Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States.
Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States; Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States; The Ohio State University College of Medicine, 370W 9th Ave, Columbus, OH 43210, United States.
Burns. 2021 May;47(3):545-550. doi: 10.1016/j.burns.2020.04.013. Epub 2020 May 16.
Accurate resuscitation of pediatric patients with large thermal injury is critical to achieving optimal outcomes. The goal of this project was to describe the degree of variability in resuscitation guidelines among pediatric burn centers and the impact on fluid estimates.
Five pediatric burn centers in the Pediatric Injury Quality Improvement Collaborative (PIQIC) contributed data from patients with ≥15% total body surface area (TBSA) burns treated from 2014 to 2018. Each center's resuscitation guidelines and guidelines from the American Burn Association were used to calculate estimated 24-h fluid requirements and compare these values to the actual fluid received.
Differences in the TBSA burn at which fluid resuscitation was initiated, coefficients related to the Parkland formula, criteria to initiate dextrose containing fluids, and urine output goals were observed. Three of the five centers' resuscitation guidelines produced statistically significant lower mean fluid estimates when compared with the actual mean fluid received for all patients across centers (4.53 versus 6.35ml/kg/% TBSA, p<0.001), (4.90 versus 6.35ml/kg/TBSA, p=0.002) and (3.38 versus 6.35ml/kg/TBSA, p<0.0001).
This variation in practice patterns led to statistically significant differences in fluid estimates. One center chose to modify its resuscitation guidelines at the conclusion of this study.
准确复苏大面积热烧伤的儿科患者对于实现最佳结果至关重要。本项目的目的是描述儿科烧伤中心之间复苏指南的差异程度及其对液体估计的影响。
儿科损伤质量改进合作组织（PIQIC）中的 5 个儿科烧伤中心提供了 2014 年至 2018 年治疗的≥15%总体表面积（TBSA）烧伤患者的数据。每个中心的复苏指南和美国烧伤协会的指南用于计算估计的 24 小时液体需求，并将这些值与实际接受的液体进行比较。
观察到在开始液体复苏的 TBSA 烧伤、与 Parkland 公式相关的系数、开始含葡萄糖液体的标准以及尿量目标方面存在差异。五个中心中的三个中心的复苏指南产生的平均液体估计值明显低于所有中心所有患者的实际平均液体接受量（4.53 与 6.35ml/kg/%TBSA，p<0.001），（4.90 与 6.35ml/kg/TBSA，p=0.002）和（3.38 与 6.35ml/kg/TBSA，p<0.0001）。
这种实践模式的差异导致液体估计值存在统计学差异。一个中心在本研究结束时选择修改其复苏指南。
