Pediatric Burn: Changing lives foreverLillian F. Liao, MD, MPHDivision of Trauma and Emergency Surgery Department of SurgeryUTHSCSA

Pediatric epidemiologyAnnual incidence of pediatric diagnosisCancer : 10,500Burn : >133,000South Texas > 200 cases annually [under estimated]

Annual pediatric mortalityHeart disease 674Birth defects 1,117Cancer 1,930Burn 2,500Trauma 12,388

EpidemiologyMOST COMMON out-patient burnsNon-intentional scalding burn

Most are preventable [woman and children]

Between 1985-2009: mortality decreases over timeBurn size and age are most important determinants

EpidemiologySocioeconomicsBurn admissions increase with decreasing socioeconomic statusHighest risk are:children in households without a separate kitchen kitchen without doors kerosene lamp usage in winter months

EpidemiologyEstimated 140,000 burns per year11,000 Children require hospitalizationSouth Texas average annual admission = 200+South Texas average annual clinic visits = 800+

Average hospital LOS = 3 daysSouth Texas average LOS = 2.4 days

Average $211 million in hospital charges annuallyLifetime cost associated with pediatric burn >$2 billion

EpidemiologyMost common types of burnScalding< 5 years 70% (Food > Water)> 5 years 30%

EpidemiologyMost common types of burnScalding< 5 years 70% (Food > Water)> 5 years 30%Flame

EpidemiologyMost common types of burnScalding< 5 years 70% (Food > Water)> 5 years 30%FlameContact

EpidemiologyMost common types of burnScalding< 5 years 70% (Food > Water)> 5 years 30%FlameContactElectrical

EpidemiologyMost common types of burnScalding< 5 years 70% (Food > Water)> 5 years 30%FlameContactElectricalNon-accidental burns - 20%

Acute burn resuscitation Four periods of treatmentEmergentAcuteChronicRehabilitation

Acute burn wound careAccess the depth of the burnSuperficialPartial thicknessFull thickness

Accurate assessment of % TBSA

Acute burn resuscitationNeed active resuscitation if >15% TBSA partial thickness burnParkland formula: [4ml] * [Kg] * [%TBSA]Brookes: [2ml] * [Kg] * [%TBSA]

Replace over first 8 hoursStarts from the time of injuryNext over the next 16 hours

Acute burn resuscitationFluid resuscitationResuscitation goals:HR [normal range for age]UOP 0.5 to 1 ml/kg/hrTemp > 37F

Acute burn resuscitationCriteria for transport to Burn centerPartial thickness burn >10% TBSA

Face, hands, feet, genitalia, major joints

Full thickness burn of any age

Electrical burns

Chemical burns

Inhalation injury

Acute burn resuscitationCriteria for transport to Burn centerPatient with multiple pre-existing medical problems + burn of any size

Burn + TraumaBurn + ChildBurn + Elderly Burn in patients with special needs

Sub-acute burn wound carePigment management

Risk of hypertrophic scarringHealing time 14-21 days: ~30% risk>21 days: ~70%

Pain management

Chronic burn wound careOccupational therapy

Physical therapy

Hypertrophic scar management

Psychosocial trauma

Prevention : To Keep Kids SafeKeep water heater setting

UT Medicine and UHS BURN TEAM

BURN Hotline:210-358-BURN

Thank you very much for inviting me to speak with you about the management of burn wounds.

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