title: Impact of reduced resuscitation fluid on outcomes of children with 10-20% body surface area scalds.
abstract: 'Permissive hypovolaemia' fluid regimes in adult burn care are suggested to improve outcomes. Effects in paediatric burn care are less well understood. In a retrospective audit, outcomes of children from the South West Children's Burn Centre (SWCBC) less than 16 years of age with scalds of 10-20% burn surface area (BSA) managed with a reduced volume fluid resuscitation regime (post-2007) were compared to (a) an historical local protocol (pre-2007) and (b) current regimes in burn services across England and Wales (E&W). Outcomes included length of stay per percent burn surface area (LOS/%BSA), skin graft requirement and re-admission rates. 92 SWCBC patients and 475 patients treated in 15 other E&W burn services were included. Median LOS/%BSA for patients managed with the reduced fluid regime was 0.27 days: significantly less than pre-2007 and other E&W burn services (0.54 days, 0.50 days, p<0.001). Skin grafting to achieve healing reduced post-2007 compared to pre-2007 and remains comparable with other E&W services. Re-admission rates were comparable between all groups. A reduced fluid regime has significantly shortened LOS/%BSA without compromising burn depth as measured by skin grafting to achieve healing. A prospective trial comparing permissive hypovolaemia to current regimes for moderate paediatric scald injuries would help clarify.
authors.affiliation: Frenchay Hospital, North Bristol NHS Trust, United Kingdom.
authors.forename: T L J
authors.initials: TL
authors.lastname: Walker
authors.affiliation: Frenchay Hospital, North Bristol NHS Trust, United Kingdom.
authors.forename: D Urriza
authors.initials: DU
authors.lastname: Rodriguez
authors.affiliation: Frenchay Hospital, North Bristol NHS Trust, United Kingdom.
authors.forename: K
authors.initials: K
authors.lastname: Coy
authors.affiliation: University of Bristol, United Kingdom.
authors.forename: L I
authors.initials: LI
authors.lastname: Hollén
authors.affiliation: University Hospitals Bristol NHS Foundation Trust, United Kingdom.
authors.forename: R
authors.initials: R
authors.lastname: Greenwood
authors.affiliation: Frenchay Hospital, North Bristol NHS Trust, United Kingdom. Electronic address: amber.young1@nhs.net.
authors.forename: A E R
authors.initials: AE
authors.lastname: Young
mesh_terms: D000293:Adolescent; D001830:Body Surface Area; D002056:Burns / Q000150:complications / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D020896:Hypovolemia / Q000209:etiology / Q000628:therapy*; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D015599:Trauma Severity Indices; D016896:Treatment Outcome
keywords: Burn care; Fluid resuscitation; Paediatrics; Permissive hypovolaemia; Scalds