Exposure of buttock burn wounds to stool in scald-abused infants and children: stool-staining of eschar and burn wound sepsis.
Between July 1, 1987 and June 30, 1990, 30 consecutive deliberately scalded children with buttock involvement were prospectively studied. Mean age was 22.5 months. Mean burn size was 18.1 per cent TBSA (total body surface area). Thirty per cent (n = 9) had diarrhea complicate their wound or autograft care. For those requiring surgery for their buttock/perineal burns, various combinations of preoperative mechanical bowel prep, oral antibiotics, postoperative occlusive intrarectal catheter, nothing-by-mouth, and rigid postoperative positioning did not protect buttock wounds and autografts from stool. Four patients had stool staining of the superficial burn wound exudate, none of whom developed burn wound sepsis or died. Four (13.3%) patients with a mean burn size of 32.3 per cent TBSA, diarrhea, and burns involving the buttock, perineum, and external genitalia died of burn wound sepsis, three of whom had deep stool staining of their burn wound and Gram-positive bacteremia. Buttock burn wounds should be examined carefully and frequently for the presence of deep stool staining, an ominous predictor of burn wound sepsis and death. Such wounds, if present, should be emergently excised.
Emory University School of Medicine, Atlanta, Georgia.
B M
BM
Renz
R
R
Sherman
D016470:Bacteremia / Q000382:microbiology; D002056:Burns / Q000382:microbiology* / Q000473:pathology* / Q000601:surgery; D002081:Buttocks / Q000293:injuries* / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D002404:Catheterization; D002423:Cause of Death; D002649:Child Abuse; D002675:Child, Preschool; D062109:Dermatologic Surgical Procedures; D003967:Diarrhea / Q000382:microbiology / Q000473:pathology; D005243:Feces / Q000382:microbiology; D006801:Humans; D007223:Infant; D010502:Perineum / Q000293:injuries / Q000382:microbiology; D011446:Prospective Studies; D012007:Rectum; D012867:Skin / Q000382:microbiology* / Q000473:pathology*; D016038:Skin Transplantation / Q000473:pathology; D015996:Survival Rate; D014945:Wound Healing; D014946:Wound Infection