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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Boissin C. Clinical decision-support for acute burn referral and triage at specialized centres - Contribution from routine and digital health tools. Glob Health Action 2022; 15:2067389. [PMID: 35762795 PMCID: PMC9246103 DOI: 10.1080/16549716.2022.2067389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Specialized care is crucial for severe burn injuries whereas minor burns should be handled at point-of-care. Misdiagnosis is common which leads to overburdening the system and to a lack of treatment for others due to resources shortage. OBJECTIVES The overarching aim was to evaluate four decision-support tools for diagnosis, referral, and triage of acute burns injuries in South Africa and Sweden: referral criteria, mortality prediction scores, image-based remote consultation and automated diagnosis. METHODS Study I retrospectively assessed adherence to referral criteria of 1165 patients admitted to the paediatric burns centre of the Western Cape of South Africa. Study II assessed mortality prediction of 372 patients admitted to the adults burns centre by evaluating an existing score (ABSI), and by using logistic regression. In study III, an online survey was used to assess the diagnostic accuracy of burn experts' image-based estimations using their smartphone or tablet. In study IV, two deep-learning algorithms were developed using 1105 acute burn images in order to identify the burn, and to classify burn depth. RESULTS Adherence to referral criteria was of 93.4%, and the age and severity criteria were associated with patient care. In adults, the ABSI score was a good predictor of mortality which affected a fifth of the patients and which was associated with gender, burn size and referral status. Experts were able to diagnose burn size, and burn depth using handheld devices. Finally, both a wound identifier and a depth classifier algorithm could be developed with relatively high accuracy. CONCLUSIONS Altogether the findings inform on the use of four tools along the care trajectory of patients with acute burns by assisting with the diagnosis, referral and triage from point-of-care to burns centres. This will assist with reducing inequities by improving access to the most appropriate care for patients.
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Affiliation(s)
- Constance Boissin
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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3
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Keating EM, Sakita F, Mmbaga BT, Nkini G, Amiri I, Tsosie C, Fino N, Watt MH, Staton CA. A cohort of pediatric injury patients from a hospital-based trauma registry in Northern Tanzania. Afr J Emerg Med 2022; 12:208-215. [PMID: 35719184 PMCID: PMC9188958 DOI: 10.1016/j.afjem.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 11/09/2022] Open
Abstract
Introduction Pediatric injuries in low- and middle-income countries are a leading cause of morbidity and mortality worldwide. Implementing hospital-based trauma registries can reduce the knowledge gap in both hospital care and patient outcomes and lead to quality improvement initiatives. The goal of this study was to create a pediatric trauma registry to provide insight into the epidemiology, outcomes, and factors associated with poor outcomes in injured children. Methods This was a prospective observational study in which a pediatric trauma registry was implemented at a large zonal referral hospital in Northern Tanzania. Data included demographics, hospital-based care, and outcomes including morbidity and mortality. Data were input into REDCap© and analyzed using ANOVA and Chi-squared tests in SAS(Version 9.4)©. Results 365 patients were enrolled in the registry from November 2020 to October 2021. The majority were males (n=240, 65.8%). Most were children 0-5 years (41.7%, n=152), 34.5% (n=126) were 6-11 years, and 23.8% (n=87) were 12-17 years. The leading causes of pediatric injuries were falls (n=137, 37.5%) and road traffic injuries (n=125, 34.5%). The mortality rate was 8.2% (n=30). Of the in-hospital deaths, 43.3% were children with burn injuries who also had a higher odds of mortality than children with other injuries (OR 8.72, p<0.001). The factors associated with in-hospital mortality and morbidity were vital sign abnormalities, burn severity, abnormal Glasgow Coma Score, and ICU admission. Conclusion The mortality rate of injured children in our cohort was high, especially in children with burn injuries. In order to reduce morbidity and mortality, interventions should be prioritized that focus on pediatric injured patients that present with abnormal vital signs, altered mental status, and severe burns. These findings highlight the need for health system capacity building to improve outcomes of pediatric injury patients in Northern Tanzania.
