Bir referans yanık merkezindeki pediatrik hastaların yanık şiddet paternlerinin ve klinik özelliklerinin karşılaştırılması: retrospektif analiz

Amaç: Yanık yaralanmaları tüm dünyada önemli bir halk sağlığı sorunu olmaya devam etmekte ve bu yaralanmalar arasındaki en kritik yükü çocukluk çağı yanıkları oluşturmaktadır. Daha nadir olmasına rağmen, pediatrik haşlanma-harici yanık yaralanmaları (aleve bağlı, elektrik, temas ve kimyasal) genellikle daha şiddetli bir seyir göstermekte ve haşlanma yanıklarına oranla daha fazla morbidite ve mortaliteye neden olmaktadır. Haşlanma yanıklarını veya haşlanma-harici yanık yaralanmalarını ayrı ayrı inceleyen birçok çalışma olsa da her iki yaralanma türü arasındaki şiddet paternlerini ve klinik özelliklerini karşılaştırmalı olarak inceleyen sınırlı sayıda çalışma mevcuttur. Bu çalışmada bir referans yanık merkezindeki pediatrik hastalarda haşlanma ve haşlanma-harici yanık yaralanmalarına ait şiddet paternlerinin ve klinik özelliklerinin araştırılması ve mevcut literatür ile karşılaştırması amaçlanmıştır.. Yöntem: Yanık şiddetini, gerçekleşme anındaki ilk yanık koşullarına göre değişim göstermektedir. Bu kapsamda, Yanık Merkezinde yatırılarak tedavi edilen pediatrik hastalarda en sıklıkla gözlenen haşlanmaya bağlı yanıklar bir grupta, haşlanma-harici yanık yaralanmaları ise diğer grupta olmak üzere iki alt gruba ayrılarak inceleme yapılmıştır. Veriler Sağlık Bilimleri Üniversitesi- Adana Tıp Fakültesi hasta dosyalarından ve elektronik kayıt sisteminden alınmıştır. Bulgular: Çalışma dönemine ait kayıtlarda, haşlama yanıkları, Yanık Merkezi’ndeki 1715 pediatrik hastanın %83’ünde gözlenirken haşlanma-harici yanıklar çalışma grubunun sadece, %17’lik kısmını oluşturmaktaydı. Buna karşın, bu çalışma sonuçlarına göre pediatrik haşlanma-harici yanık yaralanmalarının daha şiddetli bir seyre sahip oldukları gözlemlendi. Haşlanma-harici yanıkların haşlanma yanıklarına kıyasla mortalitelerin üçte ikisinden fazlasından sorumlu olduğu, ayrıca bu hasta grubunda yaklaşık üç kat daha fazla cerrahi işlem (eskaratomi/fasiyotomi) gereksinimi olduğu saptandı (p

Anahtar Kelimeler:

Çocuk yanık yaralanmaları, Pediatrik yanıklar, Elektrik yaralanmaları, Alev yanıkları, Kimyasal Yaralanmalar

Comparison of patterns of burn severity and clinical characteristics of pediatric patients in a referral burn center: a retrospective analysis

Objective: Burn injuries continue to be an important public health problem worldwide, and childhood burns constitute the most critical burden among these injuries. Although less common, pediatric non-scald burn injuries (NSBIs) generally have a more severe course and cause more significant morbidity and mortality than scald burns (SBs). Many studies only address SBs or NSBIs separately. There are limited studies comparing severity patterns and clinical characteristics of both injuries. It aimed to investigate the severity patterns and clinical characteristics of SBs and NSBIs in hospitalized pediatric patients and compare them with the existing literature. Methods: A retrospective comparative study design was created among hospitalized pediatric patients. The most frequently observed SBs caused by hot water-tea/hot milk/oil-sauce-soup formed the first group. At the same time, as burn severity was thought to be relatively varied according to initial burn conditions, the NSBIs (fire-flame-related/electrical/contact/chemical-burns) constituted the other group. Data were extracted from the University of Health Sciences- Adana Faculty of Medicine (UHS-AFM) patient files and the electronic registry system. Results: While SBs constituted 83% of 1715 hospitalized pediatric patients, NSBIs formed only 17% of the study group. Additionally, pediatric non-scald burn injuries had a more severe course in this study. It was determined that NSBIs were responsible for more than two-thirds of mortality compared to SBs. This patient group also required approximately three times more surgical procedures (escharotomy/fasciotomy). Also, the length of hospital stay (LOS) was approximately two times longer than SBs, 23.5±30.5 (1-258), vs. 11.8±9.9 (1-136) (p

Keywords:

Pediatric burn injuries, Electrical injuries, Flame-relared burns, Contact Burns, Chemical Injuries,

