Investigation of morbidity, length of stay, and healthcare costs of inpatient paediatric burns

Burn injuries are the third most common cause of death in children due to trauma. Hospitalizations related to burn injuries are common. Prolonged hospitalization associated with burn treatment can result in increased resource utilization, leading to higher costs. Thus, it is essential to investigate these areas to reduce costs. The study investigated the morbidity and length of hospital stay of paediatric burn patients, as well as calculated the social security costs of hospitalization and treatment. The retrospective observational descriptive study examined the medical records of 774 paediatric patients treated in a burn intensive care unit at a tertiary medical faculty hospital between 01 March 2019 and 31 March 2022. The invoice records of payments made by the Social Security Institution to the hospital in return for health services provided to patients were examined. The healthcare costs were calculated. A total of 57.6% of the participants were boys and 79.2% were between the ages of 1-4. About 90% of the cases involved burns with a total body surface area (TBSA) of less than 20% and a 2nd-degree burn depth. Scalding was the most common cause of burns (88.2%). Among all patients, the mortality rate was 2.1% (n = 16). The mean length of hospital stay was 10.29 ± 9.59 days. The mean cost per day was 212.02 ± 190.94 US dollars ($US), and the cost per 1% TBSA was 241.70 ± 301.32 $US. According to the causes of burn injury, the mean cost of electricity was 5000.77 ± 8101.85 $US, fire 4818.02 ± 5852.22 $US, and chemical 3285.49 ± 4503.2 $US were observed in the first 3 ranks respectively. According to this study, paediatric burn cases occur due to preventable causes, and even though the mortality rate was low, the severity of burns, TBSA%, and presence of complications caused prolonged lengths of hospital stays, which caused social security costs to rise.

Assessment of Small Paediatric Burns: A Coin-Based System

A review of paediatric burns in our burns facility in the United Kingdom demonstrated variable accuracy of size, and a majority documented as <1% total body surface area (TBSA). Accurate assessment is important for medical records, clinical management and non-accidental injuries. We propose to assess burn size with a coin-based system, where small burns are described by single/multiple sterling coins. Participants were asked about their confidence in evaluating small paediatric burns. Participants were given ten scenarios which included photographs of paediatric patients with small burns. They were asked to assess burn size in their normal manner (TBSA, measurement) and with a coin-based system. The 'burns' were drawn on children based on a given coin size and percentage so that the accuracy of the participant's answer was quantifiable. Participants provided qualitative feedback in a questionnaire on the coin-based system. Thirty nurses and medical staff of varying seniority actively involved in referral/management of paediatric burns took part, creating over 300 responses. In preliminary questions, 66% of participants did not feel confident in estimating paediatric burns and 83% needed to refer to a paediatric burns chart. Accuracy of burn size using TBSA and the coin-based system was 45% and 67%, respectively. The majority (97%) stated estimating size was easier, and 93% found it more accurate. A total of 87% found communication between colleagues easier. Results highlight the improved assessment of small burns in our hospital using a coin-based approach in comparison to TBSA, and could facilitate accurate communication between health care professionals.

Why is milk so dangerous in rural areas?

OBJECTIVE

In this study, hot milk burns observed in paediatric patients were examined, and the results were compared with those obtained from other types of scalding burns.

METHOD

A 10-year retrospective study was conducted with paediatric patients hospitalised for hot milk burns at the Gazi Yaşargil Training and Research Hospital Burn Center, Turkey.

RESULTS

Of the 87 patients included in the study, 49 (56.3%) were male and 38 (43.7%) were female, with a male/female ratio of 1.29:1. Patients were aged two months to 18 years, with a mean age of 3.62±2.82 years. The highest rate of burn injury was observed in patients aged 0-4 years (n=67, 77.0%). The upper (n=56, 64.4%) and lower extremities (n=75, 86.2%) were the most frequently affected areas. Of the total number of patients examined, 25 (28.7%) exhibited second-degree burns, while 62 (71.3%) exhibited third-degree major burns. The mean hospitalisation time was 6.28±5.04 days. None of the patients died or underwent amputation.

