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Updated: Dec 10, 2025
Author Spotlight: A Multi-Depth Porcine Model for Comprehensive Study of Burn Injuries and Healing Processes
Published on: February 23, 2024
Multicentre observational study describing the systemic response to small-area burns in children
Julia H Sarginson1, Linda Hollén2, Alan Emond2
1Children's Burns Research Centre, Bristol Royal Hospital for Children, UK.
Insights
Young children with small burns (2-10% total body surface area) exhibit a systemic inflammatory response, including fever. This finding aids in diagnosing burn-injured children presenting with fever without clear infection.
Area of Science:
- Pediatric Emergency Medicine
- Burn Injury
- Inflammatory Response
Background:
- Burns affecting less than 10% total body surface area (TBSA) are frequent in children under five.
- The systemic inflammatory response is known for larger burns (>20% TBSA) but poorly understood for smaller ones.
- This study aimed to characterize the systemic response in young children with minor burn injuries.
Purpose of the Study:
- To describe the systemic inflammatory response to burn injuries in children under five years of age with burns less than 10% TBSA.
- To identify key indicators of systemic response in pediatric burn patients.
- To provide data that can assist in the diagnosis of burn-related fever in children.
Main Methods:
- The Morbidity In Small Thermal Injury in Children (MISTIC) study was a multicenter prospective observational cohort study.
- 625 children under five with <10% TBSA burns were recruited across three English sites.
- Data included in-hospital physical observations, laboratory tests, and at-home temperature recordings.
Main Results:
- Children with 2-10% TBSA scald or contact burns showed elevated temperatures, peaking on day one and declining by days 4-7.
- No temperature elevation was observed in burns <2% TBSA.
- Higher temperatures correlated with larger burn size, younger age (under two years), and male sex. Heart rate and C-Reactive Protein peaked on day three.
Conclusions:
- A distinct systemic inflammatory response occurs in young children with small-area burns.
- This understanding can help diagnose children with burn injuries who present with fever but no other signs of infection.
- The study highlights the importance of recognizing systemic effects even in seemingly minor pediatric burns.
Background And Objectives:
Burns of less than 10% total body surface area (TBSA) are common injuries in children under five years of age. The inflammatory response to burn injury is well recognised for burns greater than 20% TBSA but has not been described for smaller burns. The aim of this study was to describe the systemic response to burn injury in young children with small-area burns.
Methods:
The Morbidity In Small Thermal Injury in Children study (MISTIC) was a multicentre prospective observational cohort study that recruited 625 patients under five years of age with burns of less than 10% TBSA over eighteen months across three sites in England. Prospectively collected data included physical observations and laboratory blood tests taken in hospital as part of routine care. Additional information was sourced from temperature recordings taken at home following discharge.
Results:
Elevated temperatures were observed in children with scald or contact burns between 2-10% TBSA, with a peak on day one after burn followed by a fall over days four to seven after burn. No temperature rise was seen in children with burns of <2% TBSA. Higher temperature readings were associated with larger burn size, age under two years and male sex. Heart rate and C-Reactive Protein levels showed a peak on day three after burn.
Conclusions:
An identifiable systemic inflammatory response to small-area burns in young children is reported. This knowledge can be used to aid in the diagnosis of children with a burn injury who re-present with a pyrexia, and no other symptoms to indicate clinical infection.
