Clinical Assesment of Pediatric Burns: A Retrospective Study

Abstract

Burn injuries represent a significant aspect of pediatric traumas, particularly prevalent during early childhood, involving a critical patient population characterized by elevated mortality and morbidity rates. This study explores burn incidents in children aged 0-6 years admitted to the Burn Unit of a tertiary hospital between January 1, 2016, and June 20, 2023, within the context of the existing literature. Additionally, it conducts an analysis of burn etiology, distribution, severity, and treatment interventions, categorizing a sample of 241 pediatric burn patients, predominantly within the 0-18 month age range. Children are categorized into three groups based on Sigmund Freud's "psychosexual development stages": 0-18 months, 18-36 months, and 36-72 months. Statistical analyses were performed using SPSS 25, with a predetermined significance level of 0.05. Burns commonly present as scalds, flames, and chemical burns, primarily falling within the 11-20% range and predominantly involving second-degree burns. Treatment approaches include a combination of dressing and medical treatment in 68% of cases, debridement under general anesthesia in 16.2%, and grafting in 15.8%. The infection rate is 10.8%, with Pseudomonas Aeruginosa emerging as the predominant pathogen, and the mortality rate reported at 0.8%. The average hospitalization duration is 9 days. Highlighting the paramount importance of meticulous planning in managing burns in children under 6 years old and emphasizing the influence of parental factors, the study advocates for educating parents on safety measures as a crucial step in mitigating burn incidence. Stressing the pivotal role of epidemiological investigations in comprehending and preventing the root causes of burns, the research suggests that more extensive age-range studies and multicenter approaches could provide more robust epidemiological insights for the effective management of burn cases.

Keywords

• Burn
• child
• epidemiology
• pediatric burn
• preschool period

References

1. Andriadze, m., Chikhladze, N., Kereselidze, M. (2022). General epıdemıologıcal characterıstıcs of burn related ınjurıes. Experimental and Clinical Medicine Georgia, 63–66. https://doi.org/10.52340/jecm.2022.828
2. Bakhiet, M.R., Koko M., Daffalla, M., Gismalla, A., Assil, S.M., Bagit, A. (2023). Patterns and management outcome of pediatrics burn in a general surgical department: experience from a secondary referral hospital. Sudanese journal of paediatrics. 23(1):74-81.
3. Başaran, A., Özlü, Ö. (2022). Pediatric burns and the leading factors of burn injury. Genel Tıp Dergisi, 32(2): 215-219. doi: 10.54005/geneltip.1002395
4. Belba, M., Belba, G. (2004). Review of statistical data about severe burn patients treated during 2001 and evidence of septic cases in Albania. Burns, Dec;30(8):813-9. doi: 10.1016/j.burns.2004.06.008.
5. Binet, A., Tartrou, H., Bousquet, M., Touze, A.L. (2023). No lockdown for pediatric burns. Arch Pediatr., Nov 20:S0929-693X(23)00177-X. doi: 10.1016/j.arcped.2023.09.007.
6. Bolton, L. (2019). Burn Debridement: Are We Optimizing Outcomes? Wounds. Dec;31(12):298- 300.
7. Burgess, M.; Valdera, F.; Varon, D.; Kankuri, E.; Nuutila, K. (2022). The Immune and Regenerative Response to Burn Injury. Cells, 11, 3073. https://doi.org/10.3390/ cells11193073 “Burns.” n.d. Accessed February 2, 2023. Retrieved from: https://www.who.int/news-room/factsheets/detail/burns.
8. Capek, K.D., Sousse, L.E., Hundeshagen, G., Voigt, C.D., Suman, O.E., Finerty, C.C., Jennings, K., Herndon, D.N. (2018). Contemporary Burn Survival. J Am Coll Surg. Apr;226(4):453-463. doi: 10.1016/j.jamcollsurg.2017.12.045.

