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Weight-based vs body surface area-based fluid resuscitation predictions in pediatric burn patients
Jan V Stevens1, Nina S Prieto1, Elika Ridelman2
1Department of Surgery, Division of Pediatric Surgery, Wayne State University/Children's Hospital of Michigan, 3901 Beaubien Blvd. #2129, Detroit, MI 48201, USA.
Insights
Pediatric burn fluid resuscitation using weight-based formulas may lead to complications. This study compared weight-based Parkland formula with BSA-based formulas, finding variations in fluid administration and highlighting the need for further research.
Area of Science:
- Pediatric Burn Management
- Fluid Resuscitation Strategies
- Clinical Outcomes in Burn Injury
Background:
- Pediatric burn treatment relies on fluid resuscitation formulas based on weight and body surface area (BSA).
- Accurate fluid estimation is crucial for preventing complications in pediatric burn patients.
- Existing formulas, such as the weight-based Parkland formula, are commonly used but their efficacy across different weight percentiles requires evaluation.
Purpose of the Study:
- To evaluate the risk of complications associated with weight-based fluid resuscitation in pediatric burn patients.
- To compare fluid resuscitation estimates from weight-based formulas with those incorporating body surface area (BSA).
- To analyze fluid administration variations across different weight percentiles in children with severe burns.
Main Methods:
- Retrospective review of 110 pediatric patients with ≥15% TBSA burn admitted over 12 years.
- Resuscitation primarily used the weight-based Parkland formula; Galveston and Cincinnati (BSA-incorporated) formula predictions were calculated.
- Patients categorized into weight groups (underweight, normal, overweight, obese); complications tracked throughout hospitalization.
Main Results:
- Total fluid administered increased with higher weight percentiles; overweight children received more fluid than obese children (p=0.023).
- The Galveston formula significantly underpredicted fluid needs in the first 24 hours (p=0.042).
- Parkland and Cincinnati formula predictions showed no significant difference from actual fluids administered.
Conclusions:
- Weight-based resuscitation in pediatric burns may present risks, with fluid administration varying by weight percentile.
- BSA-based formulas like Galveston may underpredict fluid requirements, necessitating careful clinical judgment.
- Further research is essential to determine optimal fluid resuscitation formulas for minimizing complications in pediatric burn care.
Abstract:
Treatment for pediatric burns includes fluid resuscitation with formulas estimating fluid requirements based on weight and/or body surface area (BSA) with percent total body surface area burn (%TBSA burn). This study evaluates the risk of complications using weight-based resuscitation in children following burn injuries and compares fluid estimates with those that incorporate BSA. A retrospective review was conducted on 110 children admitted to an ABA-verified urban pediatric burn center over 12 years. Patients had ≥ 15% TBSA burn and were resuscitated with the weight-based Parkland formula. BSA-based Galveston and BSA-incorporated Cincinnati formula predictions were calculated. Complications were collected throughout hospital stay. Patients were classified into weight groups based on percentile. This study included 11 underweight, 60 normal weight, 18 overweight, and 21 obese children. Total fluid administered was higher as percentile increased; however, overweight children received more fluid than the obese (p = 0.023). The Galveston formula underpredicted fluid given over the first 24 h post-injury (p = 0.042); the Parkland and Cincinnati formula predictions did not significantly differ from fluids given. Further research is needed to determine the value of weight-based vs BSA-based or incorporated formulas in reducing risk of complications.
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