Characteristics and outcome of burned children admitted to a pediatric intensive care unit

Abstract

ObjectiveTo analyze the characteristics and outcomes of children hospitalized for burns in a pediatric trauma intensive care unit for burn patients.MethodsAn observational study was conducted through the retrospective analysis of children (< 16 years) admitted to the pediatric trauma intensive care unit for burn victims between January 2013 and December 2015. Sociodemographic and clinical variables were analyzed including the causal agent, burned body surface, presence of inhalation injury, length of hospital stay and mortality.ResultsThe study analyzed a sum of 140 patients; 61.8% were male, with a median age of 24 months and an overall mortality of 5%. The main cause of burns was scalding (51.4%), followed by accidents involving fire (38.6%) and electric shock (6.4%). Mechanical ventilation was used in 20.7% of the cases. Associated inhalation injury presented a relative risk of 6.1 (3.5 - 10.7) of needing ventilatory support and a relative risk of mortality of 14.1 (2.9 - 68.3) compared to patients without this associated injury. A significant connection was found between burned body surface and mortality (p < 0.002), reaching 80% in patients with a burned area greater than 50%. Patients who died had a significantly higher Tobiasen Abbreviated Burn Severity Index than survivors (9.6 ± 2.2 versus 4.4 ± 1.1; p < 0.001). A Tobiasen Abbreviated Burn Severity Index ≥ 7 represented a relative risk of death of 68.4 (95%CI 9.1 - 513.5).ConclusionScalding burns are quite frequent and are associated with high morbidity. Mortality is associated with the amount of burned body surface and the presence of inhalation injury. Special emphasis should be given to accidents involving fire, reinforcing proper diagnosis and treatment of inhalation injury.

Navigating the Multiverse: Heterogeneity in Pediatric Burn Care in the United States*

“…Perhaps not surprisingly, inhalation injury and percentage of total body surface area (TBSA) burned on the trunk and head/neck were independently associated with the duration of IMV in burned children in this study, similar to prior reports indicating worse outcomes associated with these factors (2–6). The association of younger age and female gender with more prolonged IMV may be surprising to the reader, but some limited prior data exist.…”

“…Nearly 27% of the pediatric burn patients in the VPS database were diagnosed with acute respiratory distress syndrome, and 26% had two or more organ failures. Single-center retrospective studies in PICUs outside the United States also report high rates of IMV utilization, ranging from 21% to 37% of cases (5,14). Unfortunately, these IMV utilization rates are not easily compared with the report by Garren et al (1), which drew from all acute burn admissions and Although studies like the one by Garren et al (1) add to our understanding of pediatric burn intensive care, a more comprehensive look at children across the pediatric burn care multiverse is needed to fully understand IMV and other critical care resource utilization in this population.…”

A retrospective study analysing mortality and outcomes in the paediatric burns intensive care unit at the Chris Hani Baragwanath Academic Hospital, Johannesburg

“…It has been documented, both in our unit and in the literature, that patients with burns affecting >60% TBSA have a 100% mortality rate, irrespective of whether there is an associated inhalational component. [6,24] Similarly high mortality rates have been reported in a study from Brazil (80% mortality in patients with burns affecting >50% TBSA) [25] and Nepal (95% mortality in patients with burns affecting >40% TBSA). [26] These reports are in line with findings from a prospective analysis in a tertiary paediatric burns centre in India, in which Dhopte et al [27] concluded that the greater the extent of burn injury (expressed in terms of TBSA), the higher the risk of mortality.…”

Factores de riesgo para mortalidad en el niño gran quemado

“…Los análisis de mortalidad y la aplicación de modelos de regresión multivariable han demostrado suficientemente que la SCQ y el espesor de la quemadura son fuertes predictores de mortalidad en niños quemados. La tasa de mortalidad se incrementa significativamente con el incremento de la SCQ, donde la mortalidad puede alcanzar el 100 % en pacientes con SCQ del 70 % o más (14). El rol del efecto del espesor de la quemadura está firmemente establecido en los datos aportados de este estudio, donde constituyó un factor predictor independiente de mortalidad.…”