Outcomes of Outpatient Management of Pediatric Burns

4/17/2015

Authors:
Matthew Brown, MD, Tammy Coffee, CNP, Paul Adenuga, BS, Charles J. Yowler. MD, FACS, FCCM

Importance:
The literature surrounding pediatric burns has focused on inpatient management. The vast majority of pediatric burns are treated with outpatient management, but there is no characterization of this outpatient burn population or evidence to support this treatment modality.

Objective:
To characterize the population of pediatric burns treated as outpatients and assess outcomes validating this method of burn care.

Design:
3-year retrospective review.

Setting:
The burn clinic and burn unit of a tertiary care center.

Population:
953 patients, ages 0-18 treated at a tertiary care center burn unit over a 3 year period.

Intervention:
Patients were classified as outpatient if they were discharged from the burn clinic upon initial evaluation. All patients directly admitted to the burn unit or admitted from clinic were considered inpatient.

Main Outcome(s) and Measure(s):
Patient age, burn etiology, burn characteristics, burn mechanism and referral pattern were recorded. The type of wound care and incidence of outcomes including subsequent hospital admission, infection, scarring, and surgery served as the primary outcome data.

Results:
For the outpatient cohort the mean time of burn injury to evaluation in our clinic was 1.8 days with 64% of patients being evaluated within 1 day of injury. Age and gender showed similar distributions between inpatient and outpatient cohorts. Scalds accounted for 53% of the burn mechanism, with burns to the hand/wrist being the most frequent area involved. The mean percentage of total body surface area was 1.4% for the outpatient cohort and 8% for the inpatient cohort. Burns in the outpatient cohort healed with a mean time of 13.4 days. In the outpatient cohort nine (1%) patients had subsequent admissions and three (0.4%) patients had concern for infection. Eight patients from the outpatient cohort were treated with excision and grafting.

Conclusions and Relevance:
The vast majority of pediatric burns are small, although they may often involve more critical areas such as the face and hand. Outpatient wound care is effective treatment strategy and results in low rates of complications and should become the standard of care for children with appropriate burn size and home support.