Paediatric Burns of the Hand: Our Experience Over Three Years

Abstract

Background and aimContact burn injuries to the hand are common in the paediatric population, with the most common aetiology involving touching hot surfaces in the household. The hand is also often involved in paediatric scald injuries. The aim of this study was to determine the different presentations of hand burn injuries and analyse the outcomes in the paediatric population at Royal Aberdeen Children's Hospital (RACH). MethodsAnonymised clinic data for paediatric patients with hand burns presenting to our burn centre from 2017 to 2020 were retrospectively reviewed. A total of 52 patients (65 affected hands) were included in the study. Clinic letters stored on NHS Grampian's electronic patient record system were reviewed for burn surface area, time to healing, management measures including medications prescribed and sequelae of the burn injury. ResultsThe average patient age was three years and four months old. There were 31 male patients and 21 female patients. Paediatric hand burns were most commonly confined to the palm only, followed by the fingers only. Contact with a hob was the most common aetiology, followed by scald burns. The average time to healing was 10 days (range 2-28 days). No correlation was found between length of stay on initial hospital admission and time to complete healing. A total of 86.5% (n=45) of patients were managed with dressings and 13.5% (n=7) of patients underwent surgical management. Of these seven patients, four had surgical debridement of burn tissue, washout, and dressing, and the remaining three had an excision and grafting with thick split-thickness skin grafts. Of these three patients, one patient had to undergo secondary reconstruction with a full-thickness skin graft. ConclusionIt has been found that most patients in this study completely healed with primarily conservative measures of dressing care and regular check-ups. Isolated hand burns in the paediatric population present a low rate of sequelae and palms are the most common area of burn injury in this demographic.

Do they stay, or do they go? Children presenting to five emergency departments across New South Wales, Australia with acute burn injuries: a retrospective review

“…Males and preschoolers were most of the burn injury presentations in this retrospective study. Similar results have been previously reported in developed countries 12 18 19. Toddlers and preschool children are often seen to be exploring their world with little understanding for their own safety.…”

Multidisciplinary approach for a severe head burn caused by high-voltage electrical shock - a case report

“…Despite this, the patient left a ward specializing in burn injuries treatment after 11 days, which can be explained (for example) by good prehospital treatment and fast reaction, because the short time of tissue hypoperfusion enhances the chances of patient survival and smaller cosmetic defect 14 . On the other hand, in the pediatric population, the correlation between prolonged hospitalization and shorter healing period was questioned among all patients with burn injuries 15 .…”

What Changes Have Occurred in the Pattern of Paediatric Burns in the Last Years with Special Attention to the COVID-19 Pandemic?

“…Hands are a common body area affected by burns, reportedly the commonest [34], especially in children under the age of 5 years [61]. US and Australian papers have found that contact burns are a common source of hand burns (61.4-75.5%) [17,66], with the majority occurring on the palmar aspect of the hand [67,68] affecting either the palm only or the fingers [69]. Hand burns are particularly common in children, with toddlers being at a high risk of sustaining palmar contact burns from touching hot objects out of curiosity and lack of caution [70].…”

“…Hand burns are particularly common in children, with toddlers being at a high risk of sustaining palmar contact burns from touching hot objects out of curiosity and lack of caution [70]. Two studies in HICs found that the most common aetiology of hand burns was contact with a hot stove or oven [67,69], and fireplaces, irons and campfires are other common causes [67]. Friction burns from exercise treadmills are also a common mode of hand injury, accounting for 25% of hand burns over a 5 year period at a US level 1 paediatric burn centre and primarily occurring in the 0-4 age group [66].…”