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Affiliation(s)
- Elizabeth M. Keating
- Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Utah, Salt Lake City, UT, USA
| | - Francis Sakita
- Kilimanjaro Christian Medical Centre, Box 3010, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Box 2240, Moshi, Tanzania
| | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical Centre, Box 3010, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Box 2240, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Box 2236, Moshi, Tanzania
| | - Getrude Nkini
- Kilimanjaro Christian Medical Centre, Box 3010, Moshi, Tanzania
| | - Ismail Amiri
- Kilimanjaro Christian Medical Centre, Box 3010, Moshi, Tanzania
| | - Chermiqua Tsosie
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Nora Fino
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Melissa H. Watt
- Department of Population Health Sciences, Salt Lake City, University of Utah, UT, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Catherine A. Staton
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Surgery, Division of Emergency Medicine, Duke University Medical Center, Durham, NC, USA
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Duke University Medical Center, Durham, NC, USA
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4
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Armstrong M, Lun J, Groner JI, Thakkar RK, Fabia R, Noffsinger D, Ni A, Keesari R, Xiang H. Mobile phone virtual reality game for pediatric home burn dressing pain management: a randomized feasibility clinical trial. Pilot Feasibility Stud 2022; 8:186. [PMID: 35982492 PMCID: PMC9386208 DOI: 10.1186/s40814-022-01150-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 08/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Virtual reality (VR) gaming is considered a safe and effective alternative to standard pain alleviation in the hospital. This study addressed the potential effectiveness and feasibility of a VR game that was developed by our research team for repeated at-home burn dressing changes. METHODS A randomized clinical trial was conducted among patients recruited from the outpatient burn clinic of a large American Burn Association-verified pediatric burn center between September 2019 and June 2021. We included English-speaking burn patients aged 5-17 years old requiring daily dressing changes for at least 1 week after first outpatient dressing change. One group played an interactive VR game during dressing changes, while the other utilized standard distraction techniques available in the home for up to a week. Both child and caretaker were asked to assess perceived pain on a numerical rating scale (NRS) of 0-10. For the VR group, patients were also asked to rate various aspects of the VR game on a NRS of 0-10 and caregivers were asked questions assessing ease of use. RESULTS A total of 35 children were recruited for this study with 24 fully completing study measures. The majority of participants were male (n=19, 54.3%), White (n=29, 82.9%), and with second degree burns (n=32, 91.4%). Children and caregivers in the VR group reported less pain than the control group at the 4th dressing change. Participants in the VR group showed a clinically meaningful (≥30%) reduction in child-reported overall pain (33.3%) and caregiver-reported worst pain (31.6%) in comparison with subjects in the control group. Children's satisfaction with the VR remained at a high level across dressing changes over the 1-week period, with reported realism and engagement increasing over time. Over half of the children (54.5%) enjoyed playing the game and did not report any challenges nor any side effects. CONCLUSIONS Subjects found the VR to be a useful distraction during home dressing changes and reported no challenges/side effects. VR should be considered as a nonpharmacologic companion for pain management during at-home burn dressing changes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04548635. Registered September 14, 2020-retrospectively registered.
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Affiliation(s)
- Megan Armstrong
- Center for Pediatric Trauma Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Jonathan Lun
- Center for Pediatric Trauma Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- College of Medicine, The Ohio State University, 370 West 9th Avenue, Columbus, OH, 43210, USA
| | - Jonathan I Groner
- Center for Pediatric Trauma Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Department of Pediatrics, The Ohio State University, 370 West 9th Avenue, Columbus, OH, 43210, USA
| | - Rajan K Thakkar
- Center for Pediatric Trauma Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Department of Pediatrics, The Ohio State University, 370 West 9th Avenue, Columbus, OH, 43210, USA
| | - Renata Fabia
- Center for Pediatric Trauma Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Department of Pediatrics, The Ohio State University, 370 West 9th Avenue, Columbus, OH, 43210, USA
| | - Dana Noffsinger
- Center for Pediatric Trauma Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Ai Ni
- Division of Biostatistics, The Ohio State University College of Public Health, 1841 Neil Avenue, Columbus, OH, 43210, USA
| | - Rohali Keesari
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Road, Atlanta, GA, 30322, USA
| | - Henry Xiang
- Center for Pediatric Trauma Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
- Department of Pediatrics, The Ohio State University, 370 West 9th Avenue, Columbus, OH, 43210, USA.
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Evans CS, Hart K, Self WH, Nikpay S, Thompson CM, Ward MJ. Burn related injuries: a nationwide analysis of adult inter-facility transfers over a six-year period in the United States. BMC Emerg Med 2022; 22:147. [PMID: 35974305 PMCID: PMC9380358 DOI: 10.1186/s12873-022-00705-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 08/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background US emergency department (ED) visits for burns and factors associated with inter-facility transfer are unknown and described in this manuscript. Methods We conducted a retrospective analysis of burn-related injuries from 2009–2014 using the Nationwide Emergency Department Sample (NEDS), the largest sample of all-payer datasets. We included all ED visits by adults with a burn related ICD-9 code and used a weighted multivariable logistic regression model to predict transfer adjusting for covariates. Results Between 2009–2014, 3,047,701 (0.4%) ED visits were for burn related injuries. A total of 108,583 (3.6%) burn visits resulted in inter-facility transfers occurred during the study period, representing approximately 18,097 inter-facility transfers per year. Burns with greater than 10% total body surface area (TBSA) resulted in a 10-fold increase in the probability of transfer, compared to burn visits with less than 10% TBSA burns. In the multivariable model, male sex (adjusted odds ratio [aOR] 2.4, 95% CI 2.3–2.6) was associated with increased odds of transfer. Older adults were more likely to be transferred compared to all other age groups. Odds of transfer were increased for Medicare and self-pay patients (vs. private pay) but there was a significant interaction of sex and payer and the effect of insurance varied by sex. Conclusions In a national sample of ED visits, burn visits were more than twice as likely to have an inter-facility transfer compared to the general ED patient population. Substantial sex differences exist in U.S. EDs that impact the location of care for patients with burn injuries and warrants further investigation. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-022-00705-6.