CONCLUSION

Scalding is the most common cause of burns in the paediatric population in Turkey. Hot milk burns attract attention due to their higher infection rates and length of hospital stay.

Laryngotracheal stenosis post mechanical ventilation in paediatric burns patients

INTRODUCTION

The duration of endotracheal intubation is thought to be the most important factor in the development of acquired laryngotracheal stenosis (LTS); however, there is a paucity of studies examining the incidence of LTS in the paediatric burn population. The aim of this study was to determine the incidence of LTS in paediatric burns patients requiring mechanical ventilation to develop guidelines for consideration of a tracheostomy.

METHODS

A retrospective review of all children treated at The Children's Hospital at Westmead (CHW) Burns Unit (BU) from December 2009 to December 2019 who required intubation for their burn injury.

RESULTS

During the 10-year study period 115 patients required endotracheal intubation after having sustained a burn injury. Of these 11 were excluded. The mean age was 6.2 years (0-16), with the majority of patients being male (65%). The average TBSA was 18.5% with a range of 0.1-70%. Flame was the most common mechanism of burn (n = 59). Burns to the head and/or neck were the most common indication for intubation with the mean duration of intubation 6.1 days (range 0-40). Tracheostomies were performed on two patients (1.9%). LTS was found in two patients (1.9%).

CONCLUSION

LTS in the paediatric burn population post mechanical ventilation appears to be a rare event. Endotracheal intubation can safely be used as the route of airway access in paediatric burns patients. Based on our experience, a definitive recommendation on the timing of tracheostomy in the paediatric burn patient cannot be made.

Nanocellulose-based wound dressing for conservative wound management in children with second-degree burns

The initial care of burn wounds and choice of dressing are pivotal to optimally support the healing process. To ensure fast re-epithelialisation within 10-14 days and prevent complications, an optimal healing environment is essential. An innovative dressing based on nanocellulose was used for the treatment of burns in children. Children (0-16 years) with clean, partial-thickness burn wounds, 1 to 10% of the total body surface area were included. Complete re-epithelialisation was achieved within 7-17 days, with 13 patients showing re-epithelialised >95% by day 10. Satisfying results concerning time to re-epithelialisation and material handling were obtained. The possibility to leave the dressing on the wounds for 7 days showed a positive effect in the treatment of children, for whom every hospital visit may cause massive stress reactions. The nanocellulose-based dressing is a promising tool in conservative treatment of burns. Reducing the frequency of dressing changes supports a fast and undisturbed recovery; moreover, the dressing provides an optimal moist healing environment. The time to re-epithelialisation is comparable to frequently used materials, and cost reduction effect can be achieved without loss of quality. Possible pain and distress levels are kept to a minimum; therefore, flexibility and compliance of the patients and their parents are enhanced.

Rapid enzymatic burn debridement: A review of the paediatric clinical trial experience

NexoBrid (NXB) has been proven to be an effective selective enzymatic debridement agent in adults. This manuscript presents the combined clinical trial experience with NXB in children. Hundred and ten children aged 0.5 to 18 years suffering from deep thermal burns of up to 67% total body surface area were treated with NXB in three clinical trials. Seventy-seven children were treated with NXB in a phase I/II study, where 92.7% of the areas treated achieved complete eschar removal within 0.9 days from admission. Thirty-three children (17 NXB, 16 standard of care [SOC]) participated in a phase III randomized controlled trial. All wounds treated with NXB achieved complete eschar removal. Time to complete eschar removal (from informed consent) was 0.9 days for NXB vs 6.5 days for SOC (P < .001). The incidence of surgical excision was 7.9% for NXB vs 73.3% for SOC (P < .001). Seventeen of these children participated in a phase III-b follow-up study (9 NXB and 8 SOC). The average long-term modified Vancouver Scar Scale scores were 3.4 for NXB-treated wounds vs 4.4 for SOC-treated wounds (NS). There were no significant treatment-related adverse events. Additional studies are needed to strengthen these results.

The management of paediatric burns with Burns and Wounds ointment and burdock leaves: a case series

OBJECTIVE

In the Amish community, natural therapies, such as Burns and Wounds (B&W) ointment and burdock leaves, are preferred over modern medicine when treating burn wounds. The primary aim of this case series is to highlight the use and clinical outcomes of this treatment for paediatric Amish patients.

