Facial burns in children: A series analysis with implications for resuscitation and forensic odontology

Abstract

This study comprises a continuous (1981–1995) unselected series of all children who died from thermal injuries in teh state of Queensland, Australia. One hundred and six children, so identified, died from incineration (35 per cent), respiratory burns with smoke or carbon monoxide inhalaton (33 per cent), body surface area burns comprising greater than 60 per cent (9 per cent) and electrocution (20 per cent). The burn fatality rate electrocution (20 percent). The burn fatality rate was 0.98 per hundred thousand children (0–14 years) per year, with no secular trend and, specifically, no reduction in the annual rate of such fatalities. Eighty‐two children (49 males) had concomitant facial injuries, both thermal and nonthermal; of whom 55 per cent were under the age of five years. Sixty (73 per cent) child burn victims died in house fires. Forensic odontology is important in confirming the age of such victims in single incinerations but is of limited value wen larger numbers of children are incinerte, because of the relative lack of dental restorations in teh infant and pre‐school age group. Of the 82 children with facial and airway injuries, 12 per cent had only mild or superficial facial damage and only seven (8 per cent) were alive or resuscitatable at teh time of rescue from teh conflagration or burning injury. Child deaths from burns contributed an annual loss rate of 506 years of potential life lost (YPLL) in a population of 3 milllion of whom 21.5 per cent were children under the age of 15 years. Airway management and resuscitation, in the context of managing surviving burn victims of any age with facial injuries, pose special difficulties. Inhalational burns (smoke and the grass of conflagration) result in a mortality greater than 60 per cent. Although 81 per cent of children showed evidence of airway obstruction, analysis of current data indicates that a maximum of 8 per cent could have survived with airway maintenance and protection. Inhalational burns (to both upper and lower airway) grossly reduce survivability. Primary prevention would seem vital and thus remains a major challenge to reduce the incidence of such deaths. Some strategies include advocacy to promote the compulsory installation of smoke alarms, family drills to practise escape and the teaching of ‘first aid for all’.

Facial Burns - Our Experience

“…They pose difficulties in pre-hospital resuscitation and are challenge to clinicians managing surviving burn victims in the intensive care setting (10-11). In this retrospective study we included 350 patients in 6 year period with facial burns.…”