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Pulmonary embolism in burned children
M H Desai1, H A Linares, D N Herndon
1Shriners Burns Institute, Galveston, TX 77550.
Insights
Pulmonary embolism (PE) is rare in burned children, accounting for less than 2% of deaths. This study found PE in 1.7% of pediatric burn patient deaths, highlighting a need for awareness.
Area of Science:
- Pediatric critical care
- Trauma surgery
- Cardiovascular medicine
Background:
- Pulmonary embolism (PE) is a known complication in adult burn survivors, but data on pediatric populations is scarce.
- Diagnosing PE in burned children is challenging due to overlapping symptoms with pulmonary complications like pneumonia and inhalation injury.
- This study aimed to determine the incidence of PE in pediatric burn patients.
Observation:
- A retrospective review of 6589 pediatric burn admissions over 22 years identified 178 deaths.
- Pulmonary embolism was the primary cause of death in 3 cases (1.7% of deaths).
- Deep vein thrombosis (DVT) was associated with 2 additional deaths (1.1% of deaths).
Findings:
- The incidence of PE in this cohort of burned children was 46 per 100,000 admissions.
- Despite numerous risk factors including immobility and surgical procedures, PE accounted for a small fraction of mortality.
- The overall mortality attributed to PE in pediatric burn patients was less than 2% of all deaths.
Implications:
- Burned children face significant risks for PE, necessitating vigilant monitoring and early diagnosis.
- Understanding the incidence of PE in this population can inform clinical practice and risk stratification.
- Further research is warranted to explore preventative strategies and optimize management of PE in pediatric burn care.
Abstract:
There are occasional reports in the literature concerning the incidence of pulmonary embolism in the postburn population, but reports of burned children are especially rare. The clinical diagnosis of pulmonary embolism is particularly difficult in these populations due to the postburn pulmonary complications of pneumonia, bronchopneumonia, respiratory distress syndrome, and changes incurred through inhalation injury. A retrospective review of all patient deaths occurring at this institution during the past 22 years was performed in order to document the incidence of pulmonary embolism in burned children. Of the 6589 patients admitted during this time, 178 patients died (2.7%) and three (1.7%) deaths were attributable to pulmonary embolism. Two other deaths (1.1%) were associated with deep vein thrombosis. The incidence of pulmonary embolism can then be calculated at 46 per 100,000 admissions in this population of burned children. Burned patients always pose an increased risk for the development of pulmonary embolism. These patients are traumatized, require multiple venous and/or arterial cannulations, undergo multiple surgical procedures, are immobile for prolonged periods, prone to infectious processes and fluid and electrolyte imbalances. Despite all these risk factors, the incidence of pulmonary embolism is less than 2 per cent of all deaths in this postburn paediatric population.