Silver-Impregnated Burn Care Associated With Fewer Painful Dressing Changes and Opioid Doses for Kids

Pediatric partial thickness burn care with antibiotic ointment requires frequent dressing changes with opioid pain management. Alternatively, silver-impregnated dressings are changed less frequently. This study evaluates the association between adoption of silver-impregnated dressings and clinical outcomes and costs.

A retrospective cohort study was conducted of patients (<16 y) with partial thickness burns (05/2021-07/2024). Patients requiring grafting were excluded. Demographics, burn injury details, dressings, hospital-perspective costs were collected. Patients were grouped by management: short-term dressings (SDs) for antibiotic ointment and nonadherent gauze, long-term dressings (LDs) for silver-impregnated antimicrobial contact layers. Univariate analysis and propensity weighting with linear regressions were used.

Overall, 556 patients were treated: 77% with SD, 23% with LD. The median age was 2.7 y (interquartile range [IQR]: 1.3-6.6); 55% were male. Scald burns were most common (70%). Median total body surface area was greater in SD patients (4 [IQR: 2-7] versus 3 [IQR:2-6]; P < 0.05). Over time, the proportion of LD/year increased from 7%-52%. SD patients were prescribed more opioid doses on discharge (10.3 [95% confidence interval [CI]: 9.3-11.2] versus 5.8 [95% CI: 4.6-7.0]) by a mean difference of 4.5 (95% CI: 2.9-6.0; P < 0.001). Post discharge, 98% of SDs required twice-daily changes whereas 97% of LDs required changes every 3 d or less (P < 0.001). There was no difference in length of stay (LOS) (adjusted risk ratio: 1.04; 95% CI: 0.82-1.31), and 30-d costs were comparable (adjusted risk ratio: 1.19; 95% CI: 0.91-1.57).

LD were associated with fewer at-home dressing changes and opioid doses, and were not associated with increased LOS or hospital costs. Children with partial thickness burns should be treated with LD when possible to avoid painful dressing changes.