TY - JOUR
T1 - Early management in children with burns: Cooling, wound care and pain management
AU - Baartmans, Martinus
AU - de Jong, AEE
AU - van Baar, ME
AU - Beerthuizen, GIJM
AU - van Loey, NEE
AU - Tibboel, Dick
AU - Nieuwenhuis, MK
PY - 2016
Y1 - 2016
N2 - Introduction: Early management in burns, i.e. prior to admission in a burn center, is essential for an optimal process and outcome of burn care. Several publications have reported suboptimal early management, including low levels of pain medication after trauma, especially in children. The aim of this study was to evaluate the current practice in the Netherlands and factors related to early management in pediatric burns, i.e. cooling, wound covering and pain management. To study possible change and improvement over time, two study periods were compared. Methods: This study involved two periods; January 2002-March 2004 (period 1) and January 2007-August 2008 (period 2). All children (0-15 years of age) with acute burns admitted within 24 h after burn to one of the three Dutch Burn centers with a formal referral were eligible. Data were obtained from patient records, both retrospectively and prospectively. Results: A total of 323 and 299 children were included in periods 1 and 2, respectively. The vast majority of children in both study periods had been cooled before admission (>90%). Over time, wound covering increased significantly (from 64% to 89%) as well as pain treatment (from 68% to 79%). Predominantly paracetamol and morphine were used. Referral from ambulance services (OR = 41.4, 95% CI = 16.6-103.0) or general practitioners (OR = 59.7, 95% CI = 25.1-141.8) were strong independent predictors for not receiving pre-burn center pain medication. On the other hand, flame burns (OR = 0.2, 95% CI = 0.1-0.5) and more extensive burns (TBSA 5-10%: OR = 0.4, 95% CI = -0.2 to 0.8; TBSA >= 10%: OR = 0.2, 95% CI = 0.1-0.4) were independent predictors of receiving pain medication. Conclusion: Referring physicians of children with burns were overall well informed: they cool the wound after burns and cover it before transport to prevent hypothermia and reduce the pain. Additional studies should be conducted to clarify the duration and temperature for cooling to be effective. Furthermore, there is room and a need for improvement regarding early pain management. (C) 2016 Elsevier Ltd and ISBI. All rights reserved.
AB - Introduction: Early management in burns, i.e. prior to admission in a burn center, is essential for an optimal process and outcome of burn care. Several publications have reported suboptimal early management, including low levels of pain medication after trauma, especially in children. The aim of this study was to evaluate the current practice in the Netherlands and factors related to early management in pediatric burns, i.e. cooling, wound covering and pain management. To study possible change and improvement over time, two study periods were compared. Methods: This study involved two periods; January 2002-March 2004 (period 1) and January 2007-August 2008 (period 2). All children (0-15 years of age) with acute burns admitted within 24 h after burn to one of the three Dutch Burn centers with a formal referral were eligible. Data were obtained from patient records, both retrospectively and prospectively. Results: A total of 323 and 299 children were included in periods 1 and 2, respectively. The vast majority of children in both study periods had been cooled before admission (>90%). Over time, wound covering increased significantly (from 64% to 89%) as well as pain treatment (from 68% to 79%). Predominantly paracetamol and morphine were used. Referral from ambulance services (OR = 41.4, 95% CI = 16.6-103.0) or general practitioners (OR = 59.7, 95% CI = 25.1-141.8) were strong independent predictors for not receiving pre-burn center pain medication. On the other hand, flame burns (OR = 0.2, 95% CI = 0.1-0.5) and more extensive burns (TBSA 5-10%: OR = 0.4, 95% CI = -0.2 to 0.8; TBSA >= 10%: OR = 0.2, 95% CI = 0.1-0.4) were independent predictors of receiving pain medication. Conclusion: Referring physicians of children with burns were overall well informed: they cool the wound after burns and cover it before transport to prevent hypothermia and reduce the pain. Additional studies should be conducted to clarify the duration and temperature for cooling to be effective. Furthermore, there is room and a need for improvement regarding early pain management. (C) 2016 Elsevier Ltd and ISBI. All rights reserved.
U2 - 10.1016/j.burns.2016.03.003
DO - 10.1016/j.burns.2016.03.003
M3 - Article
C2 - 27025801
SN - 0305-4179
VL - 42
SP - 777
EP - 782
JO - Burns
JF - Burns
IS - 4
ER -