Child Supervision and Burn Outcome among Admitted Patients at Major Trauma Hospitals in the Gambia

Abstract

Burn-related injuries are a significant burden in children, particularly in low- and middle-income countries (LMICs), where more than 90% of burn-related pediatric deaths occur. Lack of adult supervision of children is a major risk for pediatric burn injuries. The goal of this paper was to examine the general characteristics of burns and identify burn injury outcomes among adult-supervised children compared to those who were not supervised. The study examined burn injury and clinical characteristics among all burn patients admitted to two trauma hospitals in The Gambia, West Africa. At intake in the emergency room, the treating physician or nurse determined the need for admission based on body surface area burned (BSAB), depth of burn, and other clinical considerations such as co-occurring injuries and co-morbidities. During the study period of 1 April 2014 through 31 October 2016, 105 burn patients were admitted and data were collected by the treating physician for all of them. Information about supervision was only asked for children aged five years or less. More than half (51%) of the burn patients were children under 18 years, and 22% were under 5 years. Among children under five, most (86.4%) were supervised by an adult at the time of burn event. Of the 19 supervised children, 16 (84.2%) had body area surface burned (BSAB) of less than 20%. Two of the three children without adult supervision at the time of burn event had BSAB ≥ 20%. Overall, 59% of the patients had 20% + BSAB. Females (aOR = 1.25; 95% CI = 0.43–3.62), those burned in rural towns and villages (aOR = 2.29; 95% CI = 0.69–7.57), or burned by fire or flames (aOR = 1.47; 95% CI = 0.51–4.23) had increased odds of having a BSAB ≥ 20%, although these differences were not statistically significant. Children 0–5 years or 5–18 years (aOR = 0.04, 95% CI = 0.01–0.17; aOR = 0.07, 95% CI = 0.02–0.23, respectively) were less likely to have BSAB ≥ 20% than adults. Those burned in a rural location (aOR = 9.23, 95% CI = 2.30–37.12) or by fire or flames (aOR = 6.09, 95% CI = 1.55–23.97) were more likely to die. Children 0–5 years or 5–18 years (aOR = 0.2, 95% CI = 0.03–1.18; aOR = 0.38; 95% CI = 0.11–1.570, respectively) were less likely to die. Children constitute a significant proportion of admitted burn patients, and most of them were supervised at the time of the burn event. Supervised children (compared to unsupervised children) had less severe burns. Programs that focus on burn prevention at all levels including child supervision could increase awareness and reduce burns or their severity. Programs need to be designed and evaluated with focus on the child development stage and the leading causes of burns by age group.

3D PED BURN app: A precise and easy‐to‐use pediatric 3D burn surface area calculation tool

“…The most important burn management decisions, especially in children, are based on a precise assessment of the burn location, TBSA, and depth. 1,5 Many computer-aided technologies have emerged aiming to overcome the limitations of the conventional methods and improve the accuracy of burn surface area estimation.…”

“…According to the World Health Organization, the estimated burn mortality rate worldwide is 180,000 deaths per year, with 20% occurring in pediatric patients. Africa and Southeast Asia have the highest incidence of pediatric burns and maintain a (more than seven times) higher mortality rate than that in high‐income countries 1 …”

“…Africa and Southeast Asia have the highest incidence of pediatric burns and maintain a (more than seven times) higher mortality rate than that in high-income countries. 1 The Lund and Browder chart, the Rule of Palms, and the Wallace Rule of Nines are the most common methods used to determine the total body surface area (TBSA) of both adult and pediatric burn patients. Previous studies have demonstrated that burn surface area is often substantially overestimated using these three conventional methods, particularly the first two.…”

Nonadult Supervision of Children in Low- and Middle-Income Countries: Results from 61 National Population-Based Surveys

“…Scholars have documented how children appreciate contributing to their families through caregiving [ 76 ] and, with the right conditions, they may build resilience [ 77 , 78 ]. At the same time, even if parents can try to ensure children’s wellbeing in their absence, time spent home alone or under the supervision of another young child has been linked to increases in occurrence and severity of unintentional injuries [ 29 , 79 ] and other negative developmental outcomes [ 2 ], particularly among younger children [ 69 , 70 , 71 ]. More research is needed to assess the extent to which emerging evidence of positive effects linked to child caregiving extends to other dimensions of child development and to younger caregivers.…”

Pathological Scar and Its Associated Factors Among Survivor of Burn Victim Pediatrics Admitted to South Gondar Zone Public Hospitals, Amhara Regional State, Ethiopia, 2020 – A Multi-Center Cross-Sectional Study

“…The authors prepared the checklist by reviewing different literature done on the same problems. [8][9][10][16][17][18][19] The checklist was focused on socio-demographic characteristics of an injured child, burn-related factors, treatment-related factors, and outcome-related factors. Eight trained BSc nurses who were working on the site other than the study setting were involved in the data collection and were supervised by four physicians who were also not a member of the study setting.…”