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Early diagnosis of staphylococcal toxaemia in burned children
R M McAllister1, N S Mercer, B D Morgan
1R.A.F.T. Department of Research, Mount Vernon Hospital NHS Trust, Northwood, Middlesex, UK.
Insights
Early diagnosis of toxic shock syndrome in burned children is crucial. Key signs include high fever, rapid heart rate, and breathing rate, with a sudden drop in white blood cells and hemoglobin.
Area of Science:
- Pediatric Burn Care
- Infectious Diseases
- Critical Care Medicine
Background:
- Toxic shock syndrome (TSS) is a severe condition.
- Previous studies described TSS features in burned children.
- Early identification is vital due to high mortality.
Observation:
- A retrospective review of six burned children with suspected TSS was conducted.
- Early diagnostic indicators were identified: severe pyrexia (≥39.5°C), tachycardia, and tachypnoea.
- A rapid, profound drop in white cell count and hemoglobin occurred within hours post-injury.
Findings:
- The 'shock' phase, occurring 3-4 days post-burn, has a 50% mortality rate.
- Early signs suggest a distinct pattern preceding the shock phase.
- Prompt treatment before shock onset significantly improves outcomes.
Implications:
- Recognizing early signs like high fever, tachycardia, and tachypnoea can lead to earlier intervention.
- Renaming the condition 'staphylococcal toxaemia' may improve diagnostic recognition.
- Earlier diagnosis and treatment can reduce the mortality associated with TSS in burned children.
Abstract:
The features of toxic shock syndrome in burned children have been described in a review of seven patients (J. D. Frame et al., Burns 1985; 11, 234). These include a 'prodromal' 24-48 h period with diarrhoea, vomiting, general malaise, pyrexia, tachycardia and tachypnoea. The white cell count and haemoglobin concentration fall prior to the 'shock' phase, which occurs 3-4 days postburn. Once 'shock' has occurred the mortality of the condition is approximately 50 per cent; in the absence of 'shock' it is much reduced. We have undertaken a retrospective review of six burned children who were admitted in a 2-year period to the Mount Vernon NHS Trust Burns Unit with a clinical diagnosis of toxic shock syndrome. The evidence from our patients suggests that reliable early diagnostic signs are a rapidly developing severe pyrexia of 39.5 degrees C or above, and a simultaneously increasing tachycardia and tachypnoea to high levels. There is a sudden profound fall in the white cell count and haemoglobin concentration over a period of hours between 1 and 3 days from injury. Specific treatment should be instituted before the onset of 'shock'. The name staphylococcal toxaemia might promote earlier diagnosis and treatment of this condition and so reduce its mortality.