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Published on: February 23, 2024
Clinical Profile of Children with Burns in a Tertiary Care Hospital
K Yashaswini1, A V Lalitha1, Gs Naresh Kanna2
1Department of Pediatric Critical Care, St John's National Academy of Health Sciences, Bengaluru, Karnataka, India.
Insights
Pediatric burn survivors with over 40% total burn surface area (TBSA) face increased mortality risks. Higher resuscitation needs and organ dysfunction scores may predict outcomes in pediatric burn patients.
Area of Science:
- Pediatric critical care medicine
- Burn injury research
- Trauma and injury epidemiology
Background:
- Optimal resuscitation strategies and outcome predictors for pediatric burns remain understudied.
- Pediatric burns are a significant cause of non-fatal injuries in children.
- This study addresses the knowledge gap in pediatric burn management.
Observation:
- A retrospective cohort study analyzed 99 children (1 month to 18 years) admitted to the pediatric intensive care unit (PICU) with burns between 2015 and 2020.
- Data collected included total burn surface area (TBSA), illness severity scores (PRISM III, PELOD-II), resuscitation requirements, and various outcome parameters.
- The study evaluated mechanical ventilation, renal replacement therapy, and hospital/PICU length of stay.
Findings:
- Multivariate analysis revealed that TBSA >40% was significantly associated with adverse outcomes (AOR 4.62).
- Pediatric logistic organ dysfunction (PELOD-II) score on day 1 was a significant predictor of 28-day mortality (HR 1.22).
- Higher resuscitation requirements correlated with increased organ dysfunction and mortality risk.
Implications:
- Findings suggest that TBSA and early organ dysfunction scores are critical in predicting mortality in pediatric burn patients.
- The study highlights the need for further research to standardize resuscitation protocols for pediatric burns.
- Improved understanding of outcome predictors can guide clinical decision-making and resource allocation in pediatric intensive care units.
Background:
Optimal resuscitation measures and outcome predictors in cases of burns are not studied in pediatric population, though it accounts for one of the leading causes of non-fatal injuries in the pediatric age group.
Objective:
We describe the clinical profile and outcome predictors in children admitted with burns.
Materials And Methods:
This retrospective cohort study included all children between 1 month and 18 years admitted to pediatric intensive care unit (PICU) with burns from January 2015 to December 2020. The total burns surface area (TBSA) was assessed and treated as per unit protocol. Illness severity score (PRISM III) and pediatric logistic organ dysfunction (PELOD-II) on day 1 and subsequently was noted. Resuscitation requirements including inotropes and colloids were evaluated. Outcome parameters like need for mechanical ventilation, renal replacement therapy, duration of hospital stay, PICU stay, and mortality were assessed.
Results:
Of 286 children admitted with burns, 99 had PICU admissions, and of these 59% were males with median (IQR) age 36 (13,72) months. Multivariate logistic regression analysis showed TBSA >40% [adjusted odds ratio (AOR) 4.62 [1.11-19.32] p-value < 0.036]. Cox regression for 28 day mortality was significant only for PELOD day 1 (heart rate (HR) 1.22 [1.05-1.41]).
Conclusion:
Higher resuscitation requirements with higher organ dysfunction scores may predict mortality in pediatric burns warranting further study for standardization of care.
How To Cite This Article:
Yashaswini K, Lalitha AV, Kanna GSN, Kujur AR, Michael Raj JA. Clinical Profile of Children with Burns in a Tertiary Care Hospital. Indian J Crit Care Med 2023;27(12):934-938.
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