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Affiliation(s)
- Christopher S Evans
- Information Services, ECU Health, Greenville, NC, USA.,Department of Emergency Medicine, East Carolina University, Greenville, NC, USA
| | - Kimberly Hart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Wesley H Self
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sayeh Nikpay
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | | | - Michael J Ward
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. .,VA Tennessee Valley Healthcare System, 1313 21st Ave South; Oxford House 312, Nashville, TN, 37232, USA.
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6
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Han D, Wei Y, Li Y, Zha X, Li R, Xia C, Li Y, Yang H, Xie J, Tian S. Epidemiological and Clinical Characteristics of 5,569 Pediatric Burns in Central China From 2013 to 2019. Front Public Health 2022; 10:751615. [PMID: 35425744 PMCID: PMC9001893 DOI: 10.3389/fpubh.2022.751615] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 03/03/2022] [Indexed: 11/21/2022] Open
Abstract
Background Pediatric burns of all the ages are prevalent worldwide, posing a severe health risk to children. This study aims to examine pediatric burns' clinical characteristics and epidemiology in central China. Methods The pediatric patients of the Burn Research Center, Department of the First People's Hospital of Zhengzhou City from 2013 to 2019 were retrospectively studied and the relevant data were collected from the hospitalized medical records [e.g., demographic, etiology, length of stay (LOS), age, gender, burn area and depth, number of surgeries, cost, and outcome]. Results A total of 5,569 pediatric burn patients were included, accounting for 43.9% of the total burn population. Electric burns represented a relatively small proportion (1.17%) but were more likely to lead to disabilities or death than scalds (90.63%) and flames (5.12%). The median age was 2 years [interquartile range (IQR): 1–4] and the boys/girls ratio ranged from 1.3:1 to 1.6:1. The most commonly burnt anatomic sites were the limbs (38.3%), with a median %TBSA (total body surface area) of 6 (IQR: 4–10). The complications of shock and pneumonia accounted for 7.6 and 19.2%, respectively. The peak months of pediatric burns included January, May, and August and the rural/urban ratio reached 1.61:1. The percentage of burn wounds treated surgically increased considerably from 2013 to 2019 (3.8 vs. 37.8%). The median hospital LOS was 15 days (IQR: 8–28 days), with the three high-risk factors (e.g., more surgeries, more %TBSA, full-thickness skin burns). The median cost of hospitalization was 1,511 USD (IQR: 848–2,648 USD) and the main risk factors consisted of full-thickness burns, more %TBSA, longer LOS, and more surgical procedures. Among all the patients, LA50 was 78.63% (95% CI = 75.12–83.45) and the overall mortality reached 0.1% since seven deaths were recorded. Conclusion Scalds, flames, contact, and chemicals are the main causes of burns among children aged 1–5 years in central China. Accordingly, various prevention strategies should be employed depending upon the cause of the burn.
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Affiliation(s)
- Dawei Han
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou, China
| | - Ying Wei
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou, China
| | - Yancang Li
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou, China
| | - Xinjian Zha
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou, China
| | - Rui Li
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chengde Xia
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou, China
| | - Yun Li
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou, China
| | - Huanna Yang
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou, China
| | - Jiangfan Xie
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou, China
| | - Shemin Tian
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou, China
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7
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Jordan KC, Di Gennaro JL, von Saint André-von Arnim A, Stewart BT. Global trends in pediatric burn injuries and care capacity from the World Health Organization Global Burn Registry. Front Pediatr 2022; 10:954995. [PMID: 35928690 PMCID: PMC9343701 DOI: 10.3389/fped.2022.954995] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 06/27/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Burn injuries are a major cause of death and disability globally. The World Health Organization (WHO) launched the Global Burn Registry (GBR) to improve understanding of burn injuries worldwide, identify prevention targets, and benchmark acute care. We aimed to describe the epidemiology, risk factors, and outcomes of children with burns to demonstrate the GBR's utility and inform needs for pediatric burn prevention and treatment. METHODS We performed descriptive analyses of children age ≤ 18 years in the WHO GBR. We also described facility-level capacity. Data were extracted in September of 2021. RESULTS There were 8,640 pediatric and adult entries from 20 countries. Of these, 3,649 (42%) were children (0-18 years old) from predominantly middle-income countries. The mean age was 5.3 years and 60% were boys. Children aged 1-5 years comprised 62% (n = 2,279) of the cohort and mainly presented with scald burns (80%), followed by flame burns (14%). Children >5 years (n = 1,219) more frequently sustained flame burns (52%) followed by scald burns (29%). More than half of pediatric patients (52%) sustained a major burn (≥15% total body surface area) and 48% received surgery for wound closure during the index hospitalization. Older children had more severe injuries and required more surgery. Despite the frequency of severe injuries, critical care capacity was reported as "limited" for 23% of pediatric patients. CONCLUSIONS Children represent a large proportion of people with burn injuries globally and often sustain major injuries that require critical and surgical intervention. However, critical care capacity is limited at contributing centers and should be a priority for healthcare system development to avert preventable death and disability. This analysis demonstrates that the GBR has the potential to highlight key epidemiological characteristics and hospital capacity for pediatric burn patients. To improve global burn care, addressing barriers to GBR participation in low- and low-middle-income countries would allow for greater representation from a diversity of countries, regions, and burn care facilities.
