Transcript Burns in Children, Evidence Based Care
Children’s Burns Research Centre
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
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 2/3 rd are in children under 5 years old
• • 60% scald burns (cup of tea) 30% contact burns (hair straighteners, hobs, BBQs, fires)
Children’s Burns Research Centre
Common injury patterns:
Hot drink scalds Contact burns: Hair straighteners and irons
Children’s Burns Research Centre
Children’s Burns Research Centre
Current research focus
17 16 15 14 13 12 11 4 3 2 1 0 10 9 8 7 6 5 All children seen at the South West UK Children's Burns Centre 2010 to 2012 99% of injuries are <20% TBSA 97% of injuries are <10% TBSA 0 20 40 60 80 100 TBSA Sarginson, 2013 The majority of the published research is on burns of >30% TBSA
Small area burn, small problem?
Pain Infection Illness Distress BURN INJURY <20% Surgery & Scarring Functional impairment Appearance concerns
slow healing
Children’s Burns Research Centre
Children’s Burns Research Centre
Burns in Children
Focussing future research …
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
Children’s Burns Research Centre
Burns in Children
What are we already researching?
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: Population: Duration:
Prospective observational cohort >28 days, <5 years old
Burn group:
<20% TBSA, all mechanisms, all depths
Comparison group:
Isolated finger-tip crush injury 18 month run – Jan 2014 to July 2015
Target recruitment:
Burn group:
570 participants
Comparison group:
120 participants Total:
690
.
Children’s Burns Research Centre
Bristol Royal Hospital for Children Recruiting from 13 th January 2014
Children’s Burns Research Centre
Birmingham Children’s Hospital
Due to start Recruiting September 2014
Broomfield Hospital, Chelmsford Recruiting from 4 th June 2014
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
Children’s Burns Research Centre
Burns in Children
Where next?
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
Children’s Burns Research Centre