Risk factors associated with higher pain levels among pediatric burn patients: a retrospective cohort study

Abstract

IntroductionThere is an absence of evidence regarding predictors of moderate to severe pain in children undergoing acute burn treatment. This investigation aimed to determine if relationships existed between patient and clinical characteristics, and pain at first dressing change for children with acute burn injuries.MethodsA retrospective cohort investigation was conducted using clinical data from pediatric burn patients treated at the Queensland Children’s Hospital, Brisbane, Australia. Data extracted included patient and burn characteristics, first aid, and follow-up care. Observational pain scores were categorized into three groups (mild, moderate, and severe pain), and bivariate and multivariable relationships were examined using proportional odds ordinal logistic regression. Data from 2013 pediatric burns patients were extracted from the database.ResultsFactors associated with increased odds of procedural pain included: hand burns (OR 1.7, 95% CI 1.3 to 2.1, p<0.001), foot burns (OR 1.5, 95% CI 1.1 to 2.1, p<0.01), baseline pain (OR 5.5, 95% CI 2.8 to 10.8, p<0.001), deep dermal partial-thickness injuries (OR 7.9, 95% CI 4.0 to 15.6, p<0.001), increased burn size (OR 1.1, 95% CI 1.0 to 1.2, p<0.01), four or more anatomical regions burned (OR 3.6, 95% CI 1.5 to 8.6, p<0.01), initial treatment at a non-burns center (OR 1.8, 95% CI 1.4 to 2.3, p<0.001), and time to hospital presentation (OR 0.9, 95% CI 0.8 to 0.9, p<0.001). These burn characteristics are associated with increased odds of moderate to severe procedural pain during a child’s first dressings change.DiscussionIt is recommended that patients presenting with one or more of the aforementioned factors are identified before their first dressing change, so additional pain control methods can be implemented.

Early non-excisional debridement of paediatric burns under general anaesthesia reduces time to re-epithelialisation and risk of skin graft

“…Additionally, effective adherence to 20 min of cool running water within the first three hours of burn injury has resulted in significantly reduced odds of skin grafting amongst other patient outcomes 50 , 51 . More recently Holbert et al highlighted the characteristics of burn wounds associated with higher pain levels 52 . Acknowledging the impact risk factors and interventions have on the time to re-epithelialisation and subsequent risk of scarring are important considerations in tailoring acute burn treatment pathways.…”

The feasibility of Negative Pressure Wound Therapy versus Standard Dressings in Paediatric Hand and Foot Burns Protocol: A Pilot, Single-Centre, Randomised Control Trial

“…Risk factors for prolonged re-epithelialisation times include burns that are deeper, more painful, cover larger total body surface areas (TBSA) become, infected and have a delayed time to presentation(18). Hand and foot burns are more painful than burns of other locations (19). Thus, a deep hand or foot burn with a prolonged time to re-epithelialisation would be considered high risk for hypertrophic scar formation.…”

Virtual reality mobility for burn patients (VR‐MOBILE): A within‐subject‐controlled trial protocol

“…Hydrotherapy in burn care is done with the use of opioids and benzodiazepines, since regular analgesics, such as acetaminophen alone, are often inadequate for pain and anxiety management 3,4 . As hydrotherapy treatments cause a great deal of pain compared to standard burn care, high dose of narcotics is required to reach an acceptable level of pain relief.…”

“…1,2 Hydrotherapy in burn care is done with the use of opioids and benzodiazepines, since regular analgesics, such as acetaminophen alone, are often inadequate for pain and anxiety management. 3,4 As hydrotherapy treatments cause a great deal of pain compared to standard burn care, high dose of narcotics is required to reach an acceptable level of pain relief. The delicate balance between pain relief and opioid requirements is often at the limit of respiratory depression and the occurrence of side effects such as nausea and vomiting.…”