METHOD

At the a paediatric burn centre, two patients were treated with B&W ointment and burdock leaves. The first patient was 11 months old with 17% total body surface area (TBSA) partial and full-thickness scald burns to her lower extremities. The second patient was 24 months old with 20% TBSA partial-thickness scald burns to the torso, bilateral upper extremities, neck and chin.

RESULTS

Soon after presentation to the hospital, both patients developed positive wound cultures and required cessation of ointment and burdock leaf therapy. Both patients ultimately underwent surgical interventions.

CONCLUSION

Managing burn wounds with B&W ointment and burdock leaves should be considered as an additional option for wound care in select cases. However, the efficacy of this therapy is limited and standard-of-care modern medical burn treatments should remain an option for these patients. It is critically important to build a mutually respectful relationship with Amish patients' community leaders, as this allows open communication and collaboration in patient care and increases the likelihood that Amish guardians will bring their children to a hospital when necessary.

Evaluation of EpiProtect® microbial cellulose burns dressings in young children

INTRODUCTION

EpiProtect® is a biosynthetic cellulose dressing indicated for the treatment of superficial burns and the dressing of deep burns. Prior to this study the youngest reported patient treated with EpiProtect® was aged 13 years.

METHOD

Data were collected prospectively for patients aged < 5 years, presenting to the Children's Burns Unit with ⩾ 2% total body surface area (TBSA) burns sustained by any mechanism.

RESULTS

Thirty children were treated (median age = 17 months, age range = 1-61 months). Thirty-six burn depths were documented: superficial partial thickness (SPT) in 53% (n=19); mid-partial thickness (MPT) in 33% (n=12); deep partial thickness (DPT) in 11% (n=4); and full thickness (FT) in 3% (n=1). Median burn size was 4.5% TBSA (range = 2%-12%). EpiProtect® was applied under general anaesthesia in all cases. The median length of stay (LOS) was two days (range = 0-6 days). EpiProtect® was tolerated well and provided effective analgesia for subsequent dressing changes. Median healing time was 13 days (SPT burns), 14 days (MPT) and 24 days (DPT burns). Three patients required split skin grafting. Hypertrophic scarring arose in one patient.

DISCUSSION

This case series represents the youngest published patient group to have been treated with EpiProtect®. Authors conclude that EpiProtect® provides a safe, reliable and well-tolerated dressing option for all burn depths in young children. Importantly, EpiProtect® is culturally neutral and may be used in situations which, for cultural reasons, may preclude the use of animal-derived products. Further studies are warranted to evaluate pain scores, burn depth, size and LOS correlation, and comparative analysis between dressing types.

LAY SUMMARY

Burn injuries in the paediatric population are common and often require multiple dressing changes. Dressing changes can be painful and distressing to both children and their care givers. This article describes the experience of using a synthetically derived burns dressing, called EpiProtect®, in children aged ⩽ 5 years. Thirty patients were recruited with varying depths of scald burns and all underwent application of EpiProtect® dressing. The results suggested that EpiProtect® was a user-friendly dressing that can be used to treat partial-thickness burns and to dress full-thickness (FT) burns. It was well-tolerated and provided effective analgesia at the time of dressing changes. There was no incidence of increased burn wound infection rates and all wounds healed. In addition, as EpiProtect® is a synthetic product, it has the benefit of being culturally neutral, which is advantageous in a culturally diverse population. Further studies are warranted to evaluate the effectiveness of this dressing and to compare it to similar dressings that are available.

