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Thermal injuries in under-4-year-old children: the Lesotho experience
A M O Shonubi1, O Akiode, A A Musa
1Queen Elizabeth II Hospital, Maseru, Kingdom of Lesotho, Nigeria. amoshonubi@yahoo.co.uk
Insights
This study reviewed pediatric thermal injuries at Queen Elizabeth II Hospital, highlighting outcomes without a specialized burns unit. High fatality rates suggest a need for a dedicated burns unit to improve patient care.
Area of Science:
- Pediatric Surgery
- Trauma Care
- Public Health
Background:
- Queen Elizabeth II Hospital, Lesotho's primary healthcare facility, lacks a dedicated burns unit.
- This study retrospectively analyzed pediatric burn patient management over five years.
Purpose of the Study:
- To document the management and outcomes of acute thermal injuries in children treated without a specialized burns unit.
- To identify areas for improvement in pediatric burn care in resource-limited settings.
Main Methods:
- Retrospective review of 98 children admitted for acute thermal injuries between May 1997 and April 2002.
- Treatment protocol included urgent shock care, fluid therapy, wound management, and early enteral feeding.
- Data collected on injury type, treatment, complications, and outcomes.
Main Results:
- Scalding (46%) and full-thickness burns (87%) were predominant, primarily affecting the upper body.
- 82% of patients required skin grafting; common complications included infection, fluid imbalance, respiratory issues, and contractures.
- Mean hospital stay was 40 days, with a case fatality rate of 9%.
Conclusions:
- Pediatric burn management is feasible without a dedicated unit, but outcomes can be improved.
- A well-staffed, specialized burns unit is crucial for reducing the high case fatality rate and enhancing patient care in Lesotho.
Abstract:
The Queen Elizabeth II Hospital is the apex of the health care services in the Kingdom of Lesotho but has no designated burns unit. A review of patients managed during a 5-year period was done to document our experience so as to show what can be achieved even without a standard burns unit. We reviewed the clinical course of children who were admitted for care of acute thermal injuries during a 5-year period, May 1997 to April, 2002 inclusive. All were treated in the children surgical ward in accordance with a protocol of care emphasizing urgent care of shock, accurate fluid therapy, open wound care and early enteral feeding. Ninety-eight children (51 males and 47 females) aged 4 months to 43 months (mean 21.66 +/- 11.30 months) were admitted on account of acute thermal injuries during the study period. The injuries included scalding (46%) involving predominantly the upper part of the body and full thickness burns (87%). Skin grafting was needed in 82% of the patients. The common complications were infection, fluid imbalance, respiratory problems, and contracture deformities. The mean duration of hospital stay was 40 +/- 4.43 days and the case fatality rate was 9%. The case fatality rate in this series is considered high and could be improved if there were a well staffed specialized burns unit.
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