Management Strategies for Pediatric Burns During the COVID-19 Pandemic

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has been challenging global health, in many countries all non-urgent medical treatments were postponed in order to focus health systems, workforce and other resources on crucial treatments for COVID-19 patients. The pediatric cases are a minority of all COVID-19 patients and might present atypically. Due to an increase in pediatric burn cases we decided to establish an outpatient pre-hospital clinic as an intermediate “station”, in order to triage pediatric burn patients into those who present at our hospital, and those treated via telemedicine. We divided our tactics into environmental and patient management both in hospitalized and outpatient patients, also medical staff management including preventive care, surgery, and bedside procedures. We found that patients and their escorts waited longer before arriving to the Emergency Room, apparently trying to avoid the hospital visit. A higher proportion of patients was hospitalized during the pandemic (4.5% in 2020, compared to 2.6% and 2.0% in 2019 and 2018, respectively). However, the length of stay was similar to routine periods, the surgery rate and length of follow up until healing was similar to that of the same month in previous years. We assume that these factors reflect treatment quality, which was not affected, due to the use of telemedicine, and that our treatment standards were maintained. It is important to have a good regulation system of prevention and care, including the tactics described below.

Challenges in Burn Care during the COVID-19 Pandemic—A Scoping Review

“…The respective studies originated in Graz, Austria [ 6 ]; Chongqing, China [ 7 ]; Chelmsford, UK [ 8 ]; Rabat, Morocco [ 9 ]; Barcelona, Spain; Singapore, Singapore; Torino, Italy; Iowa City and Seattle, USA; Chongqing and Shanghai, China; Birmingham, UK; Tokyo, Japan [ 10 ]; Petah Tikva, Israel [ 11 ]; Shanghai, China [ 12 ]; Johannesburg, Cape Town, Kimberley, and Durban, South Africa [ 13 ]; and Delhi, India [ 14 , 15 ]. A brief overview of the included studies and their key points is mentioned in Table 2 .…”

“…To prevent interpatient transmission, the establishment and declaration of different patient rooms and even wards for COVID-19 negative, positive, and suspected cases is of utmost importance [ 6 , 7 , 9 , 11 , 12 , 13 , 15 ]. According to Li et al, it is recommended that clearly differentiated areas are designated in order to avoid unnecessary contact [ 7 ].…”

“…The most important step in reducing the infection rate and preventing a collapse of the health care systems is the provision of sufficient personal protective equipment (PPE), consisting of masks, preferably FFP2/3 or N95, gloves, protective goggles, and gowns [ 6 , 7 , 8 , 10 , 11 , 12 , 13 , 14 , 15 ]. In the burn unit of the University Hospital Graz in Austria, PPE was provided and distributed by the hospital management team [ 6 ].…”

“…Medical staff of burn units in Graz, Petah Tikva, and Barcelona were divided into two teams or, in the case of Delhi, into three, of which only one was present in the hospital at any given time. The teams switched to fortnightly rotas in order to maintain sufficient personnel numbers in the case of positive staff members [ 6 , 10 , 11 , 15 ]. In some countries, all surgical staff were appointed to COVID-19 ICUs, leaving only a reduced number of medical staff to maintain vital surgical services during the first infection wave [ 10 ].…”

“…For instance, these could comprise of the setup of triage units and isolation areas, the performance of emergency-only surgeries and the postponement of elective ones. These means should help to prevent the spread of SARS-CoV-2 and comply with burn care, as well as establish and maintain capacities for COVID-19 patients [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. The aim of this review is to systematically map and summarize the experiences of various burn centers worldwide during the COVID-19 pandemic, along the range of strategies adopted during this time, as well as to identify any existing gaps in knowledge.…”