Does the heat source affect the risk of wound infection in children with scalds?

Scalds are the leading cause of burns in children younger than 5 years of age with most being related to food preparation and consumption. Hot substances causing scalds have different degrees of viscosity varying from low (liquid substances, such as water), to high (semi-solids or solids, such as oils or grease). It is still underknown whether heat substances with different viscosities are associated with varying risks of developing burn wound infections (BWI). The aim of this study was to investigate the association between heat sources of different viscosities and development of BWI within the first week after injury in children with scalds.

Children 5 years and younger of age admitted at the Linköping Burn Center for new scalds between 2015 and 2020 were included. Data source for the study population was the Burn Unit Database. BWI was defined as fulfilment of at least two ABA criteria at the time of systemic antibiotic therapy (AB) initiation between day 2-7 following scald. Medical record review was undertaken to identify the heat source causing the scald, BWI criteria, and the use of AB. Legal guardians were contacted in cases in which information was missing. Logistic regression was used to analyse the association between heat source and development of BWI.

The study population consisted of 271 children, median age was 1.5 years, 61 % were boys, median burn size was 3.5 % of the total body surface area (TBSA), 10 (4 %) had a full thickness burn. BWI were identified in 69 (26 %) of the children. Most scalds were caused by contact with hot liquids (n=184), followed by semisolids (n=52) and solids (n=35). The logistic regression model showed that the size of the burn (TBSA) was associated with BWI, while type of heating agent was not.

Our results indicate that the viscosity of the heat source does not affect the risk of wound infection in children with scalds; only the size of the area burned was an independent factor for BWI.