title: Early management in children with burns: Cooling, wound care and pain management.
abstract: BACKGROUND
  Early management in burns, i.e. prior to admission in a burn center, is essential for an optimal process and outcome of burn care. Several publications have reported suboptimal early management, including low levels of pain medication after trauma, especially in children. The aim of this study was to evaluate the current practice in the Netherlands and factors related to early management in pediatric burns, i.e. cooling, wound covering and pain management. To study possible change and improvement over time, two study periods were compared.
  
  
  METHODS
  This study involved two periods; January 2002-March 2004 (period 1) and January 2007-August 2008 (period 2). All children (0-15 years of age) with acute burns admitted within 24h after burn to one of the three Dutch Burn centers with a formal referral were eligible. Data were obtained from patient records, both retrospectively and prospectively.
  
  
  RESULTS
  A total of 323 and 299 children were included in periods 1 and 2, respectively. The vast majority of children in both study periods had been cooled before admission (>90%). Over time, wound covering increased significantly (from 64% to 89%) as well as pain treatment (from 68% to 79%). Predominantly paracetamol and morphine were used. Referral from ambulance services (OR=41.4, 95%CI=16.6-103.0) or general practitioners (OR=59.7, 95%CI=25.1-141.8) were strong independent predictors for not receiving pre-burn center pain medication. On the other hand, flame burns (OR=0.2, 95%CI=0.1-0.5) and more extensive burns (TBSA 5-10%: OR=0.4, 95%CI=-0.2 to 0.8; TBSA≥10%: OR=0.2, 95%CI=0.1-0.4) were independent predictors of receiving pain medication.
  
  
  CONCLUSIONS
  Referring physicians of children with burns were overall well informed: they cool the wound after burns and cover it before transport to prevent hypothermia and reduce the pain. Additional studies should be conducted to clarify the duration and temperature for cooling to be effective. Furthermore, there is room and a need for improvement regarding early pain management.
authors.affiliation: Department of Pediatrics, Maasstad Hospital, Rotterdam, The Netherlands. Electronic address: BaartmansM@maasstadziekenhuis.nl.
authors.forename: M G A
authors.initials: MG
authors.lastname: Baartmans
authors.affiliation: Association of Dutch Burn Centres, Burn Centre Red Cross Hospital, Beverwijk, The Netherlands. Electronic address: aeedejong@rkz.nl.
authors.forename: A E E
authors.initials: AE
authors.lastname: de Jong
authors.affiliation: Association of Dutch Burn Centres, Burn Centre Maasstad Hospital, Rotterdam, The Netherlands. Electronic address: BaarM@maasstadziekenhuis.nl.
authors.forename: M E
authors.initials: ME
authors.lastname: van Baar
authors.affiliation: Department of Surgery, Martini Hospital, Groningen, The Netherlands. Electronic address: G.I.J.M.Beerthuizen@mzh.nl.
authors.forename: G I J M
authors.initials: GI
authors.lastname: Beerthuizen
authors.affiliation: Association of Dutch Burn Centres, Beverwijk, The Netherlands. Electronic address: NvanLoey@burns.nl.
authors.forename: N E E
authors.initials: NE
authors.lastname: van Loey
authors.affiliation: Department of Pediatric Surgery, Erasmus Medical Center, Rotterdam, The Netherlands. Electronic address: DTibboel@erasmusmc.nl.
authors.forename: D
authors.initials: D
authors.lastname: Tibboel
authors.affiliation: Association of Dutch Burn Centres, Burn Centre, Martini Hospital, Groningen, The Netherlands. Electronic address: NieuweMK@mzh.nl.
authors.forename: M K
authors.initials: MK
authors.lastname: Nieuwenhuis
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000293:Adolescent; D000700:Analgesics / Q000627:therapeutic use*; D001458:Bandages / Q000706:statistics & numerical data*; D002056:Burns / Q000150:complications / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D017679:Cryotherapy / Q000706:statistics & numerical data*; D061345:Early Medical Intervention; D004632:Emergency Medical Services / Q000639:trends*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009020:Morphine / Q000627:therapeutic use; D009426:Netherlands; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D059408:Pain Management / Q000706:statistics & numerical data*; D012189:Retrospective Studies
chemical_list: D000700:Analgesics; D000082:Acetaminophen; D009020:Morphine
keywords: Burns; Child; Cooling; Pain; Wound care