Pediatric Burns from Glass-Fronted Fireplaces in Canada

Abstract Introduction Current practice for major pediatric burns includes fluid resuscitation using formulas that estimate fluid requirements based on weight and/or body surface area (BSA) along with percent total burn surface area (TBSA). Adult studies have shown that these formulas can cause fluid overload in obese patients and increase risk of complications. These findings have not been validated in pediatric patients. This study aims to evaluate whether a weight-based resuscitation formula increases the risk of complications in obese children following burn injuries and compares fluid estimates to those that incorporate BSA. Methods A retrospective review was conducted on 110 children (≤ 18 years old) admitted to an ABA-verified urban pediatric burn center from October 2008 to May 2020. Patients had ≥15% TBSA, were resuscitated with the weight-based Parkland formula, and had fluids titrated to urine output every two hours (1 ml/kg/hr if ≤ 30kg; 0.5 ml/kg/hr if > 30kg). Demographics, burn type, and TBSA were collected on admission. BSA-based Galveston and BSA-incorporated Cincinnati formula resuscitation predictions were also calculated. Output and input volumes were collected at 8h and 24h post-injury. Complications were collected throughout the hospital stay. Patients were classified into CDC-defined weight groups based on percentile ranges. Statistical analysis was conducted using SPSS Statistics version 10.0. Results This study included 11 underweight, 60 normal weight, 18 overweight, and 21 obese children. Our patients had a mean age-based weight CDC percentile of 62.2%, and mean TBSA of 25.4%. Predicted resuscitation volumes increased as CDC percentile increased for all three formulas (p=0.033, 0.092, 0.038), however there were no significant differences between overweight and obese children. Total fluid administered was higher as CDC percentile increased (p=0.023). However, overweight children received more total fluid than obese children. The difference between total fluids given and Galveston predicted resuscitation volumes were significant across all groups (p=0.042); however, the difference using the Parkland and Cincinnati formulas were not statistically significant. There were more children in the normal weight group who developed complications compared to other groups, but these findings were not significant. Conclusions The Parkland formula tended to underpredict fluid needs in the underweight, normal weight, and overweight children, and it overpredicted fluid needs for the obese. Further research is needed to determine the value of weight-based vs BSA-based or incorporated formulas in terms of their risk of complications.

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Comparisons between the clinical outcomes of early and late enteral nutrition and mortality risk factors for pediatric burns

Clinical Nutrition ESPEN ◽

10.1016/j.clnesp.2021.09.667 ◽

2021 ◽

Vol 46 ◽

pp. S779

Author(s):

N. Densupsoontorn ◽

W. Foopratipsiri ◽

K. Chinaroonchai ◽

H. Rukprayoon ◽

S. Kunnangja

Keyword(s):

Risk Factors ◽

Enteral Nutrition ◽

Clinical Outcomes ◽

Mortality Risk ◽

Pediatric Burns

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Pediatric Burns

Encyclopedia of Pain ◽

10.1007/978-3-540-29805-2_3239 ◽

2006 ◽

pp. 1782-1782

Keyword(s):

Pediatric Burns

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Application of Integra® in Pediatric Burns

Color Atlas of Burn Reconstructive Surgery ◽

10.1007/978-3-642-05070-1_15 ◽

2010 ◽

pp. 108-116

Author(s):

Paul M. Glat ◽

John F. Hsu ◽

Wade Kubat ◽

Anahita Azharian

Keyword(s):

Pediatric Burns

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Approaches of Emergency Department Physicians to Pediatric Burns: A Survey Assessment

Journal of Burn Care & Research ◽

10.1093/jbcr/irab087 ◽

2021 ◽

Author(s):

Sabri Demir ◽

Can Ihsan Oztorun ◽

Ahmet Erturk ◽

Dogus Guney ◽

Ayse Ertoy ◽

...

