Cool Running Water First Aid Decreases Skin Grafting Requirements in Pediatric Burns: A Cohort Study of Two Thousand Four Hundred Ninety-five Children

Abstract

Study objective: First-aid guidelines recommend the administration of cool running water in the early management of thermal injury. Our objective is to analyze the associations between first aid and skin-grafting requirements in children with burns.Methods: This cohort study used a prospectively collected registry of patients managed at a tertiary children's hospital. Multivariate logistic regression models were used to evaluate the relationship between first aid and the requirement for skin grafting. Secondary outcomes included time to re-epithelialization, wound depth, hospital admission and length of stay, and operating room interventions. Adequate first aid was defined as 20 minutes of cool running water within 3 hours of injury.Results: In our cohort of 2,495 children, 2,259 (90.6%) received first aid involving running water, but only 1,780 (71.3%) were given the adequate duration. A total of 236 children (9.5%) required grafting. The odds of grafting were decreased in the adequate first aid group (odds ratio [OR] 0.6; 95% confidence interval [CI] 0.4 to 0.8). The provision of adequate running water was further associated with reductions in full-thickness depth (OR 0.4; 95% CI 0.2 to 0.6), hospital admission (OR 0.7; 95% CI 0.3 to 0.9), and operating room interventions (OR 0.7; 95% CI 0.5 to 0.9), but not hospital length of stay (hazard ratio¼0.9; 95% CI 0.7 to 1.2; P¼.48). Conclusion:Burn severity and clinical outcomes improved with the administration of cool running water. Adequate first aid must be prioritized by out-of-hospital and emergency medical services in the preliminary management of pediatric burns.

Carbon Dots Induce Epithelial‐Mesenchymal Transition for Promoting Cutaneous Wound Healing via Activation of TGF‐β/p38/Snail Pathway

“…Cutaneous injury caused by trauma, burns, chronic wounds, and skin wound infection, is one of the most common clinical manifestations, which gives rise to pain, psychological stress and loss of quality life. [1][2][3][4] Numerous strategies, [5] including growth factor, [6] gene therapy, [7] cell therapy, [8] and skin grafts, [9] have…”

“…Cutaneous injury caused by trauma, burns, chronic wounds, and skin wound infection, is one of the most common clinical manifestations, which gives rise to pain, psychological stress and loss of quality life. [ 1–4 ] Numerous strategies, [ 5 ] including growth factor, [ 6 ] gene therapy, [ 7 ] cell therapy, [ 8 ] and skin grafts, [ 9 ] have been applied to promote cutaneous wound healing in present clinical studies, whereas these therapies still suffer from potential concerns related to high cost, difficult preservation of drugs or donors, immune rejection, and secondary damage to the donor sites. [ 3–6,10 ] Cutaneous wound healing generally includes three phases: hemostasis and inflammation, tissue formation, and tissue remodeling, which overlaps each other to a certain degree without a precisely defined period of time.…”

Cooling or Warming the Esophagus to Reduce Esophageal Injury During Left Atrial Ablation in the Treatment of Atrial Fibrillation

“…Given the well-described protective effects of hypothermia on injured neurons, an additional application may involve the reduction of post-operative cognitive dysfunction 29,30,31,32 . Recent data in the burn literature reviewing 2,495 patients highlight the importance of cooling thermal injury in reducing burn depth, grafting, and operative requirements, noting that the mechanisms involve more than just dissipation of heat, but also the alteration of cellular behavior through decreasing release of lactate and histamine, stabilizing thromboxane and prostaglandin levels, and inhibiting kallikrein activity 33 . If similar mechanisms of action are involved in the esophagus, additional benefits to surrounding structures might be anticipated.…”

Esophageal cooling for protection during left atrial ablation: a systematic review and meta-analysis

“…It is currently under clinical investigation for use during RF ablation, and preclinical data suggest a close correlation between water temperature and protective effect, such that increased heat extraction results in greater reduction in lesion thickness [22,23]. Recent data in the burn literature also suggests that there are improved outcomes from thermal burns (reduced full thickness depth, skin grafting requirement, hospitalization, and other operative interventions) with cooling, with a dose-response relationship noted between the odds of grafting and duration of cool running water, which may offer further support for the idea of a threshold effect to preventing progression of thermal injury after the initial thermal insult [24].…”