Sociodemographic and culture results of paediatric burns

Paediatric burn wounds are challenging conditions to manage for both the doctors and patients and can cause several complications entailing a complicated treatment and recovery process. This study aims to evaluate sociodemographic conditions and antibiogram culture results of paediatric burn wounds. Our study retrospectively evaluated 419 paediatric patients with burns regarding age, gender, burn area and degree, total days spent in hospital, surgical history, final condition, additional disease history, previous attempts, and culture results with their antibiotic resistances, haemogram results, C-reactive protein results, sociocultural conditions, burned region of the body, and structure of the burn. The prominent observations were an increased rate of incidence in male patients and patients with low socioeconomic conditions, the highest incidence of burns from scalding and domestic accidents, and the highest incidence of third-degree burns. Furthermore, even though the most encountered burn types were extremity burns, the burn types with the highest culture growth ratio were the perineum burns. The dominant culture growth bacterial group was coagulase-negative staphylococcus, and the ratio of medication resistance was 67.8%. It is imperative to raise awareness regarding domestic accidents to prevent paediatric burn wounds. The mortality risk can be reduced by carefully monitoring multiple organ involvement and providing timely treatment. Moreover, appropriate wound care is warranted to avoid infection from skin flora.

Biobrane dressing for paediatric burns in Singapore: a retrospective review

INTRODUCTION

The ideal burn dressing for children should aim to alleviate pain, decrease length of hospital stay and minimise complications such as conversion and infection. The current literature is still inconclusive with regard to the gold standard burn dressing for the paediatric population.

METHODS

We retrospectively reviewed children with superficial partial thickness burns admitted to our paediatric burns unit from January 2014 to April 2015. A total of 30 patients were included in our study, of whom 13 had Biobrane^® dressing. The remaining 17 patients were treated with conventional silver foam dressing (i.e. Biatain^® Ag) and served as matched controls. Long-term follow-up scar evaluation was carried out at an average interval of two years after injury.

RESULTS

In the Biobrane group, the length of hospital stay was significantly shorter (Biobrane vs. silver foam: 4.76 ± 2.64 days vs. 8.88 ± 5.09 days; p = 0.01) and the infection rate was significantly lower (Biobrane vs. silver foam: 0% vs. 35.3%; p = 0.02). The Biobrane group had no hypergranulation or wound infection and did not require skin grafting. Long-term follow-up scar evaluation did not reveal any statistical difference between the patient groups at the two-year interval.

CONCLUSION

Paediatric patients with partial thickness burns treated with Biobrane dressing had shorter hospital stay and lower incidence of infection compared to those treated with conventional silver foam dressing. Biobrane and silver foam dressings did not demonstrate any significant difference in terms of long-term scar outcomes over an average follow-up duration of two years.

Epidemiology and clinical pattern of paediatric burns requiring hospitalization in sarajevo canton, bosnia and herzegovina, 2012-2016

We first aimed to investigate the epidemiological characteristics and clinical pattern of hospitalized paediatric burn patients in Sarajevo Canton. Second, we aimed to determine the targets for the paediatric burn prevention program. This descriptive retrospective study was carried out to analyse the demographic, etiologic and clinical data of 73 hospitalized paediatric burn patients in Sarajevo Canton over a 5-year period from January 1, 2012 to December 31, 2016. The differences between various groups were evaluated using the chisquare test. During the course of the study, 73 paediatric burns (37 boys and 36 girls; ratio 1:0.97) were hospitalized. The overall mean age was 3.0 ± 2.9 years (range: 3 months to 12.5 years). The mean total body surface area burned was 8.4 ± 8.3%. The most common causes of burns in children were scald injuries (84.9%) followed by contact with a hot object (9.6%). No children were found to have burns caused by chemicals or electricity. A total of 97.3% of paediatric burn injuries occurred at home (p<0.001), and almost all were preventable. Although the most burns were recorded in the spring months (35.6%), there was no significant seasonal variation in burns (p = 0.199). Average length of hospital stay (LOS) was 16.32 ± 12 days (range: 1 to 65 days). The findings of the current study revealed that the main cause of paediatric burns was scald occurring at home. These data can contribute to the development of a prevention program to protect the paediatric population from burns.

Tissue expansion in burn reconstruction: what can the child and family expect?

