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Inhalation burns in children
L Whitelock-Jones1, D H Bass, A J Millar
1Department of Paediatric Surgery, Red Cross Children's Hospital, University of Cape Town, Klipfontein Road, Rondebosch, 7700, South Africa.
Insights
Inhalation injury in children is often unrecognized and can lead to severe respiratory distress and death. Early diagnosis and management of inhalation burns are crucial for improving survival rates in pediatric burn patients.
Area of Science:
- Pediatric Burn Care
- Respiratory Medicine
- Trauma Surgery
Background:
- Childhood burn survival has improved, but mortality is often linked to total body surface area burned and unrecognized inhalation injury.
- Inhalation injury significantly contributes to morbidity and mortality in pediatric thermal injuries.
- Understanding the incidence and impact of inhalation injury is vital for improving outcomes.
Purpose of the Study:
- To determine the incidence, clinical presentation, and pathology of inhalation injury in children.
- To assess the contribution of inhalation injury to morbidity and mortality in pediatric burn patients.
- To evaluate the effectiveness of diagnostic and management strategies for inhalation injury.
Main Methods:
- Retrospective review of 4,451 pediatric thermal injury cases over 10 years.
- Diagnosis of inhalation burns confirmed clinically, endoscopically, and post-mortem.
- Classification of inhalation injury using the Moylan scale (upper-airway, major-airway, parenchymal).
Main Results:
- Inhalation burns occurred in 2.2% of children (97 cases), predominantly in fire burn victims.
- Key symptoms included stridor and progressive respiratory distress, sometimes with delayed onset up to 72 hours.
- Major complications included secondary pneumonia (41.5% fire, 55% hot-water burns) and persistent airway damage, contributing to significant mortality.
Conclusions:
- Inhalation burns in children are frequently underdiagnosed and can present with delayed symptoms.
- Early clinical diagnosis, supported by endoscopy, is essential for effective airway management.
- Prompt and appropriate management of inhalation injury is critical to reduce pediatric burn morbidity and mortality.
Abstract:
Survival from serious burns in children has improved substantially in recent years. Mortality is predominantly determined by the total body surface area burned and the often unrecognised inhalation injury. A retrospective review of 4,451 consecutive children with thermal injuries over a 10-year period was undertaken to determine the incidence, clinical presentation, and pathology of inhalation injury and its contribution to morbidity and mortality. Inhalation burns were diagnosed clinically and confirmed endoscopically and post-mortem in 97 (2.2%) children; 77 sustained fire burns (mean age 4 years) and 20 hot-water burns (mean age 18 months). The Moylan classification stratified them into upper-airway burns in 59 children, major-airway burns in 29, and parenchymal burns in 44. Major-airway burns were always seen in conjunction with either upper-airway or parenchymal injury. Stridor and acute progressive respiratory distress were the two main symptoms, the onset of which was occasionally delayed for up to 72 h. Endoscopy was most helpful in confirming the diagnosis and determining airway management. Endotracheal intubation was needed in more than 50% of children, usually for less than 5 days, and was converted to tracheostomy in only 6. Persistent laryngeal and tracheal damage was identified in 4. Secondary pneumonia occurred in 41.5% of children with fire burns and 55% with hot-water burns. Extensive surface burns, parenchymal injury, and secondary pneumonia all contributed to the significant mortality. Post-mortem findings corroborated clinical and endoscopic evidence. This study suggests that inhalation burns were often not recognised, could present late, and usually had significant consequences. Early clinical diagnosis, supported by endoscopic findings and appropriate management, is essential if the high morbidity and mortality amongst these children is to be improved.