Queensland University of Technology Faculty of Health, Centre for Children's Burns and Trauma Research, South Brisbane, Queensland, Australia.
Murdoch Children's Research Institute, Royal Children's Hospital, and Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
Ann Emerg Med. 2020 Jan;75(1):75-85. doi: 10.1016/j.annemergmed.2019.06.028. Epub 2019 Aug 29.
First-aid guidelines recommend the administration of cool running water in the early management of thermal injury. Our objective is to analyze the associations between first aid and skin-grafting requirements in children with burns.
This cohort study used a prospectively collected registry of patients managed at a tertiary children's hospital. Multivariate logistic regression models were used to evaluate the relationship between first aid and the requirement for skin grafting. Secondary outcomes included time to re-epithelialization, wound depth, hospital admission and length of stay, and operating room interventions. Adequate first aid was defined as 20 minutes of cool running water within 3 hours of injury.
In our cohort of 2,495 children, 2,259 (90.6%) received first aid involving running water, but only 1,780 (71.3%) were given the adequate duration. A total of 236 children (9.5%) required grafting. The odds of grafting were decreased in the adequate first aid group (odds ratio [OR] 0.6; 95% confidence interval [CI] 0.4 to 0.8). The provision of adequate running water was further associated with reductions in full-thickness depth (OR 0.4; 95% CI 0.2 to 0.6), hospital admission (OR 0.7; 95% CI 0.3 to 0.9), and operating room interventions (OR 0.7; 95% CI 0.5 to 0.9), but not hospital length of stay (hazard ratio=0.9; 95% CI 0.7 to 1.2; P=.48).
Burn severity and clinical outcomes improved with the administration of cool running water. Adequate first aid must be prioritized by out-of-hospital and emergency medical services in the preliminary management of pediatric burns.
急救指南建议在处理热损伤的早期管理中使用冷却的自来水。我们的目的是分析急救与儿童烧伤植皮需求之间的关系。
本队列研究使用了一家三级儿童医院管理的患者前瞻性收集的登记处。使用多变量逻辑回归模型来评估急救与植皮需求之间的关系。次要结局包括再上皮化时间、伤口深度、住院和住院时间以及手术室干预。适当的急救定义为受伤后 3 小时内用冷水冲洗 20 分钟。
在我们的 2495 名儿童队列中，2259 名（90.6%）接受了涉及自来水的急救，但只有 1780 名（71.3%）接受了足够的时间。共有 236 名儿童（9.5%）需要植皮。在适当的急救组中，植皮的几率降低（优势比[OR]0.6；95%置信区间[CI]0.4 至 0.8）。提供足够的自来水还与全层深度（OR 0.4；95%CI 0.2 至 0.6）、住院（OR 0.7；95%CI 0.3 至 0.9）和手术室干预（OR 0.7；95%CI 0.5 至 0.9）的减少相关，但与住院时间（危险比=0.9；95%CI 0.7 至 1.2；P=0.48）无关。
使用冷却自来水可改善烧伤严重程度和临床结局。在儿童烧伤的初步管理中，院外和紧急医疗服务必须优先考虑适当的急救。