A child with a burn injury often has to go through reconstructive surgery after it has healed to improve function and cosmetic appearance. Tissue expansion is one of the procedures commonly used in the reconstructive process. It requires commitment from the child and the family, because it involves several hospital visits, including at least two surgical episodes, in addition to a change in lifestyle during the process, and there are time and costs involved in travelling, including time off work and school. However, most families think that the final improvement achieved is worthwhile. Multidisciplinary pre-reconstruction clinics offer information and individualised support on the clinical, practical and psychological aspects of the procedures. The audit presented in this article found that attendance at the clinics can improve patient education, reduce complications and enhance the experience of the children and their families.

The use of Biobrane® to dress split-thickness skin graft in paediatric burns

Biobrane(®) is commonly used in paediatric burns to cover partial thickness burns and donor sites of split thickness skin (SSG). The purpose of this study is to evaluate the use of Biobrane(®) in dressing SSG adjacent to skin graft donor sites or partial thickness burns. A retrospective review was undertaken to determine the use of Biobrane(®) in dressing SSG, where the grafted areas were adjacent to donor sites or partial thickness burns. Between 2009 and 2012, we reported five cases of using Biobrane(®) to dress SSG, where the grafted areas were adjacent to partial thickness burns and two cases where the grafted areas were adjacent to donor sites. Biobrane(®) promoted adherence of the SSG to the wound, prevented shearing, and allowed fluid drainage. At the same time, Biobrane(®) also facilitated healing of the adjacent donor sites or partial thickness burns.

Epidemiology of paediatric burns in Iran

We surveyed the epidemiology of the patients in a tertiary burn care centre (the Motahari Burn Hospital) in Tehran in the 4-yr period 2005-2009. Scalding was the major cause of burn injury for patients under the age of 6, while there were many more flame and electrical burns in late childhood. Males were mainly affected (male to female ratio, 1.7:1). Most burns occurred in the summer, probably due to older children's increased outdoor activities during school vacations. Most of the injuries took place in the kitchen. Age was directly related to the higher total body surface area and mortality rate. Explosion of propane gas at home had a high incidence. Length of hospital stay increased in relation to the burn surface area. Infants were found to be at greatest risk for burn injuries, while older children were at higher risk for severe burns. Before arriving at the hospital, 22 patients had received traditional therapy in the home which was not effective and caused some problems. Pre-hospital care by emergency medicine service personnel was complete and effective. 374 patients had positive results for wound culture (42.9%). The most frequent bacteria found in burn wound cultures was coagulase-negative Staphylococcus (66.8%). Blood culture was positive in 12% of the patients with positive burn wound culture and the most frequent bacteria in blood culture was Pseudomonas aeruginosa. The overall mortality rate was 10.6%. Treatment and prevention programmes should target high risk groups. Important criteria include older age, flame burn, presence of inhalation injury, total body surface area burned above 40%, and sepsis.

Profile of burn sepsis challenges and outcome in an exclusive children's hospital in Chennai, India

A group of 273 paediatric patients admitted to Kanchi Kamakoti Childs Trust Hospital Burn Unit, Chennai, India between the years 2004 to 2010 were analysed retrospectively. Of these, 89 were suffering from sepsis and septic shock and 15 died. Strict adherence to antibiotic administration and to the Paediatric Intensive Care Unit (PICU) and management protocol improved the outcome, especially in 2009 and 2010.

Bacteriology of the burn wound at the Bai Jerbai Wadia Hospital for children, Mumbai, India-A 13-year study, Part I-Bacteriological profile

AIM

To study which organisms were prevalent in our burn unit and their antibiotic sensitivity pattern in brief.

METHOD

Microbiological data of 1534 patients admitted to the burns unit of the Bai Jerbai Wadia Hospital for Children, Mumbai over a period of 13 years (1994-2006) was reviewed retrospectively. A total of 9333 swabs were cultured and antibiotic sensitivities to the isolated organisms determined. The age group of patients admitted to our facility ranged from one month to 15 years.

RESULT

Klebsiella was the predominant organism in our set-up (33.91%), closely followed by Pseudomonas (31.84%). The antibiotic sensitivities of the isolated organisms are discussed in detail in the text.

CONCLUSION

Every treatment facility has microorganisms unique to it and these change with time. It is therefore of paramount importance to have an in-depth knowledge of the resident organisms and their antibiotic sensitivity pattern so that infection-related morbidity and mortality are improved.