title: Lack of a standardised UK care pathway resulting in national variations in management and outcomes of paediatric small area scalds.
abstract: BACKGROUND
  There is a paucity of evidence guiding management of small area partial thickness paediatric scalds. This has prevented the development of national management guidelines for these injuries. This research aimed to investigate whether a lack of evidence for national guidelines has resulted in variations in both management and outcomes of paediatric small area scalds across England and Wales (E&W).
  
  
  METHODS
  A national survey of initial management of paediatric scalds ≤5% Total Body Surface Area (%TBSA) was sent to 14 burns services in E&W. Skin graft rates of anonymised burns services over seven years were collected from the international Burns Injury Database (iBID). Average skin grafting rates across services were compared. Length of stay and proportion of patients receiving general anaesthesia for dressing application at each service were also compared.
  
  
  RESULTS
  All 14 burns services responded to the survey. Only 50% of services had a protocol in place for the management of small area burns. All protocols varied in how partial thickness paediatrics scalds ≤5% TBSA should be managed. There was no consensus as to which scalds should be treated using biosynthetic dressings. Data from iBID for 11,917 patients showed that the average reported skin grafting rate across all burns services was 2.3% (95% CI 2.1, 2.6) but varied from 0.3% to 7.1% (P<0.001). Service provider remained associated with likelihood of skin grafting when variations in the %TBSA case mix seen by each service were controlled for (χ(2)=87.3, P<0.001). The use of general anaesthetics across services varied between 0.6 and 35.5% (P<0.001). The median length of stay across services varied from 1 to 3 days (P<0.001).
  
  
  CONCLUSIONS
  A lack of evidence guiding management of small-area paediatric scalds has resulted in variation in management of these injuries across E&W. There is also significant variation in outcomes for these injuries. Further research is indicated to determine if care pathways and outcomes are linked. An evidence-based national policy for the management of small area paediatric scalds would ensure that high quality, standardised care is delivered throughout E&W and variations in outcome are reduced.
authors.affiliation: St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, London SW17 0QT, United Kingdom.
authors.forename: Alexander E J
authors.initials: AE
authors.lastname: Trevatt
authors.affiliation: University of Bristol, Bristol BS8 1TH, United Kingdom.
authors.forename: Emily N
authors.initials: EN
authors.lastname: Kirkham
authors.affiliation: Whipps Cross University Hospital, Whipps Cross Road, Leytonstone, London E11 1NR, United Kingdom.
authors.forename: Bradley
authors.initials: B
authors.lastname: Allix
authors.affiliation: Healing Foundation Children's Burn Research Centre, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, BS2 8BJ United Kingdom.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Greenwood
authors.affiliation: Healing Foundation Children's Burn Research Centre, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, BS2 8BJ United Kingdom.
authors.forename: Karen
authors.initials: K
authors.lastname: Coy
authors.affiliation: Healing Foundation Children's Burns Research Centre, University of Bristol, Bristol BS8 2BN, United Kingdom.
authors.forename: Linda I
authors.initials: LI
authors.lastname: Hollén
authors.affiliation: Healing Foundation Children's Burn Research Centre, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, BS2 8BJ United Kingdom. Electronic address: amber.young1@nhs.net.
authors.forename: Amber E R
authors.initials: AE
authors.lastname: Young
mesh_terms: D018681:Anesthetics, General / Q000627:therapeutic use*; D001458:Bandages; D001830:Body Surface Area; D002056:Burns / Q000628:therapy*; D002675:Child, Preschool; D019091:Critical Pathways; D019468:Disease Management; D004739:England; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012015:Reference Standards; D016038:Skin Transplantation; D015599:Trauma Severity Indices; D006113:United Kingdom; D014852:Wales
chemical_list: D018681:Anesthetics, General
keywords: Biosynthetic dressing; Burn; Outcomes; Paediatric; Scald; Skin graft