Early non-excisional debridement of paediatric burns under general anaesthesia reduces time to re-epithelialisation and risk of skin graft

AbstractReported advantages of early excision for larger burn injuries include reduced morbidity, mortality, and hospital length of stay for adult burn patients. However, a paucity of evidence supports the best option for paediatric burns and the advantages of non-excisional (mechanical) debridement. Procedural sedation and analgesia in the emergency department is a popular alternative to debridement in operating theatres under general anaesthesia. This study aims to evaluate the association between early (< 24 h post-injury) non-excisional debridement under general anaesthesia with burn wound re-epithelialisation time and skin graft requirements. Cohort study of children younger than 17 years who presented with burns of five percent total body surface area or greater. Data from January 2013 to December 2019 were extracted from a prospectively collected state-wide paediatric burns’ registry. Time to re-epithelialisation was tested using survival analysis, and binary logistic regression for odds of skin graft requirementto analyse effects of early non-excisional debridement in the operating theatre. Overall, 292 children met eligibility (males 55.5%). Early non-excisional debridement under general anaesthesia in the operating theatre, significantly reduced the time to re-epithelialisation (14 days versus 21 days, p = 0.029)) and the odds of requiring a skin graft in comparison to paediatric patients debrided in the emergency department under Ketamine sedation (OR: 6.97 (2.14–22.67), p < 0.001. This study is the first to demonstrate that early non-excisional debridement under general anaesthesia in the operating theatre significantly reduces wound re-epithelialisation time and subsequent need for a skin graft in paediatric burn patients. Analysis suggests that ketamine procedural sedation and analgesia in the emergency department used for burn wound debridement is not an effective substitute for debridement in the operating theatre.

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Effects of Early, Non-Excisional Debridement in the Operating Theatre on Paediatric Burn Wound Re-Epithelialisation Time and Skin-Graft Requirement: A Retrospective Cohort Study.

10.21203/rs.3.rs-775872/v1 ◽

2021 ◽

Author(s):

Bronwyn Griffin ◽

Anjana Bairagi ◽

Lee Jones ◽

Zoe Dettrick ◽

Maleea Holbert ◽

...

Keyword(s):

Emergency Department ◽

Cohort Study ◽

General Anaesthesia ◽

Skin Graft ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Operating Theatre ◽

Burn Patients ◽

Burn Wound ◽

Paediatric Burns

Abstract Background: Reported advantages of early excision and grafting for larger burn injuries include reduced morbidity, mortality, and hospital length of stay for adult burn patients. Evidence to support this has strengthened over the last 50 years. However, a paucity of evidence supports the best option for paediatric burns and, less still, the advantages of non-excisional (mechanical) debridement. Ketamine procedural sedation and analgesia in the emergency department is a popular alternative to debridement in operating theatres under general anaesthesia. This study aims to evaluate the association between early (<24hours post injury) non-excisional debridement under general anaesthesia in the operating theatre with burn wound re-epithelialisation time and skin graft requirements. Methods: Children younger than 17 years who presented with burns of five percent total body surface area or greater were included in a retrospective cohort study. Data between January 2013 to December 2019 were extracted from a state-wide paediatric burns’ registry for analysis. Time to re-epithelialisation was tested using survival analysis, and binary logistic regression for odds of skin graft requirement. A propensity matched dataset based on depth and size of burn wound, was used to analyse effects of early non-excisional debridement in the operating theatre compared to control. Results: Overall, 392 children met eligibility for the study with a male over-representation of 58.2%. When propensity matched, non-excisional debridement under general anaesthesia in the operating theatre, within 24hours of injury, significantly reduced the time to re-epithelialisation (15.0 (CI: 11.00-20.00) versus 20.0 (CI:13.5 – 31.00) days) and the odds of requiring a skin graft (OR:0.319 (0.125 – 0.812).Conclusion: This study is the first to demonstrate that early, initial, non-incisional debridement under general anaesthesia in the operating theatre significantly reduces wound re-epithelialisation time and subsequent need for a skin graft in paediatric burn patients. Analysis suggests that ketamine procedural sedation in the emergency department used for burn wound debridement is not an effective substitute for debridement in the operating theatre.

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