Burns in Children
Evidence Based Care
Dr Amber Young
and Miss Julia Sarginson
The Healing Foundation Children’s
Burns Research Centre at the Royal
Bristol Hospital for Children
Children’s Burns
Research Centre
The Healing Foundation Children’s Burns
Research Centre
Children’s Burns
Research Centre
www.bristol.ac.uk/childrens-burns
The scale of the problem:
An estimated 23,000 children present to
Emergency Departments in the UK each year
with burns and scalds
Over 2/3rd are in children under 5 years old
• 60% scald burns (cup of tea)
• 30% contact burns (hair straighteners,
hobs, BBQs, fires)
Children’s Burns
Children’s
Burns
Research
Centre
Research Centre
Common injury patterns:
Hot drink scalds
Contact burns: Hair straighteners
and irons
Children’s Burns
Research Centre
Current research focus
Age of Child
All children seen at the South West UK Children's Burns Centre 2010 to 2012
17
16
15
14
13
12
11
10
9
8
7
6
5
4
3
2
1
0
99% of injuries are <20% TBSA
97% of injuries are <10% TBSA
0
20
40
60
80
100
TBSA
Sarginson, 2013
Children’s Burns
Research Centre
The majority of the published
research is on burns of >30% TBSA
Small area burn, small problem?
Pain
Infection
Distress
BURN
INJURY
<20%
Surgery &
Scarring
Illness
Functional
impairment
slow healing
Children’s Burns
Children’s
Burns
Research
Centre
Research Centre
Appearance
concerns
Burns in Children
Focussing future research …
Children’s Burns
Research Centre
Who should we be focussing on?
Common injuries:
• Small burns
• Young children
Children’s Burns
Research Centre
What should we be focussing on?
•
•
•
•
Prevention
Reduction in infection
Improvement in scarring appearance
Improved patient care pathways
Children’s Burns
Research Centre
Burns in Children
What are we already researching?
Children’s Burns
Research Centre
Three of our studies:
1. SMART Dressings
2. The MISTIC Study
3. The Paediatric Burns Literature Review
Project
Children’s Burns
Research Centre
SMART Dressings
Dressings that change
colour in the presence
of infection
Children’s Burns
Research Centre
Morbidity In Small Thermal Injury in Children
A Prospective Study into the Physiological
Response to Small-to-Moderate Burn Injury,
and the Diagnosis of Early Post-Burn Morbidity,
in Pre-School Children.
Children’s Burns
Research Centre
Aims:
1) Understand ‘typical’ physiological and
biochemical responses to a small area burn
in pre-school children to define the normal
pathway.
2) Identify risk factors and differentiating
symptoms, signs and biochemical variables
to assist in the diagnosis of post-burn illness
– pathway deviation.
Children’s Burns
Research Centre
Design:
Prospective observational cohort
Population:
>28 days, <5 years old
Burn group: <20% TBSA, all mechanisms, all depths
Comparison group:
Isolated finger-tip crush injury
Duration:
18 month run – Jan 2014 to July 2015
Target recruitment:
Burn group: 570 participants
Comparison group: 120 participants
Total: 690.
Children’s Burns
Children’s
Burns
Research
Centre
Research Centre
Birmingham
Children’s
Hospital
Bristol Royal
Hospital for
Children
Due to start
Recruiting
September
2014
Recruiting from
13th January
2014
Broomfield
Hospital,
Chelmsford
Recruiting from
4th June 2014
Children’s Burns
Research Centre
Data Collection
1. Prospective information from
medical notes
2. Parental Questionnaires
3. Parent recorded temperature
diaries
4. 6 week post-injury follow-up
telephone call
Children’s Burns
Research Centre
Children’s Burns
Research Centre
Paediatric Burns Literature
Review Project
• Aims:
1. To inform evidence-based care
2. To identify areas where research and evidence is lacking
3. To compare published research in small area burns in
children to other childhood injury and adult burn care
• All published articles on burns in children from 1960s
• Categorisation:
– Topic area / sub-theme
– Type of article or research study
NB – This is not a Systematic Review
Children’s Burns
Research Centre
Burns in Children
Where next?
Children’s Burns
Research Centre
Discussion
• Very little evidence based care for this
common childhood injury
• Very little published literature
• Different care pathways across the country
• Varying practice in the management of small
burns and scalds
Children’s Burns
Research Centre
Acknowledgements
Children’s Burns
Research Centre