Weight-based vs. BSA-based Fluid Resuscitation Predictions in Pediatric Burn Patients

Fluid resuscitation for pediatric burns uses formulas that estimate fluid requirements based on weight, and/or body surface area (BSA) along with percent total burn surface area (TBSA). Adult studies have shown that these formulas can cause fluid overload in obese patients and increase risk of complications. These findings have not been validated in pediatric patients. This study provides a retrospective review conducted with 110 children (≤ 18 years old) admitted to an ABA-verified urban pediatric burn center from October 2008 to May 2020. Patients were resuscitated with the weight-based Parkland formula, and had fluids titrated to urine output every two hours. BSA-based Galveston and BSA-incorporated Cincinnati formula resuscitation predictions were also calculated. Complications were collected throughout the hospital stay. Patients were classified into CDC-defined weight groups based on percentile ranges. We found that predicted resuscitation volumes increased as CDC percentile increased for all three formulas (p=0.033, 0.092, 0.038), however there were no significant differences between overweight and obese children. Total fluid administered was higher as CDC percentile increased (p=0.023). However, overweight children received more total fluid than obese children. The difference between total fluids given and Galveston predicted resuscitation volumes were significant across all groups (p=0.042); however, the difference using the Parkland and Cincinnati formulas were not statistically significant. There were more children in the normal weight group who developed complications compared to other groups, but these findings were not significant. Overall, the Parkland formula tended to underpredict fluid needs in the underweight, normal, and overweight children, and it overpredicted fluid needs for the obese. Further research is needed to determine the value of weight-based vs BSA-based or incorporated formulas in terms of their risk of complications

Predictive Factors for Length of Hospital Stay in Pediatric Dog Bite Patients

Title: Predictive Factors for Length of Hospital Stay in Pediatric Dog Bite Patients Authors: Alessio-Bilowus D1, Kumar N2, Ridelman E1, Shanti C21Wayne State University, Detroit, MI; 2Children’s Hospital of Michigan, Detroit, MI Introduction: Dog bite injuries are a source of significant morbidity in the United States, with children being at increased risk compared to adults, yet there is a lack of published data on factors affecting hospital length of stay (LOS) in pediatric patients. Methods: A full-text retrospective chart review was conducted of all patients presenting to our urban, academic pediatric surgery unit for dog bite injuries between January 2016 and May 2021. Multiple demographic and clinical variables were examined prior to, during and after hospital stay. All data was analyzed using IBM SPSS Statistics V22.0 to compare the impact of each variable on hospital LOS. Results: 739 pediatric patients were evaluated and treated for dog bite injuries during the study period, of which 349 were admitted for inpatient care. Hospital length of stay ranged from 1 to 34 days, with a mean of 2.9 days and median of 2.0 days. Our analysis revealed two major predictors of increased length of stay: presence of bone fracture (n = 45, mean LOS = 5.3 days, p = 0.00), and prior medical comorbidity, including infection of the wound prior to the encounter (n = 24, mean LOS = 4.3 days, p = 0.04). Demographic and other clinical variables were not associated with statistically significant increases in LOS. Conclusions: Pediatric patients admitted for dog bite injuries have significantly longer inpatient LOS when they present with bone fractures or significant medical comorbidities including prior wound infection

Ocular Complications of Facial Burns in the Pediatric Population

Introduction: Pediatric burns commonly involve the face and periocular areas, with a possibility of impairing vision. The aim of this study is to characterize ocular injuries in burn patients and identify the patients at most risk of ocular complications. Methods: This study is a retrospective review within a single academic, urban pediatric burn center. All burn patients under 18 years of age admitted from January 2010 to December 2020 with ocular involvement were included. Variables analyzed included patient demographics, burn characteristics, presence of ophthalmology consultation, ocular exam findings, follow up time period, and early and late ocular complications. Results: In the study period, 2,781 patients were admitted to our burn center, 300 of whom had facial burns involving the eyes and/or eyelids. Etiologies of burn injuries were as follows: 112 (37.5%) scald, 80 (26.8%) flame, 35 (11.7%) contact, 31 (10.4%) chemical, 28 (9.4%) grease, and 13 (4.3%) friction. Overall, 70.9% of patients with ocular burns received an ophthalmology consult. Of these patients, 61.5% had periorbital swelling and 39.8% had corneal injuries. Of the 207 patients who were seen by ophthalmology inpatient, only 61 (29.5%) had a follow-up visit as recommended. Among patients seen outpatient, 6 had serious ocular sequelae including ectropion, entropion, symblepharon, and corneal decompensation, 4 of whom had firework-related injury. Conclusion: Burns involving the ocular surface and eyelid margins are at particular risk for long-term damage. As ocular burns can cause immediate as well as delayed sequalae, ophthalmologic evaluation is important in acute and subacute periods after injury