Children's Hospital of Orange County, Orange, California.
University of California Irvine, Department of Emergency Medicine, Irvine, California.
West J Emerg Med. 2024 Jul;25(4):634-644. doi: 10.5811/westjem.17984.
Hundreds of children suffer burn injuries each day, yet care guidelines regarding the need for acute inpatient treatment vs outpatient follow-up vs no required follow-up remain nebulous. This gap in the literature is particularly salient for the emergency clinician, who must be able to rapidly determine appropriate disposition.
This was a retrospective review of patients presenting to a Level II pediatric trauma center, January 1, 2017-December 31, 2019, and discharged with an International Classification of Diseases, Rev 10, burn diagnosis. We obtained and analyzed demographics, burn characteristics, and follow-up data using univariate and bivariate analysis as well as logistic regression modeling. Patients were stratified into three outcome groups: group 1-patients who underwent emergent evaluation at a burn center or were admitted at their first follow-up appointment; group 2-patients who followed up at a burn center (as an outpatient) or at the emergency department (and were discharged home); and group 3-patients with no known follow-up.
A total of 572 patients were included in this study; 58.9% of patients were 1-5 years of age. Sixty-five patients met group 1 criteria, 189 patients met group 2 criteria, and 318 patients met group 3 criteria. Sixty-five percent of patients met at least one American Burn Association criteria, and 79% of all burns were second-degree burns. Flame and scald burns were associated with increased odds (odds ratio [OR] 1.21, OR 1.12) of group 1 vs group 2 + group 3 ( = 0.02, < 0.001). Second/third-degree burns and concern for non-accidental trauma were also associated with increased odds of group 1 vs 2 or 3 (OR = 1.11, 1.35, ≤ 0.001, 0.001, respectively). Scald burns were associated with increased odds of group 2 compared to group 3 (OR 1.11, = 0.04). Second/third degree burns were also associated with increased odds of group 2 vs 3 (OR 1.19, ≤ 0.001).
There were few statistically significant variables strongly associated with group 1 (emergent treatment/admission) vs group 2 (follow-up/outpatient treatment) vs group 3 (no follow- up). However, one notable finding in this study was the association of scald burns with treatment (admission or follow-up) suggesting that the presence of a scald burn in a child may signify to clinicians that a burn center consult is warranted.
每天都有数百名儿童遭受烧伤，但关于急性住院治疗、门诊随访或无需随访的治疗指南仍不明确。对于必须能够快速确定适当处置方法的急诊临床医生来说，文献中的这一空白尤其明显。
这是对 2017 年 1 月 1 日至 2019 年 12 月 31 日在二级儿科创伤中心就诊并出院的伴有国际疾病分类第 10 修订版烧伤诊断的患者进行的回顾性研究。我们使用单变量和双变量分析以及逻辑回归模型获取并分析了人口统计学、烧伤特征和随访数据。患者分为三组：第 1 组-在烧伤中心接受紧急评估或在首次随访时入院的患者；第 2 组-在烧伤中心（门诊）或急诊科接受随访并出院回家的患者；以及第 3 组-无已知随访的患者。
本研究共纳入 572 名患者；58.9%的患者年龄为 1-5 岁。65 名患者符合第 1 组标准，189 名患者符合第 2 组标准，318 名患者符合第 3 组标准。65%的患者至少符合美国烧伤协会的一项标准，所有烧伤中 79%为二度烧伤。火焰烧伤和烫伤与第 1 组（入院或门诊治疗）与第 2 组+第 3 组（门诊治疗）相比，发生第 1 组的几率更高（比值比 [OR] 1.21，OR 1.12）（=0.02， <0.001）。第二/三度烧伤和非意外伤害的担忧也与第 1 组与第 2 组或第 3 组相比发生几率增加相关（OR = 1.11、1.35、 ≤ 0.001、0.001）。烫伤与第 2 组相比发生第 2 组的几率更高（OR 1.11， = 0.04）。第二/三度烧伤也与第 2 组相比发生第 3 组的几率增加有关（OR 1.19， ≤ 0.001）。
有几个统计学意义上的变量与第 1 组（紧急治疗/入院）与第 2 组（随访/门诊治疗）与第 3 组（无随访）之间有显著关联。然而，本研究中的一个显著发现是烫伤与治疗（入院或随访）之间的关联，这表明儿童烫伤可能表明临床医生需要进行烧伤中心咨询。
