Variation in acute fluid resuscitation among pediatric burn centers

Area of Science:

• Pediatric critical care medicine
• Burn management and resuscitation
• Quality improvement in healthcare

Background:

• Accurate fluid resuscitation is crucial for pediatric patients with extensive thermal injuries.
• Variability in resuscitation guidelines can affect patient outcomes.
• Standardization of care is essential for optimal treatment.

Purpose of the Study:

• To assess the variability in resuscitation guidelines across pediatric burn centers.
• To determine the impact of guideline variations on estimated fluid resuscitation volumes.
• To compare center-specific guidelines with American Burn Association recommendations.

Main Methods:

• Data from five pediatric burn centers (Pediatric Injury Quality Improvement Collaborative - PIQIC) were analyzed.
• Patient data included burns ≥15% total body surface area (TBSA) from 2014-2018.
• Estimated 24-hour fluid requirements were calculated using center guidelines and compared to actual fluid received.

Main Results:

• Significant differences were observed in fluid resuscitation initiation, Parkland formula coefficients, dextrose use, and urine output goals.
• Three centers' guidelines resulted in statistically significant lower mean fluid estimates compared to actual fluid received (e.g., 3.38 vs. 6.35 ml/kg/% TBSA).
• Mean fluid received across all centers was 6.35 ml/kg/% TBSA.

Conclusions:

• Variations in pediatric burn center resuscitation practices lead to significant differences in fluid volume estimations.
• One participating center revised its resuscitation guidelines post-study due to observed variations.
• The findings underscore the need for standardized resuscitation protocols in pediatric burn care.