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Published on: February 23, 2024
Pediatric Burn Injuries: Risk Factors for Increased Mortality
Samantha M Koenig1, Luqin Deng2, Chinwendu Onwubiko1
1Division of Pediatric Surgery, Children's of Alabama, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
Insights
Pediatric burn injury mortality is linked to nonaccidental burns, Black race, and multiple body region involvement. Older children faced higher mortality risks, contrasting with prior research findings.
Area of Science:
- Pediatric surgery
- Trauma research
- Public health
Background:
- Burn injuries are a leading cause of unintentional death in children.
- Limited research exists on mortality disparities in pediatric burn injuries, particularly concerning nonaccidental burns.
- Understanding risk factors is crucial for improving outcomes in pediatric burn patients.
Purpose of the Study:
- To identify risk factors associated with mortality in pediatric burn injuries.
- To characterize the patient population with severe burn injuries.
- To investigate disparities in burn injury mortality among children.
Main Methods:
- Utilized the Trauma Quality Improvement Program database (2017-2019).
- Identified pediatric burn patients (≤14 years old).
- Analyzed demographics, insurance type, and physical abuse descriptors to assess mortality risk factors using multivariable logistic regression.
Main Results:
- Overall mortality was low (<1%) in 13,472 pediatric burn patients.
- Burns to multiple body regions, older age groups (5 to <10 years), and Black race were independent risk factors for mortality.
- Nonaccidental burns showed twice the mortality of accidental burns; government insurance was common among deceased patients.
Conclusions:
- Key mortality risk factors in pediatric burns include Black race, multiple affected body regions, and nonaccidental injuries.
- This study highlights increased mortality risk in older pediatric burn patients, differing from previous findings.
- Addressing nonaccidental burns and racial disparities is critical for reducing pediatric burn mortality.
Introduction:
Burn injuries are among the top ten leading causes of unintentional death in pediatric patients and are encountered by pediatric surgeons in all practice settings. There is a lack of literature evaluating mortality in pediatric burn injuries in regard to nonaccidental burns and potential disparities. Our study aims to determine the risk factors associated with mortality in pediatric burn injuries and highlight the characteristics of this patient population.
Methods:
We utilized the Trauma Quality Improvement Program database from 2017 to 2019 to identify primary burn injuries in children ≤14 y old. Physical abuse descriptors were used to identify patients with suspected nonaccidental injuries. Further demographics, including age, race, ethnicity, and insurance type, were evaluated. Descriptive statistics were generated and a multivariable logistic regression analysis was utilized to evaluate risk factors for mortality.
Results:
13,472 pediatric burn patients (≤14 y old) were identified. The overall mortality was low (<1%). Children with burns to multiple body regions had the highest independent risk of mortality in this cohort. All older age groups had an independent risk of mortality compared to the youngest patients, but those from ages 5 to <10 y old had the highest risk of mortality (OR = 11.40; 95% confidence interval: 4.41-29.43, P < 0.001). Black children had a significantly higher mortality compared to White children. Nonaccidental burns carried a mortality that was twice that of accidental burns. Government insurance type was the primary insurance type for a majority of patients who died.
Conclusions:
Risk factors for mortality in pediatric burn include Black race, multiple affected body regions, and nonaccidental burns. This study identified an increased mortality risk in the older age groups in contrast to previous studies that showed increased mortality in younger patients suffering from burn injuries.
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