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Affiliation(s)
- Kelly C Jordan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, United States
| | - Jane L Di Gennaro
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, United States
| | - Amélie von Saint André-von Arnim
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
| | - Barclay T Stewart
- Division of Trauma, Burn, and Critical Care Surgery, Department of Surgery, University of Washington, Seattle, WA, United States
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8
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Sorenson TJ, Mohr WJ, Mahajan AY. Pediatric Hand Burns Requiring Emergency Care in the United States. J Burn Care Res 2021; 44:704-708. [PMID: 34297093 DOI: 10.1093/jbcr/irab144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Indexed: 11/12/2022]
Abstract
PURPOSE Hand and finger burns represent a relatively common occurrence in children, and serious injuries may require surgical intervention to prevent long-term disability. This study examines the epidemiological characteristics of pediatric patients presenting for emergency care of hand and finger burns within the United States (US). METHODS We report a cross-sectional study of patients reported to the National Electronic Injury Surveillance System (NEISS) from January 1, 2010 to December 31, 2019. Patients were included in our study if they were younger than 18 years old and evaluated for an isolated hand or finger burn. United States census data from the same period were utilized for determining epidemiological estimates of injury incidence. RESULTS During the 10-year study period, an estimated 300,245 pediatric hand and finger burns were treated in 778,497,380 person-years: an incidence rate of 38.6 burns per 100,000 person years. Most treated burns occurred in the 1- to 2-year age group (28.3%) with an approximate 50% reduction in incidence for each 1-year age stratum until stabilizing at 6 years. Most burns occurred in white children (58%), but Black children had a higher incidence than white children when corrected for US population (45.15 burns versus 21.45 burns per 100,000 person-years). The most common etiology was a stove or oven (1595/10420; 15%). CONCLUSIONS Pediatric hand and finger burns occurred most frequently in young children from the oven and/or stove. We urge that parents be assertively counseled about potential burn risks to their young children's hands and fingers, especially once they reach ambulatory age.
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Affiliation(s)
- Thomas J Sorenson
- Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - William J Mohr
- Department of Critical Care and Burn Surgery, Regions Hospital, Saint Paul, Minnesota, USA
| | - Ashish Y Mahajan
- Department of Plastic Surgery, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Plastic Surgery, Regions Hospital, Saint Paul, Minnesota, USA
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Abstract
Patients with burn injuries are often initially transported to centers without burn capabilities, requiring subsequent transfer to a higher level of care. This study aimed to evaluate the effect of this treatment delay on outcomes. Adult burn patients meeting American Burn Association (ABA) criteria for transfer at a single burn center were retrospectively identified. A total of 122 patients were evenly divided into two cohorts - those directly admitted to a burn center from the field, versus those transferred to a burn center from an outlying facility. There was no difference between the transfer and direct admit cohorts with respect to age, percent total body surface area burned, concomitant injury, or intubation prior to admission. Transfer patients experienced a longer median time from injury to burn center admission (1 vs. 8 hours, p <, 0.01). Directly admitted patients were more likely to have inhalation burn (18 vs. 4, p <, 0.01), require intubation after admission (10 vs. 2, p = 0.03), require an emergent procedure (18 vs. 5, p <, 0.01), and develop infectious complications (14 vs. 5, p = 0.04). There was no difference in ventilator days, number of operations, length of stay, or mortality. The results suggest that significantly injured, high acuity burn patients were more likely to be immediately identified and taken directly to a burn center. Patients who otherwise met ABA criteria for transfer were not affected by short delays in transfer to definitive burn care.
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Affiliation(s)
- Nathan E Bodily
- Department of Surgery, University of Louisville, Louisville, KY
| | | | - Neal Bhutiani
- Department of Surgery, University of Louisville, Louisville, KY
| | - Selena The
- Department of Surgery, University of Louisville, Louisville, KY
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10
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Huang Z, Forst L, Friedman LS. Burn Center Referral Practice Evaluation and Treatment Outcomes Comparison Among Verified, Nonverified Burn Centers, and Nonburn Centers: A Statewide Perspective. J Burn Care Res 2021; 42:439-447. [PMID: 33022054 DOI: 10.1093/jbcr/iraa167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The American Burn Association (ABA) has developed comprehensive referral criteria to determine which burn-injured patient should be transferred to burn centers. This was a retrospective analysis of burn injuries using Illinois inpatient and outpatient hospital data from 2010 to 2015. Multivariable logistic and linear regression models were developed to evaluate ABA burn center referral criteria adherence and to compare treatment outcomes among those treated in verified burn center (VB), nonverified burn center (NVB), and other facilities (OF). In this study, 66% of those treated in facilities without specialized burn teams met the ABA referral criteria. Patients who were older than the age of 40 years, lived farther from burn units, and were originally treated in level I trauma center without burn units were less likely to be transferred to burn centers. Those transported and treated in burn centers had overall better treatment outcomes including fewer infection complications (VB vs OF: adjusted odds ratio [aOR]: 0.5, 95% confidence interval [CI]: 0.4-0.6; NVB vs OF: aOR: 0.5, 95% CI: 0.4-0.6), fewer patients requiring additional care in skilled nursing/rehabilitation facilities (VB vs OF: aOR: 0.5, 95% CI: 0.4-0.6; NVB vs OF: aOR: 0.7, 95% CI: 0.6-0.9), shorter length of hospitalization (VB vs OF: β: -0.4, P < .001; NVB vs OF: β: -0.8, P < .001), and comparable in-hospital mortality (VB vs OF: aOR: 1.3, 95% CI: 0.97-1.7; NVB vs OF: aOR: 1.01, 95% CI: 0.7-1.5). While verified and unverified burn centers demonstrated better treatment outcomes, the data demonstrated a need to understand the barriers of adhering to ABA criteria and an improved regional burn center referral guidelines education.
