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Early management in children with burns: Cooling, wound care and pain management
M G A Baartmans1, A E E de Jong2, M E van Baar3
1Department of Pediatrics, Maasstad Hospital, Rotterdam, The Netherlands.
Insights
Early burn management in children improved over time, with increased wound covering and pain treatment. However, pain management requires further enhancement for optimal pediatric burn care.
Area of Science:
- Pediatric Burn Care
- Emergency Medicine
- Trauma Management
Background:
- Optimal burn care outcomes depend on effective early management.
- Suboptimal early management, particularly pain relief in children, has been reported.
- This study evaluates current Dutch practices in pediatric burn pre-hospital care.
Purpose of the Study:
- To assess early management practices for pediatric burns in the Netherlands.
- To identify factors influencing cooling, wound covering, and pain management.
- To compare changes in these practices over two distinct time periods.
Main Methods:
- A comparative study of two periods: 2002-2004 and 2007-2008.
- Inclusion of children aged 0-15 years with acute burns admitted within 24 hours.
- Data collection via retrospective and prospective review of patient records from Dutch Burn Centers.
Main Results:
- Cooling was consistently high (>90%) in both periods.
- Significant increases observed in wound covering (64% to 89%) and pain treatment (68% to 79%).
- Referral source and burn characteristics influenced pain medication administration; improvement in pain management is needed.
Conclusions:
- Referring physicians generally provide adequate cooling and wound covering for pediatric burn patients.
- Early pain management in pediatric burns still presents an area for significant improvement.
- Further research is needed to optimize cooling protocols and enhance early pain relief strategies.
Introduction:
Early management in burns, i.e. prior to admission in a burn center, is essential for an optimal process and outcome of burn care. Several publications have reported suboptimal early management, including low levels of pain medication after trauma, especially in children. The aim of this study was to evaluate the current practice in the Netherlands and factors related to early management in pediatric burns, i.e. cooling, wound covering and pain management. To study possible change and improvement over time, two study periods were compared.
Methods:
This study involved two periods; January 2002-March 2004 (period 1) and January 2007-August 2008 (period 2). All children (0-15 years of age) with acute burns admitted within 24h after burn to one of the three Dutch Burn centers with a formal referral were eligible. Data were obtained from patient records, both retrospectively and prospectively.
Results:
A total of 323 and 299 children were included in periods 1 and 2, respectively. The vast majority of children in both study periods had been cooled before admission (>90%). Over time, wound covering increased significantly (from 64% to 89%) as well as pain treatment (from 68% to 79%). Predominantly paracetamol and morphine were used. Referral from ambulance services (OR=41.4, 95%CI=16.6-103.0) or general practitioners (OR=59.7, 95%CI=25.1-141.8) were strong independent predictors for not receiving pre-burn center pain medication. On the other hand, flame burns (OR=0.2, 95%CI=0.1-0.5) and more extensive burns (TBSA 5-10%: OR=0.4, 95%CI=-0.2 to 0.8; TBSA≥10%: OR=0.2, 95%CI=0.1-0.4) were independent predictors of receiving pain medication.
Conclusion:
Referring physicians of children with burns were overall well informed: they cool the wound after burns and cover it before transport to prevent hypothermia and reduce the pain. Additional studies should be conducted to clarify the duration and temperature for cooling to be effective. Furthermore, there is room and a need for improvement regarding early pain management.
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