - B. J. Y. Lee
- Department of Orthopaedic Surgery & Division of Surgery, KK Women’s & Children’s Hospital, Singapore, Singapore
| | - U. G. Narayanan
- Divisions of Orthopaedic Surgery & Child Health Evaluative Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Canada
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Survey of the Statewide Impact of Payer Source on Referral of Small Burns to Burn Centers. J Burn Care Res 2018; 38:e699-e703. [PMID: 27606548 DOI: 10.1097/bcr.0000000000000437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
It is generally agreed that patients with large burns will be referred to organized burn centers, however, the referral of patients with smaller burns is less certain. A two-part survey was conducted to identify referral patterns for burn patients that meet American Burn Association referral criteria, and any effect insurance type might have on the referral patterns. The emergency departments of our state hospital association's member hospitals were contacted seeking a referral for a fictitious patient with a third-degree scald of the dominant hand. The referral sites were contacted twice, first stating that the patient had commercial insurance, next stating that the patient had Medicaid. Data collected included wait time for an appointment or reasons for denial of an appointment. Of 218 hospitals, 46 were excluded because they did not offer emergency care, and eight because they were listed as burn centers on the American Burn Association website. Of the remaining 164, 119 (73%) would refer to a burn center, 21 (13%) to a plastic surgeon, 10 (6%) to a hand surgeon, 7 (4%) to a wound center, 7 (4%) to another nonburn physician resource. There was no difference in wait time to the first available appointment with regards to insurance type (6.56 ± 4.68 vs 6.53 ± 5.05 days). Our state's referral pattern gives us insight into the regional referral pattern. This information will be used to guide a focused education and communication program to provide better service for the burn victims of our state.
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Abstract
Although the overall incidence of and mortality rate associated with burn injury have decreased in recent decades, burns remain a significant source of morbidity and mortality in children. Children with major burns require emergent resuscitation. Resuscitation is similar to that for adults, including pain control, airway management, and administration of intravenous fluid. However, in pediatrics, fluid resuscitation is needed for burns greater than or equal to 15% of total body surface area (TBSA) compared with burns greater than or equal to 20% TBSA for adults. Unique to pediatrics is the additional assessment for non-accidental injury and accurate calculation of the percentage of total burned surface area (TBSA) in children with changing body proportions are crucial to determine resuscitation parameters, prognosis, and disposition.
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Affiliation(s)
- Ashley M Strobel
- Department of Emergency Medicine, University of Minnesota School of Medicine, Hennepin County Medical Center, University of Minnesota Masonic Children's Hospital, 701 South Park Avenue R2.123, Minneapolis, MN 55414, USA.
| | - Ryan Fey
- Department of Surgery, University of Minnesota School of Medicine, Hennepin County Medical Center, 701 South Park Avenue, Minneapolis, MN 55414, USA
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Abstract
Hypertrophic scar and contracture in burn patients is a complex process. Contributing factors include critical injury depth and activation of key cell subpopulations, including deep dermal fibroblasts, myofibroblasts, fibrocytes, and T-helper cells, which cause scarring rather than regeneration. These cells influence each other via cellular profibrotic and antifibrotic signals, which help to determine the outcome. These cells also both modify and interact with extracellular matrix of the wound, ultimately forming hypertrophic scar. Current treatments reduce hypertrophic scar formation or improve remodeling by targeting these pathways and signals.
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Affiliation(s)
- Peter O Kwan
- 2A Plastic Surgery, Kaye Edmonton Clinic, University of Alberta, 11400 University Avenue, Edmonton, Alberta T6G 1Z1, Canada
| | - Edward E Tredget
- Department of Surgery, University of Alberta, 2D2.28 WMHSC, 8440-112 Street Northwest, Edmonton, Alberta T6G 2B7, Canada.