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Affiliation(s)
- Zhenna Huang
- School of Public Health, University of Illinois at Chicago
| | - Linda Forst
- School of Public Health, University of Illinois at Chicago
| | - Lee S Friedman
- School of Public Health, University of Illinois at Chicago
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11
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Patterson KN, Fabia R, Giles S, Verlee SN, Marx D, Aguayo P, Ziegfeld S, Parrish C, Stewart FD, Fritzeen J, Burd RS, Vitale L, Cloutier D, Shanti C, Klein J, Thakkar RK. Defining Benchmarks in Pediatric Burn Care: Inception of the Pediatric Injury Quality Improvement Collaborative (PIQIC). J Burn Care Res 2021; 43:277-280. [PMID: 33677547 DOI: 10.1093/jbcr/irab048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Pediatric burn care is highly variable nationwide. Standardized quality and performance benchmarks are needed for guiding performance improvement within pediatric burn centers. A network of pediatric burn centers was established to develop and evaluate pediatric-specific best practices. A multi-disciplinary team including pediatric surgeons, nurses, advanced practice providers, pediatric intensivists, rehabilitation staff, and child psychologists from five pediatric burn centers established a collaborative to share and compare performance improvement data, evaluate outcomes, and exchange best care practices. In December 2016, the Pediatric Injury Quality Improvement Collaborative (PIQIC) was established. PIQIC members chose quality improvement indicators, drafted and approved a memorandum of understanding (MOU), data use agreement (DUA) and charter, formalized the multidisciplinary membership, and established a steering committee. Since inception, PIQIC has conducted monthly teleconferences and biannual in-person or virtual group meetings. A centralized data repository has been established where data is collated and analyzed for benchmarking in a blinded fashion. PIQIC has shown the feasibility of multi-institutional data collection, implementation of performance improvement metrics, publication of research, and enhancement of aggregate and institution-specific pediatric burn care.
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Affiliation(s)
- Kelli N Patterson
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Renata Fabia
- Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH.,Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Sheila Giles
- Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Sarah N Verlee
- Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Daniel Marx
- Department of Pediatric Surgery, Children's Mercy Hospitals and Clinics, Kansas City, MO
| | - Pablo Aguayo
- Department of Pediatric Surgery, Children's Mercy Hospitals and Clinics, Kansas City, MO
| | - Susan Ziegfeld
- Department of Pediatric Surgery, Johns Hopkins Children's Center, Baltimore, MD
| | - Carisa Parrish
- Department of Pediatric Surgery, Johns Hopkins Children's Center, Baltimore, MD
| | - F Dylan Stewart
- Department of Pediatric Surgery, Johns Hopkins Children's Center, Baltimore, MD
| | - Jennifer Fritzeen
- Division Trauma and Burn Surgery, Children's National Hospital, Washington, DC
| | - Randall S Burd
- Division Trauma and Burn Surgery, Children's National Hospital, Washington, DC
| | - Lisa Vitale
- Department of Pediatric Surgery, Children's Hospital of Michigan, Detroit Medical Center, Detroit MI
| | - Dawn Cloutier
- Department of Pediatric Surgery, Children's Hospital of Michigan, Detroit Medical Center, Detroit MI
| | - Christina Shanti
- Department of Pediatric Surgery, Children's Hospital of Michigan, Detroit Medical Center, Detroit MI
| | - Justin Klein
- Department of Pediatric Surgery, Children's Hospital of Michigan, Detroit Medical Center, Detroit MI
| | - Rajan K Thakkar
- Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH.,Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH
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12
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Dolan KJ, Flint JL, Benton TC, Miller M, Miller JO. Implementation and Maintenance of a Pediatric Severe Burn Guidelines Quality Improvement Project. Pediatr Qual Saf 2021; 6:e388. [PMID: 38571517 PMCID: PMC10990325 DOI: 10.1097/pq9.0000000000000388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/26/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction Critically injured pediatric burn patients require specialized management, yet few verified pediatric burn centers exist in the United States. Many pediatric hospitals have resources to care for severely burned patients but lack standardized care guidelines, which improve outcomes. To improve the morbidity and mortality of severely burned pediatric patients admitted to the pediatric intensive care unit, we created a specialized burn team. We implemented Pediatric Severe Burn Guidelines, focusing on improving fluid resuscitation accuracy and providing timely nutritional support. Methods This investigation is of a 9-year (2010-2019) retrospective preintervention and postintervention study of the effect of the formation of a multidisciplinary burn leadership committee and development and implementation of Pediatric Severe Burn Guidelines. The primary outcome measures are increasing the accuracy of fluid resuscitation and improving the timely administration of nutritional support. The process measure is the percentage of time the electronic health record power plan was used for burn admissions with burn leadership review of the cases. Balancing measures are pediatric intensive care unit and hospital length of stay. Results Preprotocol patients received acceptable fluid resuscitation 25% (5/20) of the time compared to 61.5% (8/13) of the time in postprotocol patients (P = 0.04). In postprotocol patients, there is an improvement in the timely placement of postpyloric feeding tube and initiation of feeds 48 hours after admission. Conclusions Extensive guidelines for standardized care require careful implementation and monitoring of adherence gaps. Creating a specialized burn team and implementing clinical guidelines standardize care leading to improvement in critical patient outcomes.
