Predictors of re-epithelialization in pediatric burn

Nadia J Brown; Roy M Kimble; Galina Gramotnev; Sylvia Rodger; Leila Cuttle

doi:10.1016/j.burns.2013.09.027

Predictors of re-epithelialization in pediatric burn

Burns. 2014 Jun;40(4):751-8. doi: 10.1016/j.burns.2013.09.027. Epub 2013 Oct 31.

Authors

Nadia J Brown¹, Roy M Kimble², Galina Gramotnev², Sylvia Rodger³, Leila Cuttle⁴

Affiliations

¹ Centre for Children's Burns and Trauma Research, The University of Queensland, Queensland Children's Medical Research Institute, Royal Children's Hospital, Herston Road, Herston, QLD 4029, Australia. Electronic address: nadia.brown@uqconnect.edu.au.
² Centre for Children's Burns and Trauma Research, The University of Queensland, Queensland Children's Medical Research Institute, Royal Children's Hospital, Herston Road, Herston, QLD 4029, Australia.
³ The University of Queensland, School of Health & Rehabilitation Sciences, Division of Occupational Therapy, Brisbane, Australia.
⁴ Centre for Children's Burns and Trauma Research, The University of Queensland, Queensland Children's Medical Research Institute, Royal Children's Hospital, Herston Road, Herston, QLD 4029, Australia; Queensland University of Technology, Institute of Health and Biomedical Innovation, Tissue Repair and Regeneration Domain, Brisbane, Australia.

PMID: 24184285
DOI: 10.1016/j.burns.2013.09.027

Abstract

Introduction: An important treatment goal for burn wounds is to promote early wound closure. This study identifies factors associated with delayed re-epithelialization following pediatric burn.

Methods: Data were collected from August 2011 to August 2012, at a pediatric tertiary burn center. A total of 106 burn wounds were analyzed from 77 participants aged 4-12 years. Percentage of wound re-epithelialization at each dressing change was calculated using Visitrak™. Mixed effect regression analysis was performed to identify the demographic factors, wound and clinical characteristics associated with delayed re-epithelialization.

Results: Burn depth determined by laser Doppler imaging, ethnicity, pain scores, total body surface area (TBSA), mechanism of injury and days taken to present to the burn center were significant predictors of delayed re-epithelialization, accounting for 69% of variance. Flame burns delayed re-epithelialization by 39% compared to all other mechanisms (p = 0.003). When initial presentation to the burn center was on day 5, burns took an average of 42% longer to re-epithelialize, compared to those who presented on day 2 post burn (p < 0.000). Re-epithelialization was delayed by 14% when pain scores were reported as 10 (on the FPS-R), compared to 4 on the first dressing change (p = 0.015) for children who did not receive specialized preparation/distraction intervention. A larger TBSA was also a predictor of delayed re-epithelialization (p = 0.030). Darker skin complexion re-epithelialized 25% faster than lighter skin complexion (p = 0.001).

Conclusions: Burn depth, mechanism of injury and TBSA are always considered when developing the treatment and surgical management plan for patients with burns. This study identifies other factors influencing re-epithelialization, which can be controlled by the treating team, such as effective pain management and rapid referral to a specialized burn center, to achieve optimal outcomes.

Keywords: Burns; Child; Pediatric; Re-epithelialization.

Publication types

Randomized Controlled Trial

MeSH terms

Bandages*
Burns / therapy*
Child
Child, Preschool
Debridement*
Female
Humans
Linear Models
Male
Re-Epithelialization*
Treatment Outcome
Wound Healing