Jimbo Masaya, Overholt Tyler L, Cosma Gabriela L, Hudak Steven J, Granberg Candace F, Gargollo Patricio C
Department of Urology, Mayo Clinic, Rochester, MN, USA.
Department of Urology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
J Pediatr Urol. 2020 Apr;16(2):220.e1-220.e6. doi: 10.1016/j.jpurol.2020.01.011. Epub 2020 Jan 31.
There are limited published data characterizing pediatric burn patients with genital burns (GB).
Assess prevalence of GB in pediatric burn patients and analyze clinical characteristics including predictors of mortality.
We queried American Burn Association's National Burn Repository to identify all pediatric burn patients who presented to North American burn centers over a 10-year period. We excluded all patients aged ≥18 years and patients with unknown sex, race, and/or mortality. We also excluded subsequent encounters for patients with multiple visits. Demographic and clinical characteristics were compared between patients with and without GB. Univariable and multivariable logistic regression analyses were performed to identify predictors of mortality.
Among 38 211 pediatric burn patients, 1244 (3.3%) suffered from second- or third-degree GB. Patients who suffered from third-degree GB (GB3) were significantly older than patients who suffered from second-degree GB (GB2) or patients without GB. Of the patients, 32.3% were aged 0-2 years. Scalding was the most common mechanism of injury for pediatric GB patients at 73.8%. Compared to non-GB patients, GB patients had significantly higher total body surface area (TBSA) burned (16.5% vs 7.0%), higher rates of associated inhalation injury (4.1% vs 2.6%), longer length of stay (LOS) (14.3 days vs 6.7 days), higher rates of urinary tract infection (UTI) (13.0% vs 2.8%) and sepsis (14.1% vs 2.3%), and higher mortality (3.5% vs 0.7%) (P < 0.0001 for all). The differences were more pronounced for the subset of patients who suffered from GB3 (TBSA 43.5%, associated inhalation injury 19.9%, LOS 42.9 days, 21.3% UTI, 33.3% sepsis, and 19.3% mortality). On multivariable analysis, the presence of GB3, TBSA, non-white ethnicity, and the presence of associated inhalation injury were significant predictors of mortality. Only 4.5% of pediatric GB patients underwent genital surgery, with the majority consisting of excision, reconstruction, or repair of the penis, vulva, or perineum. No patient required orchiectomy or suprapubic catheter placement.
This is the largest study to date of pediatric GB patients. A minority of pediatric burn patients present with GB. However, when they occur, GB are associated with significantly worse clinical outcomes. Importantly, the presence of GB3 is an independent predictor of mortality in pediatric burn patients.
The presence of GB appears to be a strong marker of severe burn injury. Pediatric GB patients need to be carefully assessed and aggressively managed for additional injuries, complications, surgical needs, and mortality risk.
关于小儿生殖器烧伤（GB）患者的已发表数据有限。
评估小儿烧伤患者中GB的患病率，并分析包括死亡率预测因素在内的临床特征。
我们查询了美国烧伤协会的国家烧伤资料库，以确定在10年期间就诊于北美烧伤中心的所有小儿烧伤患者。我们排除了所有年龄≥18岁的患者以及性别、种族和/或死亡率未知的患者。我们还排除了多次就诊患者的后续就诊情况。比较了有GB和无GB患者的人口统计学和临床特征。进行单变量和多变量逻辑回归分析以确定死亡率的预测因素。
在38211例小儿烧伤患者中，1244例（3.3%）患有二度或三度GB。三度GB（GB3）患者明显比二度GB（GB2）患者或无GB患者年龄大。患者中，32.3%年龄在0至2岁。烫伤是小儿GB患者最常见的致伤机制，占73.8%。与非GB患者相比，GB患者的烧伤总面积（TBSA）明显更高（16.5%对7.0%），吸入性损伤发生率更高（4.1%对2.6%），住院时间更长（14.3天对6.7天），尿路感染（UTI）发生率更高（13.0%对2.8%）和脓毒症发生率更高（14.1%对2.3%），死亡率更高（3.5%对0.7%）（所有P<0.0001）。对于GB3患者亚组，差异更为明显（TBSA 43.5%，吸入性损伤19.9%，住院时间42.9天，UTI 21.3%，脓毒症33.3%，死亡率19.3%）。多变量分析显示，GB3、TBSA、非白人种族以及存在吸入性损伤是死亡率的重要预测因素。只有4.5%的小儿GB患者接受了生殖器手术，大多数手术包括阴茎、外阴或会阴的切除、重建或修复。没有患者需要睾丸切除术或耻骨上导管置入术。
这是迄今为止关于小儿GB患者的最大规模研究。少数小儿烧伤患者伴有GB。然而，当发生GB时，其临床结局明显更差。重要的是，GB3的存在是小儿烧伤患者死亡率的独立预测因素。
GB的存在似乎是严重烧伤损伤的一个重要标志。小儿GB患者需要仔细评估，并积极处理其他损伤、并发症、手术需求和死亡风险。