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Affiliation(s)
- Kristin J. Dolan
- From the Section of Critical Care Medicine, Texas Children’s Hospital, Baylor College of Medicine, Houston, Tex
| | - Jennifer L. Flint
- Department of Critical Care, Children’s Mercy Hospital, Kansas City, Mo
| | - Tara C. Benton
- Department of Critical Care, Children’s Mercy Hospital, Kansas City, Mo
| | - Mikaela Miller
- From the Section of Critical Care Medicine, Texas Children’s Hospital, Baylor College of Medicine, Houston, Tex
- Department of Critical Care, Children’s Mercy Hospital, Kansas City, Mo
- Constituent Understandings and Insights, Children International, Kansas City, Mo
| | - Jenna O. Miller
- Department of Critical Care, Children’s Mercy Hospital, Kansas City, Mo
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13
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Grote AC, Lacey AM, Garner WL, Gillenwater TJ, Maniago E, Yenikomshian HA. Small Pediatric Burns Can Be Safely Managed on an Outpatient Basis. J Burn Care Res 2020; 41:1029-1032. [PMID: 32652009 DOI: 10.1093/jbcr/iraa115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
American Burn Association (ABA) guidelines recommend that all pediatric burns be transferred to a burn center if their presenting hospital lacks the necessary personnel or equipment for their care. Our institution often treats small burns (<10% TBSA) in pediatric patients in an ambulatory setting with a nondaily dressing. The aim of this study was to determine whether small pediatric burns could be safely managed on an outpatient basis. A retrospective review at a single ABA-verified burn center was conducted, including 742 pediatric patients presenting to the burn evaluation clinic in a 3-year period. Postburn day, age, sex, TBSA, burn etiology, body area burned, burn dressing type, outpatient versus inpatient management, reason(s) for admission, and any operative intervention were collected. Overall, the most common burn etiologies were scald (68%), contact (20%), and flame (5%). In this cohort, 14% (101) of patients were admitted on evaluation to the burn center with a mean TBSA of 9%. The remaining 86% (641) of patients were treated outpatient with a mean TBSA of 3%. Of those who were treated outpatient, 96% (613) successfully completed outpatient care and 4% (28) were subsequently admitted. The patients who were successfully managed in an ambulatory setting had a mean TBSA of 3%, whereas the patients who failed outpatient care had a mean TBSA of 4%. The primary reason for the subsequent admission of these patients was nutrition optimization (61%). The vast majority of small pediatric burns can be effectively treated on an outpatient basis with a nondaily dressing.
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Affiliation(s)
| | | | - Warren L Garner
- Keck School of Medicine, Los Angeles, California.,LAC + USC Medical Center Burn Unit, Los Angeles, California
| | - Timothy Justin Gillenwater
- Keck School of Medicine, Los Angeles, California.,LAC + USC Medical Center Burn Unit, Los Angeles, California
| | - Ellen Maniago
- LAC + USC Medical Center Burn Unit, Los Angeles, California
| | - Haig A Yenikomshian
- Keck School of Medicine, Los Angeles, California.,LAC + USC Medical Center Burn Unit, Los Angeles, California
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14
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Bettencourt AP, Romanowski KS, Joe V, Jeng J, Carter JE, Cartotto R, Craig CK, Fabia R, Vercruysse GA, Hickerson WL, Liu Y, Ryan CM, Schulz JT. Updating the Burn Center Referral Criteria: Results From the 2018 eDelphi Consensus Study. J Burn Care Res 2020; 41:1052-1062. [PMID: 32123911 DOI: 10.1093/jbcr/iraa038] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Existing burn center referral criteria were developed several years ago, and subsequent innovations in burn care have occurred. Coupled with frequent errors in the estimation of extent of burn injury and depth by referring providers, patients are both over and under-triaged when the existing criteria are used to support patient care decisions. In the absence of compelling clinical trial data on appropriate burn patient triage, we convened a multidisciplinary panel of experts to execute an iterative eDelphi consensus process to facilitate a revision. The eDelphi process panel consisted of n = 61 burn stakeholders and experts and progressed through four rounds before reaching consensus on key clinical domains. The major findings are that 1) burn center consultation is strongly recommended for all patients with deep partial-thickness or deeper burns ≥ 10% TBSA burned, for full-thickness burns ≥ 5% TBSA burned, for children and older adults with specific dressing and medical needs, and for special burn circumstances including electrical, chemical, and radiation injuries; 2) smaller burns are ideally followed in burn center outpatient settings as soon as possible after injury, preferably without delays of a week or more; 3) frostbite, Stevens-Johnson syndrome/TENS, and necrotizing soft-tissue infection patients benefit from burn center treatment; and 4) telemedicine and technological solutions are of likely benefit in achieving this standard. Unlike the original criteria, the revised consensus-based guidelines create a framework promoting communication so that triage and treatment are specifically tailored to individual patient characteristics, injury severity, geography, and the capabilities of referring institutions.
