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Pisano C, Fabia R, Shi J, Wheeler K, Giles S, Puett L, Stewart D, Ziegfeld S, Flint J, Miller J, Aguayo P, Alberto EC, Burd RS, Vitale L, Klein J, Thakkar RK. Variation in acute fluid resuscitation among pediatric burn centers. Burns 2020; 47:545-550. [PMID: 33707085 DOI: 10.1016/j.burns.2020.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/22/2019] [Revised: 02/13/2020] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Accurate resuscitation of pediatric patients with large thermal injury is critical to achieving optimal outcomes. The goal of this project was to describe the degree of variability in resuscitation guidelines among pediatric burn centers and the impact on fluid estimates. METHODS Five pediatric burn centers in the Pediatric Injury Quality Improvement Collaborative (PIQIC) contributed data from patients with ≥15% total body surface area (TBSA) burns treated from 2014 to 2018. Each center's resuscitation guidelines and guidelines from the American Burn Association were used to calculate estimated 24-h fluid requirements and compare these values to the actual fluid received. RESULTS Differences in the TBSA burn at which fluid resuscitation was initiated, coefficients related to the Parkland formula, criteria to initiate dextrose containing fluids, and urine output goals were observed. Three of the five centers' resuscitation guidelines produced statistically significant lower mean fluid estimates when compared with the actual mean fluid received for all patients across centers (4.53 versus 6.35ml/kg/% TBSA, p<0.001), (4.90 versus 6.35ml/kg/TBSA, p=0.002) and (3.38 versus 6.35ml/kg/TBSA, p<0.0001). CONCLUSIONS This variation in practice patterns led to statistically significant differences in fluid estimates. One center chose to modify its resuscitation guidelines at the conclusion of this study.
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Affiliation(s)
- Courtney Pisano
- Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States.
| | - Renata Fabia
- Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States; Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States; The Ohio State University College of Medicine, 370W 9th Ave, Columbus, OH 43210, United States.
| | - Junxin Shi
- Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States; Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States.
| | - Krista Wheeler
- Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States; Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States.
| | - Sheila Giles
- Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States; Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States.
| | - Lisa Puett
- Department of Pediatric Surgery, Johns Hopkins Children's Center, 1800 Orleans Street, Baltimore, MD 21287, United States.
| | - Dylan Stewart
- Department of Pediatric Surgery, Johns Hopkins Children's Center, 1800 Orleans Street, Baltimore, MD 21287, United States.
| | - Susan Ziegfeld
- Department of Pediatric Surgery, Johns Hopkins Children's Center, 1800 Orleans Street, Baltimore, MD 21287, United States.
| | - Jennifer Flint
- Department of Pediatric Surgery, Children's Mercy Hospitals and Clinics, 2401 Gillham Road, Kansas City, MO 64108, United States.
| | - Jenna Miller
- Department of Pediatric Surgery, Children's Mercy Hospitals and Clinics, 2401 Gillham Road, Kansas City, MO 64108, United States.
| | - Pablo Aguayo
- Department of Pediatric Surgery, Children's Mercy Hospitals and Clinics, 2401 Gillham Road, Kansas City, MO 64108, United States.
| | - Emily C Alberto
- Division Trauma and Burn Surgery, Center for Surgical Care, Children's National Medical Center, 111 Michigan Ave, Washington, DC 20010Alb, United States.
| | - Randall S Burd
- Division Trauma and Burn Surgery, Center for Surgical Care, Children's National Medical Center, 111 Michigan Ave, Washington, DC 20010Alb, United States.
| | - Lisa Vitale
- Department of Pediatric Surgery, Children's Hospital of Michigan, Detroit Medical Center, 3901 Beaubien Blvd, Detroit MI 48201, United States.
| | - Justin Klein
- Department of Pediatric Surgery, Children's Hospital of Michigan, Detroit Medical Center, 3901 Beaubien Blvd, Detroit MI 48201, United States.
| | - Rajan K Thakkar
- Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States; Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States; The Ohio State University College of Medicine, 370W 9th Ave, Columbus, OH 43210, United States.
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