Infant burns: A single institution retrospective review

Brink, Christie; Isaacs, Q.; Scriba, M F; Nathire, M.E.H.; Rode, H.; Martinez, R.

doi:10.1016/j.burns.2018.11.005

Cited by 15 publications

(6 citation statements)

References 32 publications

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“…According to figures from the ABA (American Burn Association), 22.5% of burn patients in 2013 presented major burns 48 . In children, 77% of patients presented burns affecting less than 10% TBSA, in line with other studies 28 , 35 , 36 , 41 , 49 .…”

Section: Discussionsupporting

confidence: 91%

Epidemiology and mortality in patients hospitalized for burns in Catalonia, Spain

Abarca,

Guilabert,

Martin

et al. 2023

Sci Rep

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Burn injuries are one of the leading causes of morbidity worldwide. Although the overall incidence of burns and burn-related mortality is declining, these factors have not been analysed in our population for 25 years. The aim of this study has been to determine whether the epidemiological profile of patients hospitalized for burns has changed over the past 25 years. We performed a retrospective cohort study of patients hospitalised between 1 January 2011 and 31 December 2018 with a primary diagnosis of burns. The incidence of burns in our setting was 3.68/105 population. Most patients admitted for burns were men (61%), aged between 35 and 45 years (16.8%), followed by children aged between 0 and 4 years (12.4%). Scalding was the most prevalent mechanism of injury, and the region most frequently affected was the hands. The mean burned total body surface (TBSA) area was 8.3%, and the proportion of severely burned patients was 9.7%. Obesity was the most prevalent comorbidity (39.5%). The median length of stay was 1.8 days. The most frequent in-hospital complications were sepsis (16.6%), acute kidney injury (7.9%), and cardiovascular complications (5.9%). Risk factors for mortality were advanced age, high abbreviated burn severity index score, smoke inhalation, existing cardiovascular disease full-thickness burn, and high percentage of burned TBSA. Overall mortality was 4.3%. Multi-organ failure was the most frequent cause of death, with an incidence of 49.5%. The population has aged over the 25 years since the previous study, and the number of comorbidities has increased. The incidence and severity of burns, and the percentage of burned TBSA have all decreased, with scalding being the most prevalent mechanism of injury. The clinical presentation and evolution of burns differs between children and adults. Risk factors for mortality were advanced age, smoke inhalation, existing cardiovascular disease, full-thickness burn, and high percentage of burned TBSA.

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Section: Discussionsupporting

confidence: 91%

Epidemiology and mortality in patients hospitalized for burns in Catalonia, Spain

Abarca,

Guilabert,

Martin

et al. 2023

Sci Rep

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“…All children survived. [4] These results are supported by the meta-analysis by Cabral et al, [5] who found procalcitonin to be 46.8 ng/mL (95% CI 2.…”

mentioning

confidence: 66%

Role of procalcitonin in paediatric burn wound sepsis

Martinez

Rode

2018

S Afr Med J

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Role of procalcitonin in paediatric burn wound sepsis To the Editor: Wound infection is a leading cause of mortality and morbidity in patients with burns. It can cause burn wound conversion, spread systemically, delay wound healing and lead to hypertrophic scars, and it increases mortality by 50-60% despite improvements in antimicrobial management. Many factors contribute to the high incidence of burn wound infection, i.e. delayed initial care, deep burns, burns >30% of the total body surface area, delayed wound closure and various host factors, such as malnutrition, comorbidities and immunosuppression. Other factors include the bioburden and virulence of the bacterial infection. The early diagnosis of burn sepsis is of crucial importance, as it reduces mortality and morbidity, and shortens antibiotic treatment and hospital stay. Furthermore, the unnecessary use of antibiotics has side-effects and can lead to antibiotic resistance, both of which are detrimental to the burn patient. Burn wound infection remains a clinical and laboratory diagnosis and can be difficult to distinguish from the hyperdynamic, hypermetabolic status associated with burn injuries and systemic inflammatory response syndrome (SIRS). Because of the inflammatory response and immunoparesis associated with burns, standard laboratory tests for sepsis are difficult to interpret. [1] As the clinical picture between SIRS and sepsis can overlap and blood culture yields are typically low, diagnostic predicaments are created that have implications for therapeutic choices. In our paediatric burns unit, we have introduced specific measures to reduce the infection rate, detect burn sepsis early and differentiate SIRS from sepsis. Diagnostic uncertainty is common in the burns patient, despite careful physical examination, radiographs, tissue biopsies and various laboratory tests. We introduced procalcitonin testing to assist with this diagnostic dilemma. Procalcitonin is a 116 amino acid protein and the precursor of calcitonin. It becomes detectable within 2-4 hours after a triggering inflammatory stimulus, peaking at 12-24 hours and remaining elevated for 24 hours. Procalcitonin secretion parallels the severity of the bacterial inflammatory insult, with higher levels associated with more severe disease and declining levels with resolution of illness. It does not increase in the case of viral or fungal burn infection. [2]