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Affiliation(s)
- Amanda P Bettencourt
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor
| | - Kathleen S Romanowski
- Shriners Hospitals for Children Northern California, University of California, Davis, Sacramento
| | - Victor Joe
- UC Irvine Health Regional Burn Center, Division of Trauma, Burns, Critical Care, and Acute Care Surgery, Irvine, California
| | - James Jeng
- Crozer-Chester Medical Center, Upland, Pennsylvania
| | | | - Robert Cartotto
- Ross Tilley Burn Center, University of Toronto, Ontario, Canada
| | | | - Renata Fabia
- Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children Hospital, Columbus
| | | | | | - Yuk Liu
- Loyola University, Chicago, Illinois
| | - Colleen M Ryan
- Harvard Medical School, Boston, Massachusetts.,Shriners Hospitals for Children-Boston®, Massachusetts General Hospital, Boston
| | - John T Schulz
- Loyola University, Chicago, Illinois.,Sumner Redstone Burn Center, Massachusetts General Hospital, Boston
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15
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Manning Ryan L, Costabile P, Ziegfeld S, Puett L, Turner A, Strockbine V, Klein BL. Assessment of a quality improvement intervention to improve the consistency of total body surface area burn estimates between referring facilities and a pediatric burn center. Burns 2019; 45:1827-32. [DOI: 10.1016/j.burns.2019.07.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/14/2019] [Accepted: 07/18/2019] [Indexed: 11/22/2022]
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16
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Ewbank C, Sheckter CC, Warstadt NM, Pirrotta EA, Curtin C, Newton C, Wang NE. Variations in access to specialty care for children with severe burns. Am J Emerg Med 2019; 38:1146-1152. [PMID: 31474377 DOI: 10.1016/j.ajem.2019.158401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/09/2019] [Accepted: 08/18/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Pediatric burns account for 120,000 emergency department visits and 10,000 hospitalizations annually. The American Burn Association has guidelines regarding referrals to burn centers; however there is variation in burn center distribution. We hypothesized that disparity in access would be related to burn center access. METHODS Using weighted discharge data from the Nationwide Inpatient Sample 2001-2011, we identified pediatric patients with International Classification of Diseases-9th Revision codes for burns that also met American Burn Association criteria. Key characteristics were compared between pediatric patients treated at burn centers and those that were not. RESULTS Of 54,529 patients meeting criteria, 82.0% (n = 44,632) were treated at burn centers. Patients treated at burn centers were younger (5.6 versus 6.7 years old; p < 0.0001) and more likely to have burn injuries on multiple body regions (88% versus 12%; p < 0.0001). In urban areas, 84% of care was provided at burn centers versus 0% in rural areas (p < 0.0001), a difference attributable to the lack of burn centers in rural areas. Both length of stay and number of procedures were significantly higher for patients treated at burn centers (7.3 versus 4.4 days, p < 0.0001 and 2.3 versus 1.1 procedures, p < 0.0001; respectively). There were no significant differences in mortality (0.7% versus 0.8%, p = 0.692). CONCLUSION The majority of children who met criteria were treated at burn centers. There was no significant difference between geographical regions. Of those who were treated at burn centers, more severe injury patterns were noted, but there was no significant mortality difference. Further study of optimal referral of pediatric burn patients is needed.
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Affiliation(s)
- Clifton Ewbank
- University of California San Francisco East Bay Department of Surgery, Oakland, CA, United States of America; University of California San Francisco Benioff Children's Hospital Oakland, Oakland, CA, United States of America.
