602 Concomitant Pediatric Burns and Craniomaxillofacial Trauma: A Pediatric Burn Center’s Experience over 20 Years

Abstract

Introduction Recent progress in pediatric burn care has reduced the mortality rate by 48.1% (Armstrong, 2020). Although it is well understood that mortality increases with increased number of systems involved, prior studies have not documented the effect of concomitant pediatric burn and craniomaxillofacial (CMF) trauma in pediatric patients. This retrospective cohort study is the first known to characterize presentation, management, and long-term outcomes of concomitant burns with CMF trauma in pediatric patients. Methods We performed a retrospective cohort study of all pediatrics patients who presented at a tertiary care center between the years 1990 to 2010 with CMF fractures and burns. Patient charts were reviewed for demographics, mechanism of injury, burn characteristics (TBSA %, location, and degree), imaging and interventions, involvement of child protective services, and long-term outcome. Data was analyzed using two-tailed Student’s t tests and chi square analysis. Results Of the 2,966 pediatric CMF trauma patients (64.0% boys; average age 7 ±4.7 years) that were identified, a total of 10 (0.34%) patients were identified to have concomitant burn injuries. Patients with concomitant burn and CMF injuries were less likely to have sustained blunt injuries (P < 0.0001) and had longer hospital lengths of stay (13 □ 18.6 vs 4 □ 6.2 days, P < 0.0001). Approximately 60% of CMF fractures were upper-third injuries. The CMF fractures of all 10 cases (100%) were managed non-operatively. 40% were due to child abuse, 40% due to motor vehicle collisions, and 20% due to house fires. Of the four patients who presented due to child abuse, CMF trauma was incidentally found on imaging. One (13 months, female) child-abuse case was found to have 32% TBSA 2nd and 3rd degree burns to bilateral lower extremities after being submerged in hot bathwater and had concomitant orbit/skull fractures. Two other child abuse cases presented with hand burns and concomitant nasal/skull fractures. All four child abuse patients presented in a delayed fashion. Conclusions Concomitant burns and CMF trauma is rare injury pattern in pediatric populations and is associated with longer hospital lengths of stay. Child abuse and motor vehicle accidents caused 80% of the cases.