Pediatric Burn: Changing

lives forever
Lillian F. Liao, MD, MPH
Division of Trauma and Emergency
Surgery
Department of Surgery
UTHSCSA

Pediatric
epidemiology
Annual incidence of pediatric

diagnosis

Cancer : 10,500
Burn : >133,000
South Texas > 200 cases annually [under
estimated]

Annual pediatric mortality

Heart disease
Birth defects
Cancer
Burn
Trauma

674
1,117
1,930
2,500
12,388

Epidemiology
MOST COMMON out-patient burns
Non-intentional scalding burn
Most are preventable [woman and
children]
Between 1985-2009: mortality
decreases over time
Burn size and age are most important
determinants

Epidemiology
Socioeconomics
Burn admissions increase with
decreasing socioeconomic status
Highest risk are:
1.children in households without a
separate kitchen
2.kitchen without doors
3.kerosene lamp usage in winter months

Epidemiology
Estimated 140,000 burns per year
11,000 Children require hospitalization
South Texas average annual admission = 200+
South Texas average annual clinic visits = 800+

Average hospital LOS = 3 days

South Texas average LOS = 2.4 days

Average $211 million in hospital charges

annually
Lifetime cost associated with pediatric
burn >$2 billion

Epidemiology
Most common types of burn
Scalding
< 5 years 70% (Food > Water)
> 5 years 30%

Epidemiology
Most common types of burn
Scalding
< 5 years 70% (Food > Water)
> 5 years 30%

Flame

Epidemiology
Most common types of burn
Scalding
< 5 years 70% (Food > Water)
> 5 years 30%

Flame
Contact

Epidemiology
Most common types of burn
Scalding
< 5 years 70% (Food > Water)
> 5 years 30%

Flame
Contact
Electrical

Epidemiology
Most common types of burn
Scalding
< 5 years 70% (Food > Water)
> 5 years 30%

Flame
Contact
Electrical

Non-accidental burns

- 20%

Acute burn
resuscitation
Four periods of treatment
1. Emergent
2. Acute
3. Chronic
4. Rehabilitation

Acute burn wound

care
Access the depth of the burn
Superficial

Partial thickness

Full thickness

Accurate assessment of %
TBSA

Acute burn resuscitation

Need active resuscitation if
>15% TBSA partial thickness burn
Parkland formula: [4ml] * [Kg] *
[%TBSA]
Brookes: [2ml] * [Kg] * [%TBSA]
Replace over first 8 hours
Starts from the time of injury

Next over the next 16 hours

Acute burn
resuscitation

Fluid resuscitation

Resuscitation goals:
HR [normal range for age]
UOP 0.5 to 1 ml/kg/hr
Temp > 37F

Acute burn
resuscitation
Criteria
for transport
to
Partial
thickness
burn >10% TBSA
Burn center

Face, hands, feet, genitalia,

major joints
Full thickness burn of any age
Electrical burns
Chemical burns
Inhalation injury

Acute burn
resuscitation
Criteria
transport
Patient
with for
multiple
pre- to
Burn center
existing
medical problems + burn
of any size

Burn + Trauma
Burn + Child
Burn + Elderly
Burn in patients with special
needs

Sub-acute burn wound care

Pigment management
Risk of
hypertrophic
scarring
Healing time
14-21 days: ~30%
risk
>21 days: ~70%

Pain management

Chronic burn wound care

Occupational therapy
Physical therapy
Hypertrophic scar management
Psychosocial trauma

Prevention : To Keep
Kids Safe

Keep water heater setting <120F

Never leave a child alone in the kitchen or

bathroom
Install smoke alarms
Keep matches, lighters, and flammables out of
reach of children
Keep appliance cords out of reach, install
outlet plugs.

UT Medicine and UHS

BURN TEAM
BURN Hotline:
210-358-BURN