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No statistically significant difference in long term scarring outcomes of pediatric burns patients treated surgically
1Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom.
Insights
Long-term scarring outcomes in paediatric burns patients were similar between surgical Versajet® debridement/Biobrane® and conservative Mepitel®/Acticoat® treatments. This study utilized the paediatric Brisbane Burn Scar Impact Profile (BBSIP) to assess patient-reported outcomes.
Area of Science:
- Paediatric burn management
- Scar outcome assessment
- Clinical trial methodology
Background:
- Long-term scar outcomes in paediatric burns are poorly understood.
- Most children receive limited follow-up post-discharge.
- Scar services are not universally available.
Purpose of the Study:
- To compare long-term scar outcomes in paediatric burn patients.
- To evaluate surgical Versajet® debridement and Biobrane® versus conservative Mepitel® and Acticoat® dressings.
- To determine if treatment modality impacts scar quality.
Main Methods:
- Telephone contact with parents of admitted paediatric burn patients (Oct 2014-Sep 2017).
- Administration of the paediatric Brisbane Burn Scar Impact Profile (BBSIP), a patient-reported outcome measure (PROM).
- Statistical analysis of BBSIP scores comparing surgical and conservative treatment groups.
Main Results:
- 34 patients (13 surgical, 21 conservative) responded out of 107 admitted.
- No statistically significant difference in BBSIP scores between surgical and conservative groups.
- Optimal outcomes (lowest scores) were observed in 31 BBSIP questions for all patients.
Conclusions:
- Surgical intervention for paediatric burns should be considered without undue fear of long-term scar impact.
- This study is the first to use BBSIP for assessing long-term paediatric burn scar outcomes.
- Further research with larger datasets and multi-centre comparisons is warranted.
Introduction:
Paediatric burns are a common clinical presentation. The long-term scar outcomes in paediatric burns patients are relatively unknown as most are discharged after 6 weeks follow up, apart from the small number that are followed up by scar services depending on geographical availability. We aimed to determine whether the long-term scarring outcomes are significantly different in those who had surgical treatment with Versajet® debridement and Biobrane®, vs. those treated conservatively with non-adherent Mepitel® and Acticoat® dressings, in a cohort of paediatric burns patients.
Methods:
The parents of all paediatric burns patients admitted to Stoke Mandeville Hospital from October 2014 to September 2017 were contacted by telephone to fill in the paediatric Brisbane Burn Scar Impact Profile (BBSIP), the only patient reported outcome measure (PROM) specifically aimed at children. The results from the questionnaires underwent statistical analysis to see if there was a significant difference in questionnaire scores between children treated surgically vs. those treated conservatively.
Results:
A total of 107 children were admitted in the timeframe, responses were received from 34 patients with 13 having been treated surgically and 21 having been treated conservatively. In all 58 questions that make up the BBSIP, there was no statistically significant difference observed in the scores of those treated surgically vs. those treated conservatively. For 31 questions on the BBSIP, the lowest score indicating the best outcome was observed in all patients in both groups.
Discussion:
Surgical management for burns is always the last resort. Our results could be interpreted to suggest clinicians need not fear the longer-term impact a scar may have when deciding whether to treat a paediatric burns patient surgically or conservatively. This study is the first to assess longer-term scar outcomes using the BBSIP. A larger data set and comparison with other burn units in the UK may help to provide more information on scar outcomes between different methods of surgical and conservative treatment. We found no statistically significant difference in the long-term scar outcomes as assessed by the BBSIP in paediatric burn patients treated with Versajet® debridement and Biobrane®, vs. those treated conservatively with non-adherent Mepitel® and Acticoat® dressings.
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