Keyword(s):

Emergency Department ◽

Emergency Medicine ◽

Emergency Departments ◽

Correct Choice ◽

Inhalation Injury ◽

Burn Patients ◽

Surface Areas ◽

Pediatric Burns ◽

Insufficient Knowledge ◽

Parkland Formula

Abstract Burned children generally arrive at emergency departments before referring to specialized burn centers. Their initial treatments are performed by non-burn doctors who work in emergency departments. The aim of this study was to evaluate emergency department doctors’ knowledge regarding the initial interventions and transfer of pediatric burn patients. There were 196 participants who completed the survey: 59 were emergency medicine specialists, 46 were general practitioners, and 91 were emergency medicine residents. Sixty-five stated that they always calculate the burn surface areas, and 144 stated that the Parkland formula should be used to calculate the fluid requirements for the first 24 hours. Of all participants, only 21 marked the correct choice as the Lund-Browder scheme to calculate the total burned surface area in children. Only 52 participants marked the correct choice as the Lactated Ringer’s of the fluid given in the first 24 hours. Only 108 correctly recognized inhalation injury. To the question “What is the first intervention that doctors should do at the emergency room to burned children?”, 127 participants stated correctly as the assessment of airway maintenance. Among the participants, 124 stated that they use lidocaine pomades when covering burned children’s wounds. Incorrect interventions with burned children increase morbidity and mortality. This survey shows that non-burn doctors working in emergency departments have insufficient knowledge about pediatric burns and require further training. Therefore, they should be trained continuously and regularly on the approach to both adult and childhood burns.

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Chapter-026 Pediatric Burns

Pediatric Surgery Diagnosis &amp Management 2 Volume Set ◽

10.5005/jp/books/10608_26 ◽

2008 ◽

pp. 307-320

Author(s):

Gupta K

Keyword(s):

Pediatric Burns

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766 Clinical Outcome Assessment of a Psychosocial Intensive Retreat for Girls with Severe Burns

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.345 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S217-S217

Author(s):

Sarah A Stoycos ◽

Ashley J Sammons ◽

Lesia S Cartelli ◽

Leigh Ann Price

Keyword(s):

Identity Formation ◽

Support Groups ◽

Mental Health Professionals ◽

Burn Injury ◽

Psychosocial Care ◽

Self Esteem ◽

Psychological Inflexibility ◽

Program Outcomes ◽

Negatively Associated ◽

Pediatric Burns

Abstract Introduction Burn camps and peer support groups are widely utilized for the psychosocial care of pediatric burn survivors, providing community and recreation. However, camps and support groups often do not involve psychological therapy to assist with potential distress. This abstract presents program development outcome assessments for an alternative approach to psychosocial care: a psychosocial intensive retreat for adolescent survivors of pediatric burns, led by trained mental health professionals, with group therapy interspersed with recreation. Methods A 6-day, residential psychosocial intensive was open to adolescent girls with disfiguring burns. Psychological assessments were administered for clinical utility at the start (T0) and end (T1) of the program and were used to guide programming. Assessments included: Posttraumatic Stress Checklist for DSM-5 (PCL), Satisfaction with Appearance Scale (SWAP), Rosenberg Self-Esteem Scale (RSES) and the Acceptance and Action Questionnaire (AAQ) measuring psychological inflexibility. Bivariate correlations and univariate t-tests were used to assess program outcomes. Results Fifteen girls (Mage = 16, SD = 2.04; Mageofburn = 6.64, SD = 5.40) attended. At T0, girls reported subclinical scores (PCL (M = 23.53, SD = 20.20, range 1–65); SWAP (M = 44.93, SD = 11.88); RSES (M = 27.28, SD = 5.76); AAQ (M = 20.71, SD = 9.64) with a subset of 5 reporting clinical distress on PCL. Therapeutic programming was adjusted to primarily focus on typically developing adolescent issues such as communication, boundaries, identity formation, and healthy relationships, with some burns-specific groups (grief and loss, social exposures). Those with clinically significant distress participated in trauma and affect regulation training. AAQ at T0 was negatively associated with RSES (r = -.78, p = .003) and positively associated with PCL scores (r = .82, p < .001). RSES was negatively associated with PCL (r = -.87, p < .001). SWAP was not associated with any measures. From T0 (M = 26.70, SD = 6.07) to T1 (M = 30.18, SD = 5.74) girls reported a significant increase in RSES, t(10) = -3.15, p = .01. As expected given low symptoms reported at T0, no other pre to post changes occurred. TBSA, time since burn and age were not associated with outcome variables. Conclusions Overall, girls suffered burn injury before the age of 7 and current symptom profiles replicated prior literature supporting subthreshold, long-term psychological morbidity for pediatric burns. A brief, 6 day psychosocial intensive may facilitate growth in self-esteem. Use of clinical assessments to inform programming is emphasized. Applicability of Research to Practice Psychosocial intensives that intersperse empirically-supported, assessment-driven therapeutic programming with social connection may be useful in increasing adolescent self-esteem for girls with a history of disfiguring burns.

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