Variation in acute fluid resuscitation among pediatric burn centers

Burns. 2021 May;47(3):545-550. doi: 10.1016/j.burns.2020.04.013. Epub 2020 May 16.


Background: Accurate resuscitation of pediatric patients with large thermal injury is critical to achieving optimal outcomes. The goal of this project was to describe the degree of variability in resuscitation guidelines among pediatric burn centers and the impact on fluid estimates.

Methods: Five pediatric burn centers in the Pediatric Injury Quality Improvement Collaborative (PIQIC) contributed data from patients with ≥15% total body surface area (TBSA) burns treated from 2014 to 2018. Each center's resuscitation guidelines and guidelines from the American Burn Association were used to calculate estimated 24-h fluid requirements and compare these values to the actual fluid received.

Results: Differences in the TBSA burn at which fluid resuscitation was initiated, coefficients related to the Parkland formula, criteria to initiate dextrose containing fluids, and urine output goals were observed. Three of the five centers' resuscitation guidelines produced statistically significant lower mean fluid estimates when compared with the actual mean fluid received for all patients across centers (4.53 versus 6.35ml/kg/% TBSA, p<0.001), (4.90 versus 6.35ml/kg/TBSA, p=0.002) and (3.38 versus 6.35ml/kg/TBSA, p<0.0001).

Conclusions: This variation in practice patterns led to statistically significant differences in fluid estimates. One center chose to modify its resuscitation guidelines at the conclusion of this study.

Keywords: Burn resuscitation; Fluid resuscitation; Pediatric burns; Pediatric thermal injury.

MeSH terms

  • Body Surface Area
  • Burn Units / organization & administration
  • Burn Units / statistics & numerical data
  • Child
  • Child, Preschool
  • Female
  • Fluid Therapy / methods*
  • Fluid Therapy / standards
  • Fluid Therapy / trends
  • Humans
  • Infant
  • Male
  • Pediatrics / methods
  • Pediatrics / trends
  • Resuscitation / methods
  • Resuscitation / standards
  • Resuscitation / trends*
  • Retrospective Studies