9. Csenkey, A,, Jozsa, G., Gede. N,, Pakai. E,, Tinusz. B, et al. (2019). Systemic antibiotic prophylaxis does not affect infectious complications in pediatric burn injury: A meta-analysis. PLoS One, Sep 25;14(9):e0223063. doi: 10.1371/journal.pone.0223063.
10. Duke, J.M,, Rea, S,, Boyd, J.H., Randall, S.M., Wood, F.M. (2015). Mortality After Burn Injury in Children: A 33-year Population-Based Study. Pediatrics, 135 (4): e903–e910. doi: 10.1542/peds.2014-3140.
11. Diler, B., Dalgıç, N., Karadağ, Ç.A., Dokucu, A.İ. (2012). Bir Pediatrik Yanık Ünitesinde Epidemiyoloji ve Enfeksiyonlar: Üç Yıllık Deneyimimiz. J Pediatr Inf, 6: 40-5. doi:10.5152/ced.2012.10
12. Eunsol, K., Drew, P.J. (2021). Management of burn injury. Surgery. Wound Management, 40:1:p62- 69. https://doi.org/10.1016/j.mpsur.2021.11.006
13. Fernandes, F.M.F.A., Torquato, I.M.B., Dantas, M.S.A., Junior, F.A.C.P., Ferreira, J.A., Collet, N. (2012). Burn injuries in children and adolescents: clinical and epidemiological characterization. Revista gaúcha de enfermagem (Rev Gaucha Enferm). Dec; 33(4):133-141.
14. Haberal, M., Uçar, N., Bilgin, N. (1995). Epidemiological survey of burn treated in Ankara, Turkey and desirable burn prevention strategies. Burns, 21: 601-606. Doi: 10.1016/0305- 4179(95)00044-C.
15. Jordan, K.C., Gennaro, J.L.D., Arnim, A.S.A., Stewart, B.T. (2022). Global trends in pediatric burn injuries and care capacity from the World Health Organization Global Burn Registry. Frontiers in Pediatrics. Sec. Pediatric Critical Care, July 19:10. doi: 10.3389/fped.2022.954995.
16. “Lund and Browder Chart.” 2022. In Wikipedia. The Free Encyclopedia. Wikimedia Foundation, Inc. Retrieved [Access Date: 13 December 2023] from: https://en.wikipedia.org/w/index.php?title=Lund_and_Browder_chart&oldid=1073461374.
17. Lund, C.C., Browder, N.C. (1994). The estimation of areas of burns. Surg Gynecol Obstet, 79:352-8. Manning, J. (2018). Sepsis in the Burn Patient. Critical care nursing clinics of North America, Sep;30(3):423-430. doi: 10.1016/j.cnc.2018.05.010.
18. Mashavave, N.Z., Withers, A., Doedens, L.,Jugmohan, B., Loveland, J. (2020). A retrospective study analysing mortality and outcomes in the paediatric burns intensive care unit at the Chris Hani Baragwanath Academic Hospital, Johannesburg. South African Journal of Child Health. Dec;14(4):212.
19. Mohan, K. (2023). T. A retrospective analysis of paediatric scald burns in a teritary care hospital. International journal of scientific research, 12(5):19-20. doi : 10.36106/ijsr.
20. Nakarmi, K., Pathak, B.D. (2020). Prevalence of Acute Pediatric Burns in a Tertiary Care Hospital. Journal of Nepal Medical Association. 58(231):862-865.
21. Olatain, B.P., Dairo, D.M., Uduezue, A.U., Ogbonnaya, S.I. (2007). Paediatric burns: mortality in a burns unit. African Journal of Paediatric Surgery (Medknow publications). Feb;4(2):82-85.
22. Pratama, A. M. O., & Lewa, A. . (2022). The Protective Role of Strong Antioxidant Astaxanthin on Burn Wound and Burn-Induced Early Acute Kidney Injury through Abilities to Relieve Oxidative Stress and Inhibit Apoptosis by Modulating Mitochondrial-Apoptotic Pathways. International Journal of Medical Science and Clinical Research Studies, 2(12), 1591–1595. https://doi.org/10.47191/ijmscrs/v2-i12-37
23. Riedlinger, D.I., Jennings, P.A., Edgar, D.W., Harvey, J.G., Cleland,H.J., Wood, F.M., Cameron, P.A. (2015). Scald burns in children aged 14 and younger in Australia and New Zealand—an analysis based on the Burn Registry of Australia and New Zealand (BRANZ). Burns. May;41(3):462-8. doi: 10.1016/j.burns.2014.07.027.
24. Rosanova, M.T., Stamboulian, D., Lede, R. (2013). Infections in burned children: epidemiological analysis and risk factors. Arch Argent Pediatr, Jul-Aug;111(4):303-8. doi: 10.5546/aap.2013.eng.303.
25. Sengoelge, M., El-Khatib, Z., Laflamme, L. (2017). The global burden of child burn injuries in light of country level economic development and income inequality. Prev Med Rep, 6:115–20. doi: 10.1016/j.pmedr.2017.02.024.
26. Stanojcic, M., Vinaik, R., Jeschke, M.G. (2018). Status and Challenges of Predicting and Diagnosing Sepsis in Burn Patients. Surgical Infections, Feb 168-175. doi: 10.1089/sur.2017.288.
27. Taneja, N., Emmanual, R., Chari, P.S., Sharma, M.A. (2004). Prospective study of hospital-acquired infections in burn patients at a tertiary care referral centre in North India. Burns, Nov;30(7):665-9. doi: 10.1016/j.burns.2004.02.011.
28. Yastı, A.Ç., Koç, O., Şenel, E., Kabalak, A.A. (2011). Hot milk burns in children: a crucial issue among 764 scaldings. Ulus Travma Acil Cerrahi Derg, 17: 419-422. doi: 10.5505/tjtes.2011.95815.
29. Yastı, A.Ç., Şenel, E., Saydam, M., Özok, G., Çoruh, A., Yorgancı, K. (2015). Guideline and treatment algorithm for burn injuries. Ulus Travma Acil Cerrahi Derg, March; Vol. 21, No. 2.
30. Yiğit, Y.D., Yiğit, E. (2022). Türkiye Güneydoğu Anadolu bölgesinde pediatrik yanık vakalarının analizi:10 yıllık retrospektif çalışma. KSÜ Tıp Fakültesi Dergisi. 17(3):152-159.