PDF

___

Peck, MD. Epidemiology of burns throughout the world. Part I: Distribution and risk factors. Burns. 2011;37(7):1087-100. https://doi.org/10.1016/j.burns.2011.06.005.
Andrews CJ, Kimble RM, Kempf M, Cuttle L. Evidence-based injury prediction data for the water temperature and duration of exposure for clinically relevant deep dermal scald injuries. Wound Repair Regen. 2017;25(5):792-804. https://doi.org/10.1111/wrr.12577.
Martin NA, Falder S. A review of the evidence for threshold of burn injury. Burns. 2017;43(8):1624-39. https://doi.org/10.1016/j.burns.2017.04.003.
Drago DA. Kitchen scalds and thermal burns in children five years and younger. Pediatrics. 2005;115(1):10–6. https://doi.org/10.1542/peds.2004-0249
Vloemans AFPM, Hermans MHE, van der Wal MBA, Liebregts J, Middelkoop E. Optimal treatment of partial thickness burns in children: a systematic review. Burns. 2014;40(2):177-90. https://doi.org/10.1016/j.burns.2013.09.016.
Loo TL, Haider S, Py YL, Jeffrey S. Predictor of the depth of burn injuries: A time and temperature relationship review. International Journal of Medical Science and Clinical Invention. 2018;5(11):4119–28. https://doi.org/10.18535/ijmsci/v5i11.01
Henriques FC, Moritz AR. Studies of thermal injury: I. The conduction of heat to and through skin and the temperatures attained therein. A theoretical and an experimental investigation. Am J Pathol. 1947;23(4):530–49.
Moritz AR, Henriques FC. Studies of thermal injury: II. The relative importance of time and surface temperature in the causation of cutaneous burns. Am J Pathol. 1947;23(5):695–720.
Moritz AR. Studies of thermal injury: III. The pathology and pathogenesis of cutaneous burns. An experimental study. Am J Pathol. 1947;23(6):915-41.
Moritz AR, Henriques FC, et al. Studies of thermal injury IV; exploration of the casualty-producing attributes of conflagrations; local and systemic effects of general cutaneous exposure to excessive circumambient (air) and circumradiant heat of varying duration and intensity. Arch Pathol. 1947;43(5):466–88.
Henriques FC. Studies of thermal injury; the predictability and the significance of thermally induced rate processes leading to irreversible epidermal injury. Arch Pathol. 1947;43(5):489–502.
R. Rayner, J. Prentice, Paediatric burns: a brief global review, Wound Practice Res. 2011;19(1):39–46.
Gurbuz K, Demir M. Patterns and outcomes of high-voltage versus low-voltage pediatric electrical injuries: an 8-year retrospective analysis of a tertiary-level burn center. J Burn Care Res. 2021 Sep 15;irab178. Online ahead of print. https://doi.org/10.1093/jbcr/irab178.
Yang LK, Fan XZ, Man ZL, Tao JY, Wei W, et al. Epidemiology of pediatric burns requiring hospitalization in China: a literature review of retrospective studies. Pediatrics. 2008;122(1):132-42. https://doi.org/10.1542/peds.2007-1567.
Kara YA. Burn etiology and pathogenesis. Hot Topics in Burn Injuries, Intechopen. 2018 17-28. doi:10.5772/Intechopen.71379.
Brusselaers N, Monstrey S, Vogelaers D, Hoste E, Blot S. Severe burn injury in Europe: a systematic review of the incidence, etiology, morbidity, and mortality. Crit Care. 2010;14(5):R188. https://doi.org/10.1186/cc9300
Teo AI, Van As AB, Cooper J. A comparison of the epidemiology of paediatric burns in Scotland and South Africa. Burns. 2012;38(6):802-6. https://doi.org/10.1016/j.burns.2012.04.010
Yates J, McKay M, Nicholson AJ. Patterns of scald injuries in children—has anything changed? Ir Med J. 2011;104(9):263–5.
Kemp AM, Jones S, Lawson Z, Maguire SA. Patterns of burns and scalds in children. Arch Dis Child. 2014;99(4):316-21. https://doi.org/10.1136/archdischild-2013-304991
Lowell G, Quinlan K, Gottlieb LJ. Preventing unintentional scald burns: moving beyond tap water. Pediatrics. 2008;122(4):799-804. https://doi.org/10.1542/peds.2007-2979
Jeschke MG, van Baar ME, Choudhry MA, Chung KK, Gibran, Logsetty S. Burn injury. Nat Rev Dis Primers. 2020;6(1):1-25. https://doi.org/10.1038/ s41572-020-0145-5
Yastı AÇ, Koç O, Şenel E, Kabalak AA. Hot milk burns in children: a crucial issue among 764 scaldings. Ulus Travma Acil Cerrahi Derg. 2011;17(5):419-22.
Keck M, Herndon DH, Kamolz LP, Frey M, Jeschke MG. Pathophysiology of burns. Wien Med Wochenschr. 2009;159(13-14):327-36. https://doi.org/10.1007/s10354-009-0651-2
Nduagubam OC, Mba UC, Onumaegbu OO, Onah II, Chukwubuike KE, et al. Paediatric burn injuries in Enugu, South-East Nigeria: A 7-year multi-centre retrospective review. Burns. 2021;7;S0305-4179(21)00119-4. Online ahead of print. https://doi.org/10.1016/j.burns.2021.04.029
Trop M, Herzog SA, Pfurtscheller K, Hoebenreich AM, Schintler MV, Stockenhuber A, et al. The past 25 years of pediatric burn treatment in Graz and important lessons been learned. An overview. Burns. 2015;41(4):714-20. https://doi.org/10.1016/j.burns.2014.10.001.