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“…Another study investigating the association between PCT levels and septicemia has reported that a serum PCT level above 0.5 ng/mL had 100% sensitivity and 83% speci city for predicting septicemia, which was con rmed with a positive blood culture [39]. Routine use of a PCT level above 2 ng/mL for the assessment of sepsis in children with burn injuries has been reported as well [40]. While these reports are not conclusive for the optimal use of PCT for diagnosing sepsis in pediatric burns, our results are in line with available evidence, supporting continued investigation of PCT as a sepsis biomarker in pediatric burns.…”

Section: Discussionmentioning

confidence: 96%

Use of procalcitonin as a biomarker for sepsis in pediatric burns

Öncül

Dalgıç²,

Demir³

et al. 2023

Eur J Pediatr

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Introduction: Infection and sepsis continue to be the leading cause of morbidity and death in burn injuries. Diagnosing sepsis in burns is challenging as signs and symptoms of sepsis are not speci c and overlap with those related to the burn injury. While use of procalcitonin (PCT) as a biomarker is recommended for diagnosing sepsis in burns, evidence for children with burns is scarce. In this study, we aimed to investigate the role of PCT for distinguishing sepsis in pediatric burns.Methods: A prospective observational study was conducted in a single pediatric burn unit. Children hospitalized with burns ≤30% of total body surface area were included while patients with chemical burn, inhalation injury or concomitant chronic disease were excluded. Patients were classi ed into three groups for sepsis, systemic in ammatory response syndrome (SIRS) or controls using the American Burn Association (ABA) criteria. Predictive role of C-reactive protein (CRP) and PCT was investigated for distinguishing sepsis.Results: Seventy-two patients were included in the study. Median total body surface area (TBSA) size was 12% (2.0-28.5%) and median abbreviated burn severity index (ABSI) score was 3 (2-7). Median length of burn unit stay was 9.5 days (1-59 days). Sepsis was diagnosed in 11 patients (15.2%) and SIRS was present in 23 patients (40.0%), whereas 38 patients (52.8%) had neither SIRS nor sepsis (control group).Receiver operating characteristic analysis revealed that CRP and PCT levels distinguished sepsis patients from non-sepsis patients while PCT had a higher positive predictive value (64.3% vs 47.6%). Optimal cutoff values of CRP and PCT for distinguishing sepsis were 66.75 mg/L and 2.54 ng/mL. Conclusions: PCT levels could distinguish sepsis in children with burn injuries, performing better than CRP levels. Con rmatory studies are needed to evaluate the development of sepsis and role of PCT for diagnosing sepsis in pediatric burn patients.

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Infant burns: A single institution retrospective review

Cited by 15 publications

References 32 publications

Epidemiology and mortality in patients hospitalized for burns in Catalonia, Spain

Epidemiology and mortality in patients hospitalized for burns in Catalonia, Spain

Role of procalcitonin in paediatric burn wound sepsis

Use of procalcitonin as a biomarker for sepsis in pediatric burns

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