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Etiology and outcome of pediatric burns
S E Morrow1, D L Smith, B A Cairns
1Department of Surgery, University of North Carolina at Chapel Hill, NC 27599-7210, USA.
Insights
Pediatric burn victims under age 4 face the highest mortality risk, especially with large burns or inhalation injuries. Even smaller burns can be fatal in young children, highlighting the critical need for early intervention and prevention strategies.
Area of Science:
- Pediatric Burn Injury
- Trauma Surgery
- Public Health
Background:
- Pediatric burn injuries represent a significant cause of morbidity and mortality.
- Understanding the specific risk factors and outcomes in different age groups is crucial for effective treatment and prevention.
Purpose of the Study:
- To analyze the causes and outcomes of pediatric burns treated at a major burn center.
- To identify key predictors of mortality in children with burn injuries.
Main Methods:
- A 6-year retrospective review of 449 pediatric burn patients (<16 years).
- Data stratified by age, sex, burn size (total body surface area - TBSA), inhalation injury, burn cause, and residence.
- Statistical analysis to determine factors influencing mortality.
Main Results:
- Overall mortality was 4.7%, with 18 of 21 deaths in children under 4.
- Children under 4 with large burns (>30% TBSA) had significantly higher mortality (46.9%) than older children (12.5%).
- Large burn size, age under 4, and inhalation injury were strong predictors of mortality.
Conclusions:
- Infants and young children are at the highest risk for fatal burn injuries.
- Even smaller burns (<30% TBSA) without inhalation injury can be lethal in this vulnerable population.
- Burn prevention and targeted interventions for young children are essential.
Abstract:
A 6-year retrospective review of burn victims hospitalized at a major burn center was conducted to determine the etiology and outcome of pediatric burns. Four hundred forty-nine patients under age 16 years were identified and stratified by age, sex, burn size, presence or absence of inhalation injury, cause of burn, and county of residence. The mean patient age was 4.3 +/- 0.2 years, and the male:female ratio was 1.9:1. There were 21 deaths overall (4.7%), the majority of which (18) were among children under 4 years of age. With respect to large burns, defined as > and = 30% total body surface area (TBSA), the mortality rate for children under age 4 was significantly higher than that for older children (46.9% v 12.5%; P < .01), despite the nearly identical mean burn size of the two groups. Except for burn incidence, there were no significant differences between males and females. The mean burn size was 15.1% +/- 0.7%, and was significantly larger for nonsurvivors than survivors (55.3% +/- 5.7 v 13.1% +/- 0.5%; P < .01). Inhalation injuries were strongly associated with large burns and were present in all 15 flame-burn fatalities. Scalds were the most common type of burn among children under 4 years of age; flame burns predominated in older children. There were 6 deaths related to scalds, all of which occurred in children under 4. Burn type, size, and mortality rate did not differ between children from urban and rural counties. Large burn size was the strongest predictor of mortality, followed by (in order) age less than 4 and the presence of inhalation injury. Infants and young children have the highest risk of death from burn injury. Burns smaller than 30% TBSA without an inhalation injury (such as small scald injuries) occasionally are lethal in infants and small children, despite modern therapy.