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The optimal time for excision of scald burns in toddlers
Insights
Early surgical excision and grafting for pediatric scald burns may not be optimal. Delaying surgery beyond five days could reduce excised area and blood loss without increasing hospital stay.
Area of Science:
- Pediatric Burn Care
- Surgical Intervention Efficacy
- Scald Injury Management
Background:
- Early excision and grafting reduce morbidity and mortality in moderate to large burns.
- Limited data exists on the effectiveness of early surgical intervention for pediatric scald burns.
Purpose of the Study:
- To evaluate the impact of the timing of surgical procedures on outcomes in children under age 4 with scald burns.
- To determine if delaying excision and grafting affects excised area, blood loss, and hospital stay.
Main Methods:
- Retrospective study of pediatric patients (under 4 years) admitted within three days of a scald injury.
- Patients were grouped based on the day of their first surgical procedure (≤5 days, 6-10 days, 11-20 days, >20 days).
- Analysis of excised area, blood loss, and length of hospital stay across the four groups, controlling for age, weight, and % TBSA burn.
Main Results:
- Group 1 (surgery ≤5 days) had significantly larger excised areas and greater blood loss compared to groups 2 and 3.
- Only Group 4 (surgery >20 days) showed a significantly increased length of hospital stay.
- No significant differences in length of stay were observed between groups 1, 2, and 3.
Conclusions:
- Delaying surgical excision and grafting for pediatric scald burns until after day 5 may decrease the excised area and blood loss.
- This delay might be achievable without prolonging the length of hospital stay, suggesting a potential optimization of treatment protocols.
- Further research is warranted to confirm these findings and establish optimal timing for surgical intervention in pediatric scald burn management.
Abstract:
During the past decade, morbidity and mortality have been shown to be decreased by early excision and grafting in treatment of moderate and large burns. Because of the lack of data on the efficacy of such treatment in scald burns, a retrospective study was done of children under age 4 who were admitted to a burn unit within three days of scald injury. Four groups were examined according to day of first surgical procedure: (1) sooner than five days; (2) 6-10 days; (3) 11-20 days; and (4) later than 20 days. The four groups (similar in age, weight, and percent of TBSA burn) were also analyzed for differences in percent of excised area, blood loss, and length of hospital stay. The amount of excised area in group 1 was significantly larger than in groups 2 and 3, and group 1 also had a significantly greater blood loss. Only in group 4 was the length of stay significantly increased. If excision could be delayed until after day 5, the area excised and the blood loss might be decreased without prolonging hospital stay.