Introduction The United States Consumer Product Safety Commission (CPSC) estimated that 15,600 firework-related injuries were treated in US hospital emergency departments during calendar year 2020 and that there has been a trend of increased injuries from 2005-2020. The goal of this project was to look at the experience of one center with a large referral network, to identify trends and opportunities. Methods A retrospective chart review was performed to analyze data points including mechanism, age, sex, TBSA, injury locations, procedures performed, outcomes and complications length of stay, and services involved. The burn registry was utilized to identify cases throughout a 15-year period. Results During this period, 24 pediatric patients required admission for firework injuries. Eighty-four percent were males compared to 16% in females. Most injuries (67%) occurred while the patient was holding the firework and lighting it as opposed to being struck by a firework. Most of the injuries had small TBSA percentages (84% < TBSA of 15). In addition, most were referred from outside facilities. Most common sites of injury included the hands and face, followed by the eyes. Sixty percent of patients required operative intervention for their injuries, some requiring multiple surgeries. The average length of stay was 2 days, while 8 patients stayed longer than 5 days. Ninety-two percent were admitted to the burn service with additional specialty consultants. Most children required multiple follow up visits. Conclusions Firework related injuries in children result in significant injury often requiring surgical procedures along with a long outpatient treatment course. This work highlights a need for continued advocacy, education, an intervention. This program uses a curriculum and process for children who are injured due to setting fires. The program is evaluating a similar model of intervention and 1:1 counseling for children injured due to fireworks. Applicability of Research to Practice This project is applicable to practice as it highlights the continued opportunity for intervention and prevention for firework related injuries. The trends are not decreasing, and the injuries are significant. Evaluation of a model for youth who have fireworks related injuries, similar to the youth fire-setting program, would be a beneficial next step.

Introduction Frostbite in children is very rare with few citations in the literature. Thrombolytic therapy is commonly used to salvage threatened tissue in frostbitten adults, but there is little to no data on the use of such therapy in children. The aim of this case series is to advance our understanding of pediatric frostbite by describing risk factors and outcomes, as well as commenting on the safety of thrombolytic therapy in this population. To our knowledge, thrombolytic therapy has not been studied in children, and this is the largest case series of pediatric frostbite to date. Methods This is a retrospective, single-center study reviewing cases of pediatric (< 14 years) frostbite from 2006-2022. Thirteen patients (6 males and 7 females) were found to fit inclusion criteria, and data was collected from the electronic medical record. Results A total of thirteen cases were reviewed. Nine patients were managed conservatively with diligent local wound cares, while four were prescribed thrombolytic therapy in an attempt at tissue salvage. Two patients underwent intravenous thrombolytic therapy, and two underwent intra-arterial thrombolytic therapy; there were no complications in either group. We also reviewed patient demographics. Thirty-eight percent of patients were documented as Black or African American, 23% Asian, 23% Caucasian, and 8% Hispanic or Latino. The remainder were unlisted. Notably, 31% of the children had trouble with communication (whether foreign speaking or non-verbal). None of the patients had a positive EtOH or urine drug screen. All of the children were poorly supervised when the frostbite occurred. Outcomes were as follows: 69% were completely healed upon follow up, 23% had very severe frostbite injury upon arrival with significant tissue loss likely requiring amputation (but did not return for follow up), and 8% never followed up. Conclusions The use of thrombolytics for the treatment of frostbite injury appears to be safe in children. We have found that risk factors for frostbite in this population include an inability to communicate and poor supervision at the time of injury. Applicability of Research to Practice We have been able to safely treat children presenting with severe frostbite injury with thrombolytic therapy. This work is highly applicable to practice. Specifically, the ability to administer intravenous thrombolytic therapy is nearly ubiquitous. This can be done at referring hospitals if there are issues with inclement weather or transportation that would delay transfer to a verified burn center.

Squamous cell carcinoma (SCC) or keratoacanthoma (KA) development at split thickness skin graft donor sites is a documented but very rare entity. We describe a case in which a patient develops a lesion at his graft site seven weeks postoperatively. Upon pathological review, it was found to be SCC and was excised expediently thereafter. Notably, in reviewing the literature, these lesions tend to develop soon after the trauma of skin graft harvest with over half diagnosed within three months and a vast majority within one year of the operation. This is in contrast to Marjolin ulcers which take years to develop after the initial burn insult. Given the diversity of autograft indications in the reviewed literature, it seems unlikely that the burns themselves contribute to the development of SCC at the donor site. Our case highlights the need for routine surveillance of graft donor sites postoperatively with an emphasis on catching malignant sequelae.