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Abstract
The literature surrounding pediatric burns has focused on inpatient management. The goal of this study is to characterize the population of burned children treated as outpatients and assess outcomes validating this method of burn care. A retrospective review of 953 patients treated the burn clinic and burn unit of a tertiary care center. Patient age, burn etiology, burn characteristics, burn mechanism, and referral pattern were recorded. The type of wound care and incidence of outcomes including subsequent hospital admission, infection, scarring, and surgery served as the primary outcome data. Eight hundred and thirty children were treated as outpatients with a mean time of 1.8 days for the evaluation of burn injury in our clinic. Scalds accounted for 53% of the burn mechanism, with burns to the hand/wrist being the most frequent area involved. The mean percentage of TBSA was 1.4% for the outpatient cohort and 8% for the inpatient cohort. Burns in the outpatient cohort healed with a mean time of 13.4 days. In the outpatient cohort, nine (1%) patients had subsequent admissions and three (0.4%) patients had concern for infection. Eight patients from the outpatient cohort were treated with excision and grafting. The vast majority of pediatric burns are small, although they may often involve more critical areas such as the face and hand. Outpatient wound care is an effective treatment strategy which results in low rates of complications and should become the standard of care for children with appropriate burn size and home support.
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McWilliams T, Hendricks J, Twigg D, Wood F. Burns education for non-burn specialist clinicians in Western Australia. Burns 2015; 41:301-7. [DOI: 10.1016/j.burns.2014.06.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 06/29/2014] [Accepted: 06/30/2014] [Indexed: 11/24/2022]
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Demographic Comparison of Burn Emergency Only Visits and Admissions in an Urban Burn Center. J Burn Care Res 2014; 37:181-90. [PMID: 25423441 DOI: 10.1097/bcr.0000000000000197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There are few publications about demographics of Emergency Department (ED) burn patient visits. The purpose of this study was to compare ED only burn patients with admitted patients in an urban burn center. This was a retrospective review (1999 to 2014) of a burn unit patient registry. Patients were seen either in the Emergency Room or Trauma Bay (ED-TB) by staff, who determined whether the patient required admission or not. During this period, of the 5936 burn injury ED-TB encounters, there were 3754 (63%) admissions and 2182 (37%) ED-TB only (evaluation and discharge) visits. The median age was 30 years, and the %TBSA in the ED-TB only versus admitted patients was 1% vs 4% TBSA, P < .0001. Both groups had mainly scalding injuries in the kitchen. The majority of the ED-TB only patients presented with upper extremity burns (40%), whereas admitted patients had burns in multiple areas (49%). Most of the ED-TB only patients (73%) came to the hospital themselves, 23% were transferred from other hospitals, and 2% each, direct from the scene and clinic. In contrast, 53% of admitted patients were transferred from other hospitals, 29% came in on their own, and 11% were brought in direct from the scene, or from the burn clinic (7%), P = .0001. This review suggests that the main reason for non-admission of ED-TB only patients was the severity of injury; ED-TB only patients had a significantly less severe %TBSA (P < .0001), and fewer comorbidities compared to admitted patients.
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Hardwicke J, Bechar J, Bella H, Moiemen N. Cutaneous chemical burns in children – A comparative study. Burns 2013; 39:1626-30. [DOI: 10.1016/j.burns.2013.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Revised: 04/10/2013] [Accepted: 04/11/2013] [Indexed: 11/25/2022]
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Treatment of the burn patient in primary care. Nurse Pract 2010; 35:24-31; quiz 31-2. [PMID: 20644448 DOI: 10.1097/01.npr.0000383946.64100.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Dysregulated wound healing and pathologic fibrosis cause abnormal scarring, leading to poor functional and aesthetic results in hand burns. Understanding the underlying biologic mechanisms involved allows the hand surgeon to better address these issues, and suggests new avenues of research to improve patient outcomes. In this article, the authors review the biology of scar and contracture by focusing on potential causes of abnormal wound healing, including depth of injury, cytokines, cells, the immune system, and extracellular matrix, and explore therapeutic measures designed to target the various biologic causes of poor scar.
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Affiliation(s)
- Peter Kwan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, 2D2.28 WMC, University of Alberta, 8440-112 Street, Edmonton, AB T6G 2B7, Canada
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