Is the Use of Routine Echocardiograms Warranted in Large Pediatric Burns?

Area of Science:

• Pediatric Cardiology
• Burn Medicine
• Critical Care

Background:

• Large pediatric burns (≥30% Total Body Surface Area) can lead to cardiac dysfunction, including left ventricular dysfunction and dilated cardiomyopathy.
• This cardiac abnormality can prolong hospital stays, particularly in patients with burns exceeding 40% TBSA.
• Early recognition of cardiac dysfunction is crucial for timely intervention and improved patient outcomes.

Purpose of the Study:

• To evaluate the efficacy of early echocardiogram use in identifying pediatric burn patients at risk for cardiac dysfunction.
• To determine if routine echocardiograms in large pediatric burns can predict perioperative or long-term cardiac complications.
• To assess the utility of echocardiography in managing cardiac abnormalities in pediatric burn patients.

Main Methods:

• Prospective evaluation of pediatric burn patients (0-18 years) with ≥30% TBSA burns or documented cardiac dysfunction.
• Echocardiograms were performed upon admission and repeated monthly until three normal studies were achieved, or upon discharge/symptomatic presentation.
• Data collected included patient demographics, burn characteristics (TBSA, depth), and echocardiogram findings.

Main Results:

• Ten patients met enrollment criteria out of 130 admitted burn patients.
• The average age was 5 years, with 70% males and 90% flame injuries; average TBSA was 45%.
• One patient with a 25% TBSA burn showed severe left ventricular dysfunction (EF 25%) due to myocardial stunning, which fully recovered; other patients showed no abnormalities.

Conclusions:

• Routine early echocardiograms in asymptomatic pediatric burn patients with large TBSA injuries did not reveal cardiac dysfunction.
• Echocardiography is most valuable when used in symptomatic pediatric burn patients or those with specific cardiac concerns.
• Current evidence suggests a targeted approach to echocardiogram use in this population is more effective than routine screening.