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

Reported 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.

Haemofiltration in the Management of Severe Paediatric Burns – Experience in a UK Burns Centre and Systematic Review

Paediatric burns are life-threatening injuries due to the acute injury and secondary complications. In acute phase burns, hypovolaemia and vasoconstriction cause renal impairment. Sepsis and multi-organ failure compound the problem resulting in morbidity and mortality. This paper outlines 5 years’ experience using haemofiltration in major paediatric burns, and a review of the current literature.Retrospective patient data collection was undertaken identifying relevant paediatric burns undergoing Continuous Veno-Venous Haemofiltration. Data were analysed to identify demographics, indication, duration of therapy, and outcomes. A systematic review was also performed using PRISMA principles. PubMed, Science Direct and OVID databases were explored and relevant papers were included.From January 2015-December 2019, haemofiltration was utilised in 5 cases. Age range 3-15 years (mean: 12), 4 males / 1 female, mean weight 56kg (12-125kg). TBSA 21-61% (mean: 37.6%), mechanism of injury was scald-60%, flame-40%. Overall survival was 100%. 3 patients were filtered for a brief period during the first 24 hours to correct metabolic acidosis and control temperature. 2 patients required prolonged therapy. All patients recovered without further long term renal support. A total of 3814 papers were identified for systematic review. 3 were considered relevant for inclusion.This paper reflects the benefits of haemofiltration in the management of severe paediatric burns. Renal replacement therapy is useful in managing metabolic acidosis, temperature control and renal failure. The current literature supports judicious use on a patient-by-patient basis. Given the lack of evidence in the literature, further studies are required to establish guidelines for the use of haemofiltration in paediatric burns.

TP10.1.11Into the Pandemic and Out of the Fire?

Aim The Covid-19 pandemic has seen various government restrictions on all aspects of daily life. We assessed whether these lifestyle alterations have affected the number, severity and presentation of burns seen at a Paediatric Burns Unit. Methods We looked at Paediatric Burns admissions to Plastic Surgery during the Covid-19 pandemic of March 2020 to Jan 2021 (DC), as well as comparison data prior to Covid-19 from April 2019 to February 2020 (PC). We also looked at specific periods of national lockdown. Using data from our electronic records we looked at varying aspects of a patient’s journey. Results In total 788 cases were admitted to the Burn’s team from April19 -January21. The mean age of patients both DC and PC were 4.7 years with the mean during the first lockdown of 5. The time to presentation PC was 2.6 days, DC was 1.79 days and 2.4 days during the first lockdown. This was not significant (p = 0.2). The median total body surface area (TBSA) was &lt;1% in both PC and DC patients. Scalds made up 53% of the first lockdown injuries, this had no statistically significant difference as compared to PC and DC injuries (48% and 46% respectively). Conclusions Overall burns admissions during the Covid-19 pandemic did not significantly change as compared to the previous year. This contrasts published adult results, which demonstrates reduced burns admissions during Covid-19. We suggest this may be due to unchanged causative factors in paediatric burns which are predominantly found in domestic lockdown environments.

101 Paediatric Burns and The Coronavirus Pandemic: Were Children Staying Safe in Lockdown or Did The Virus Increase Burns Admissions?

Aim We aimed to identify if there was a change in the number of paediatric burns during the coronavirus pandemic and whether there was a change in the management of said burns. Method Data on ten parameters for all burns assessed on the Burns Unit at Alder Hey Children’s Hospital from April to May of 2020 was collected and compared to the same period from 2019. Results There was a decrease in the number of patients presenting to hospital, down to 24 from 32 in 2019. Scald injuries increased to 67% compared to 44%, while all other mechanisms of injuries decreased. Fewer very small burns (&lt;1% TBSA) presented to hospital (28%) compared to 50% the previous year. There was an overall increase in the presentation of burns greater than 1% TBSA (1-5% TBSA increased to 47% from 31%; 5-10% TBSA increased to 19% from 3%; 10-20% TBSA increased to 6% from 3%). A comparable rate of burns was managed conservatively as an outpatient (89% vs 88%), admitted for dressing changes (81% vs 78%), and managed surgically (11% vs 13%). Conclusions The coronavirus pandemic resulted in a decrease in the number of children experiencing burns, while at the same time causing an increase in the number of scald injuries. Our data showed no significant change in the management of burns indicating that regardless of the pandemic, paediatric burns were managed appropriately as per national guidelines.

312 Retrospective Analysis of Long-Term Scarring Outcomes in Paediatric Burns Patients

Introduction Paediatric burns are a common presentation to a plastic surgery unit. The long-term scar outcomes in paediatric burns patients are relatively unknown as most are discharged after 6 weeks follow up. We aimed to determine whether the long-term scarring outcomes are significantly different in those who had surgical treatment with Versajetâ debridement and Biobraneâ, versus those treated conservatively with non-adherent dressings, in a cohort of paediatric burns patients. Method The parents of all paediatric burns patients admitted to Stoke Mandeville Hospital from October 2014 to September 2017 were contacted by telephone to fill in the Brisbane Burn Scar Impact Profile (BBSIP), a patient reported outcome measure specifically aimed at children. The results from the questionnaires underwent statistical analysis to see if there was a significant difference in questionnaire scores between children treated surgically versus those treated conservatively. Results A total of 107 children were admitted in the timeframe, responses were received from 34 patients with 13 having been treated surgically and 21 having been treated conservatively. In all 58 questions that make up the BBSIP, there was no statistically significant difference observed in the scores of those treated surgically versus those treated conservatively. For 31 questions on the BBSIP, the lowest score indicating the best outcome was observed in all patients in both groups. Conclusions We found no statistically significant difference in the long-term scar outcomes as assessed by the BBSIP in paediatric burn patients treated with Versajetâ debridement and Biobraneâ, versus those treated conservatively with non-adherent dressings.

1576 Safeguarding Tools in Paediatric Burns

Introduction When assessing paediatric patients presenting with burns, non-accidental injury always has to be considered. In our department, local policy dictates that all patients aged 18 or below should have a child safeguarding tool completed on initial clerking. Method A retrospective audit of all paediatric burns seen over one month was performed. Primary outcome measures included completion of a safeguarding tool and documentation of referral outcome. These results were presented locally and implementing changes were carried out. This was then re-audited over a further monthly period. Results Initial data collection showed a safeguarding tool completion rate of 69% and referral outcome documentation rate of 50% (n = 16). Implement changes included dissemination of initial audit results to the department, changing the layout of our clerking proformas and introducing posters in the unit which provided more information on risk assessing paediatric patients. The re-audit results showed a safeguarding tool completion rate of 100% and a referral outcome documentation rate of 100% (n = 14). Conclusions There was a significant improvement in both the safeguarding tool completion and referral outcome documentation rates following our interventions. Simple measures just such education and strategic adjustments of clerking proformas have been shown to be effective measures for increasing documental compliance of child safeguarding tools.

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.

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.