| | - Clifford C Sheckter
- Stanford University Department of Surgery, Stanford, CA, United States of America
| | - Nicholus M Warstadt
- Stanford University School of Medicine, Stanford, CA, United States of America
| | | | - Catherine Curtin
- Stanford University Department of Surgery, Stanford, CA, United States of America
| | - Christopher Newton
- University of California San Francisco Benioff Children's Hospital Oakland, Oakland, CA, United States of America
| | - N Ewen Wang
- Stanford University Department of Emergency Medicine, Stanford, CA, United States of America
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17
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Anderson KT, Bartz-Kurycki MA, Garwood GM, Martin R, Gutierrez R, Supak DN, Wythe SN, Kawaguchi AL, Austin MT, Huzar TF, Tsao K. Let the right one in: High admission rate for low-acuity pediatric burns. Surgery 2019; 165:360-364. [DOI: 10.1016/j.surg.2018.06.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/11/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022]
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18
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Sheckter CC, Kiwanuka H, Maan Z, Pirrotta E, Curtin C, Wang NE. Increasing ambulatory treatment of pediatric minor burns—The emerging paradigm for burn care in children. Burns 2019; 45:165-72. [DOI: 10.1016/j.burns.2018.08.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/10/2018] [Accepted: 08/30/2018] [Indexed: 11/18/2022]
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19
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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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20
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Thakkar RK, Diltz Z, Drews JD, Wheeler KK, Shi J, Devine R, Fabia R, Hall M. Abnormal lymphocyte response after pediatric thermal injury is associated with adverse outcomes. J Surg Res 2018; 228:221-227. [PMID: 29907215 DOI: 10.1016/j.jss.2018.03.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 02/07/2018] [Accepted: 03/15/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Burns are a leading cause of morbidity in children, with infections representing the most common group of complications. Severe thermal injuries are associated with a profound inflammatory response, but the utility of laboratory values to predict infections in pediatric burn patients is poorly understood. MATERIALS AND METHODS Our institutional burn database was queried for patients aged 18 y and younger with at least 10% total body surface area burns. Demographics, mechanism, laboratory results, and outcomes were extracted from the medical record. Patients were classified as having an abnormal or normal total white blood cell count, neutrophil percentage, and lymphocyte percentage using the first complete blood count drawn 72 or more hours postinjury. Outcomes were compared between groups. RESULTS White blood cell data were available for 90 patients, 84 of whom had neutrophil and lymphocyte percentages. Abnormal lymphocyte percentage 72 h or more after burn injury was associated with a significant increase in infections (67.9% versus 32.3%, P = 0.003), length of stay (33.1 versus 18.8 d, P = 0.02), intensive care unit length of stay (13.1 versus 3.7 days, P = 0.01), and ventilator days (5.8 versus 2.3, P = 0.02). It was also an independent predictor of infection (odds ratio 7.2, 95% confidence interval 2.1-24.5). CONCLUSIONS Abnormal lymphocyte percentage at or after 72 h after burn injury is associated with adverse outcomes, including increased infectious risk.
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Affiliation(s)
- Rajan K Thakkar
- The Ohio State University College of Medicine, Columbus, Ohio; Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatric Surgery, Burn Center, Nationwide Children's Hospital, Columbus, Ohio; Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
| | - Zachary Diltz
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Joseph D Drews
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Krista K Wheeler
- Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Junxin Shi
- Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Racheal Devine
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Renata Fabia
- The Ohio State University College of Medicine, Columbus, Ohio; Department of Pediatric Surgery, Burn Center, Nationwide Children's Hospital, Columbus, Ohio; Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Mark Hall
- The Ohio State University College of Medicine, Columbus, Ohio; Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, Ohio
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21
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Wheeler KK, Shi J, Xiang H, Thakkar RK, Groner JI. US pediatric trauma patient unplanned 30-day readmissions. J Pediatr Surg 2018; 53:765-770. [PMID: 28844536 PMCID: PMC5803463 DOI: 10.1016/j.jpedsurg.2017.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/22/2017] [Accepted: 08/01/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE We sought to determine readmission rates and risk factors for acutely injured pediatric trauma patients. METHODS We produced 30-day unplanned readmission rates for pediatric trauma patients using the 2013 National Readmission Database (NRD). RESULTS In US pediatric trauma patients, 1.7% had unplanned readmissions within 30days. The readmission rate for patients with index operating room procedures was no higher at 1.8%. Higher readmission rates were seen in patients with injury severity scores (ISS)=16-24 (3.4%) and ISS ≥25 (4.9%). Higher rates were also seen in patients with LOS beyond a week, severe abdominal and pelvic region injuries (3.0%), crushing (2.8%) and firearm injuries (4.5%), and in patients with fluid and electrolyte disorders (3.9%). The most common readmission principal diagnoses were injury, musculoskeletal/integumentary diagnoses and infection. Nearly 39% of readmitted patients required readmission operative procedures. Most common were operations on the musculoskeletal system (23.9% of all readmitted patients), the integumentary system (8.6%), the nervous system (6.6%), and digestive system (2.5%). CONCLUSIONS Overall, the readmission rate for pediatric trauma patients was low. Measures of injury severity, specifically length of stay, were most useful in identifying those who would benefit from targeted care coordination resources. LEVEL OF EVIDENCE This is a Level III retrospective comparative study.
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Affiliation(s)
- Krista K. Wheeler
- Center for Pediatric Trauma Research, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH, 43205,Center for Injury Research and Policy, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH, 43205
| | - Junxin Shi
- Center for Pediatric Trauma Research, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH, 43205,Center for Injury Research and Policy, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH, 43205
| | - Henry Xiang
- Center for Pediatric Trauma Research, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH, 43205,Center for Injury Research and Policy, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH, 43205,The Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210
| | - Rajan K. Thakkar
- Center for Pediatric Trauma Research, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH, 43205,The Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210,Department of Pediatric Surgery, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH, 43205
| | - Jonathan I. Groner
- Center for Pediatric Trauma Research, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH, 43205,The Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210,Department of Pediatric Surgery, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH, 43205
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