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The occurrence of single and multiple organ dysfunction in pediatric electrical versus other thermal burns
Gabriel Hundeshagen1, Paul Wurzer, Abigail A Forbes
1From the Department of Surgery (G.H., P.W., C.V., J.C-D., C.C.F., D.N.H., L.K.B.), University of Texas Medical Branch, Galveston, Texas; Shriners Hospitals for Children-Galveston, Galveston, Texas (G.H., P.W., C.V., J.C-D., C.C.F., D.N.H., L.K.B.); Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery (P.W., J.C-D.), Medical University of Graz, Graz, Austria; Sealy Center for Molecular Medicine and the Institute for Translational Sciences, University of Texas Medical Branch, Galveston, Texas (C.C.F.); and School of Medicine, University of Texas Medical Branch, Galveston, Texas (A.F., V.C.).
Insights
Electrical burns in children show a lower incidence of multiple organ failure (MOF) compared to thermal burns. Early tissue debridement is vital for improving outcomes in pediatric electrical burn patients.
Area of Science:
- Pediatric Surgery
- Burn Injury Research
- Critical Care Medicine
Background:
- Multiple organ failure (MOF) is a significant cause of death in burned children.
- The incidence and severity of single organ failure (SOF) and MOF in pediatric electrical burns are not well-established.
- This study compares SOF and MOF incidence and severity between electrical and thermal burns in children.
Purpose of the Study:
- To determine and compare the incidence and severity of SOF and MOF in pediatric patients with electrical burns (EB) versus thermal burns (CTR).
- To analyze other complications, demographic data, and outcomes in both burn groups.
- To compare serum cytokine expression profiles between EB and CTR groups.
Main Methods:
- A retrospective chart review of 288 pediatric patients (96 EB, 192 CTR) from 2001-2016.
- Statistical analysis of demographic data, hospitalization length, operations, amputations, and complications.
- SOF and MOF incidence assessed using DENVER2 classification and mixed-effects models; cytokine profiles compared.
Main Results:
- Groups were comparable in age, burn size (TBSA), and hospitalization length.
- MOF incidence was significantly lower in EB (2.1%) vs. CTR (10.4%; p < 0.05).
- Amputations were more frequent in EB patients; inhalation injury was higher in CTR patients. Mortality and cytokine profiles were comparable.
Conclusions:
- Pediatric electrical burns are associated with a lower incidence of MOF compared to thermal burns.
- Early and thorough debridement of nonviable tissue is critical for managing electrical burn injuries.
- Outcomes in pediatric electrical burn patients can be improved through timely surgical intervention.
Background:
Multiple organ failure (MOF) is a major contributor to morbidity and mortality in burned children. While various complications induced by electrical injuries have been described, the incidence and severity of single organ failure (SOF) and MOF associated with this type of injury are unknown. The study was undertaken to compare the incidence and severity of SOF and MOF as well as other complications between electrically and thermally burned children.
Patients And Methods:
Between 2001 and 2016, 288 pediatric patients with electrical burns (EB; n = 96) or thermal burns (CTR; n = 192) were analyzed in this study. Demographic data; length of hospitalization; and number and type of operations, amputations, and complications were statistically analyzed. Incidence of SOF and MOF was assessed using the DENVER2 classification in an additive mixed model over time. Compound scores and organ-specific scores for lung, heart, kidney, and liver were analyzed. Serum cytokine expression profiles of both groups were also compared over time. Significance was accepted at p < 0.05.
Results:
Both groups were comparable in age (CTR, 11 ± 5 years, vs EB, 11 ± 5 years), percent total body surface area burned (CTR, 33% ± 25%, vs EB, 32 ± 25%), and length of hospitalization (CTR, 18 ± 26 days, vs EB, 18 ± 21 days). The percentage of high-voltage injury in the EB group was 64%. The incidence of MOF was lower in the EB group (2 of 96 [2.1%]) than the CTR group (20 of 192 [10.4%]; p < 0.05). The incidence of single organ failure was comparable between groups. Incidence of pulmonary failure was comparable in both groups, but incidence of inhalation injury was significantly higher in the CTR group (p < 0.0001). Patients in the EB group had more amputations (p < 0.001), major amputations (p = 0.001), and combined major amputations (p < 0.01). Mortality was comparable between the groups. Serum cytokine expression profiles were also comparable between the groups.
Conclusions:
In pediatric patients, electrical injury is associated with a lower incidence of MOF than other thermal burns. Early and radical debridement of nonviable tissue is crucial to improve outcomes in the electrical burn patient population.
Level Of Evidence:
Retrospective chart review, level III.
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