Early excision of major burns in children: Effect on morbidity and mortality

Pietsch, John B.; Netscher, David T.; Nagaraj, Hirikati S.; Groff, Diller B.

doi:10.1016/s0022-3468(85)80039-7

Cited by 52 publications

(31 citation statements)

References 12 publications

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“…Early burn wound excision now occurs within the first few days after burn injury and has resulted in improved survival (30,127,170,185,196,200,253,334,390,429). Full-thickness and deep partial-thickness wounds are excised as soon after injury as possible once the patient has been hemodynamically stabilized.…”

Section: Early Excision and Burn Wound Closurementioning

confidence: 99%

“…Sepsis syndrome is clinically heralded by the onset of hypothermia or hyperthermia, hypotension, decreased urinary output, hyperglycemia, neutropenia or neutrophilia, and thrombocytopenia (20,47,86,140,177). Burn wound sepsis was predominantly due to invasive wound infection prior to the advent of early burn wound excision (30,127,170,185,253,296,334,429).…”

Section: Sepsis and Toxic Shock Syndromementioning

confidence: 99%

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Burn Wound Infections

Church

Elsayed

Reid³

et al. 2006

Clin Microbiol Rev

1,585

1,345

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SUMMARYBurns are one of the most common and devastating forms of trauma. Patients with serious thermal injury require immediate specialized care in order to minimize morbidity and mortality. Significant thermal injuries induce a state of immunosuppression that predisposes burn patients to infectious complications. A current summary of the classifications of burn wound infections, including their diagnosis, treatment, and prevention, is given. Early excision of the eschar has substantially decreased the incidence of invasive burn wound infection and secondary sepsis, but most deaths in severely burn-injured patients are still due to burn wound sepsis or complications due to inhalation injury. Burn patients are also at risk for developing sepsis secondary to pneumonia, catheter-related infections, and suppurative thrombophlebitis. The introduction of silver-impregnated devices (e.g., central lines and Foley urinary catheters) may reduce the incidence of nosocomial infections due to prolonged placement of these devices. Improved outcomes for severely burned patients have been attributed to medical advances in fluid resuscitation, nutritional support, pulmonary and burn wound care, and infection control practices.

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Section: Early Excision and Burn Wound Closurementioning

confidence: 99%

Section: Sepsis and Toxic Shock Syndromementioning

confidence: 99%

Burn Wound Infections

Church

Elsayed

Reid³

et al. 2006

Clin Microbiol Rev

1,585

1,345

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“…The optimal timing of early burn excision and grafting varies. Past studies have described early excision to range from 24 h to within 6 days of the burn [6–10]. …”

Section: Introductionmentioning

confidence: 99%

Timing of early excision and grafting following burn in sub-Saharan Africa

Gallaher¹,

Mjuweni²,

Shah³

et al. 2015

Burns

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Background This study sought to establish appropriate timing of burn wound excision and grafting in a resource-poor setting in sub-Saharan Africa. Methods All burn patients (905 patients) admitted to Kamuzu Central Hospital (KCH) Burn Unit in Lilongwe, Malawi over three years (2011–2014) were studied. Results 275 patients (30%) had an operation during their admission. In patients who received an operation, median age was 5 years (IQR, 2.7–19) and median total body surface area burn was 15% (IQR, 8–25). 91 patients (33%) had early excision (≤5 days) and 184 patients (67%) had late excision (>5 days). Mortality was significantly greater in the early group (25.3% vs. 9.2%, p = 0.001). Controlling for total body surface area burn and age, the adjusted predictive probability of mortality were 0.256 (CI 0.159–0.385) and 0.107 (CI 0.062–0.177) if operated ≤5 and >5 days, respectively ( p = 0.0114). The odds ratio for mortality if operated >5 days is 0.34 (CI 0.15–0.79, p < 0.000). Conclusions Early excision and grafting in a resource-poor area in sub-Saharan Africa is associated with a significant increase in mortality. Delaying the timing of early excision and grafting of burn patients in a resource-poor setting past burn day 5 may confer a survival advantage.

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“…Children with more compliant chest walls are at greater risk of respiratory embarrassment with circumferential chest wall burns. Early excision and grafting decreases morbidity [10] and should be performed but it is preferable to have an adequately resuscitated patient and to be prepared for significant blood loss and hypothermia.…”

Section: Are the Surgical Options Different?mentioning

confidence: 99%

Paediatric Trauma Management on Deployment

et al. 2011

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There remains a significant paediatric workload through the military hospital in Camp Bastion. In this paper the authors review and discuss particular problems with resuscitation, investigation, anaesthetic and surgical issues in dealing with children suffering from ballistic injuries. Personal experience and recent papers are used for a qualitative analysis of difficult decisions in the management of paediatric ballistic trauma. Key questions are answered in separate paragraphs for each specialty. The information described in this paper should assist any deployed physician deal with paediatric casualties particularly if they are unaccustomed to paediatric patients in their normal practice.

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Early excision of major burns in children: Effect on morbidity and mortality

Cited by 52 publications

References 12 publications

Burn Wound Infections

Burn Wound Infections

Timing of early excision and grafting following burn in sub-Saharan Africa

Paediatric Trauma Management on Deployment

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