title: Partial-thickness scalds in children: A comparison of different treatment strategies.
abstract: OBJECTIVE
  The aim of this study was to compare the clinical outcomes of different treatment strategies for children with partial-thickness scalds at two burn centers. At the first burn center, these burns were treated with a hydrofiber dressing (Aquacel®, Convatec, Inc.®, Princeton, NJ, USA) or silver sulfadiazine (SSD, Flammazine®, Sinclair IS Pharma, London, UK Pharmaceuticals), while at the second burn center, cerium nitrate-silver sulfadiazine (CN-SSD, Flammacerium®, Sinclair IS Pharma, London, UK Pharmaceuticals) was used.
  
  
  METHODS
  A two-center retrospective study was conducted of children admitted between January 2009 and December 2013 for partial-thickness scalds up to 10% TBSA who were treated primarily with a hydrofiber dressing or silver sulfadiazine (Burn Center Rotterdam) vs. cerium nitrate-silver sulfadiazine (Burn Center Groningen). The Dutch Burn Repository R3 and the electronic medical records of the study population were used for data extraction. The primary outcome was the time to wound healing. The secondary outcomes were the length of hospital stay, wound infection, and surgical treatment.
  
  
  RESULTS
  The time to wound healing differed between the groups (HR=1.46, 95%CI 1.17-1.82); the shortest time to wound healing was observed in the patients treated with CN-SSD (median 13 days), compared with 15 days for the patients treated with hydrofiber and 16 days for the patients treated with SSD (p<0.01). The length of stay was significantly shorter for the hydrofiber patients (medians: hydrofiber 3 days, SSD 10 days and CN-SSD 7 days; p<0.01), but their outpatient treatment period was significantly longer (medians: hydrofiber 12 days, SSD 6 and CN-SSD 4 days; p<0.01). The proportion of surgeries and the mean time to surgery was similar between the burn centers.
  
  
  CONCLUSIONS
  This study compared different burn centers' treatment strategies for children with partial-thickness scalds and found a shorter time to wound healing in the CN-SSD group. Patients treated with hydrofiber had a shorter clinical period in comparison with the SSD and CN-SSD patients. The results of CN-SSD are promising and warrant further study. A prospective study is needed to gain full insight into the merits and drawbacks of the treatment strategies. This will allow clinicians to make full use of the strengths of particular treatments to benefit specific patients.
authors.affiliation: Erasmus Medical Centre, Erasmus University of Rotterdam, Rotterdam, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: de Graaf
authors.affiliation: Association of Dutch Burn Centers, 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 Pediatrics, Maasstad Hospital, Rotterdam, The Netherlands.
authors.forename: M G A
authors.initials: MGA
authors.lastname: Baartmans
authors.affiliation: Department of Surgery, Burn Center, Martini Hospital, Groningen, The Netherlands.
authors.forename: S M H J
authors.initials: SMHJ
authors.lastname: Scholten-Jaegers
authors.affiliation: Association of Dutch Burn Centers, Martini Hospital, Groningen, The Netherlands.
authors.forename: M K
authors.initials: MK
authors.lastname: Nieuwenhuis
authors.affiliation: Department of Surgery, Burn Center, Martini Hospital, Groningen, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Eshuis
authors.affiliation: Department of Surgery, Burn Center, Martini Hospital, Groningen, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Hiddingh
authors.affiliation: Department of Surgery, Burn Center, Martini Hospital, Groningen, The Netherlands.
authors.forename: G I J M
authors.initials: GIJM
authors.lastname: Beerthuizen
authors.affiliation: Department of Surgery, Burn Center, Maasstad Hospital, Rotterdam, The Netherlands.
authors.forename: C H
authors.initials: CH
authors.lastname: van der Vlies
mesh_terms: D000293:Adolescent; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D002056:Burns / Q000473:pathology / Q000628:therapy*; D002266:Carboxymethylcellulose Sodium / Q000627:therapeutic use*; D002563:Cerium / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D009426:Netherlands; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012837:Silver Sulfadiazine / Q000627:therapeutic use*; D015599:Trauma Severity Indices; D014945:Wound Healing
chemical_list: D000891:Anti-Infective Agents, Local; C032786:cerium nitrate; D002563:Cerium; D002266:Carboxymethylcellulose Sodium; D012837:Silver Sulfadiazine
keywords: Cerium nitrate-silver sulfadiazine; Hydrofiber; Partial-thickness burns; Scalds; Silver sulfadiazine