P2.D061: Burns in Children Younger Than Two Years of Age

Background: Burn injury remains the third leading cause of injury-related death worldwide. While young children are at the greatest risk for sustaining a burn injury, young age is not a reliable predictor of mortality. This study aims to describe this unique subpopulation of children to facilitate better understanding of the clinical characteristics and outcomes for these young patients.

Methods: We conducted a retrospective cohort study of patients 0-24 months of age who required admission to a regional pediatric burn center for inpatient level of care between 1st January 1994 and 1st September 2023. Data was extracted from the ACS National Trauma Data Bank and the ABA BCQP burn registry.

Results: Of the 4599 patients admitted for inpatient burn care, 50.8% (n=2334) were under 24 months of age. The average age was 14.3 (5.7) months, 59.3% were male, and 19.4% identified as Hispanic ethnicity. Infants less than 12 months made up 31.1%. The primary causes of injury were scald burns (68.3%) and contact burns (25.5%). The average total body surface area (TBSA) was 7.0 ± 9.3% (range 0.25 to 85%) with 1.6% of children sustaining inhalation injury. Patients were hospitalized for an average of 7.0 ± 15.9 days (range 1 to 268 days) which represented 1 day per percent body surface burn. For the total sample the mortality rate was 0.09%, there were 2 deaths.

A total of 1686 patients were treated from 2005 to 2023, with 72.6% (n=1224) having small ( < 10% TBSA) burns without full thickness involvement. These children followed a conservative treatment approach of topical therapy and dressing changes, with 98.5% not requiring operative intervention. This is compared to the 27.3% (n = 460) of patients who presented with more serious burns commonly requiring operative intervention (57%), intensive care unit admission (23.7%), ventilator support (10.2%), central venous catheter placement (26.1%), and Foley placement (23.7%). In this sample, the highest complication risks were wound infection (2.1%), sepsis (0.9%), and urinary tract infection (0.9%).

Conclusion: This study describes a 30-year experience caring for a unique population of pediatric burn patients. Approximately 2 in 3 children presented with scald injury most commonly by spill of hot beverage or cooking-related liquids, it is here that prevention efforts should be focused. Young children with small burns ( < 10% TBSA) or those that do not extend full thickness were successfully treated with a conservative approach. Management of more serious burn injuries required invasive support devices and prompt wound excision but can be expected to survive with low incidence of clinical complications. This approach to burn care was associated with an infant burn mortality of 0.14% (national average = 0.49%) and 0.06% for children 12 months to 24 months (national average = 0.15%).