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Surgical Treatment of Burns in Children Workup

  • Author: Renata Fabia, MD, PhD; Chief Editor: Harsh Grewal, MD, FACS, FAAP  more...
 
Updated: Feb 01, 2016
 

Laboratory Studies

Monitoring of electrolytes and blood counts is often helpful, especially with large burns requiring aggressive fluid resuscitation. Obtaining the carboxyhemoglobin level can be important in patients with inhalation injury, especially in those burned in enclosed spaces. Lactate levels correlate with burn severity and cyanide poisoning, and serial levels could be used to define the endpoint of burn shock resuscitation. Prealbumin levels should be monitored weekly in patients with burns involving more than 20% of total body surface area (TBSA) as a measure of nutritional repletion.

A fever workup (including a complete blood count [CBC]; urinalysis, and blood, urine, sputum, and wound cultures) should be performed as clinically indicated.

If invasive burn wound sepsis is suspected (clinical deterioration, a change in the appearance of the burn, an odor to the burn) definitive diagnosis can be obtained with quantitative burn wound cultures (requiring removal of at least 1 g of burned tissue at the bedside) with the microbiology laboratory alerted that quantitative wound cultures are being sent. Invasive burn wound sepsis is defined as more than 105 organisms/g tissue.

An alternative method of diagnosing invasive burn wound sepsis is by burn wound biopsy with histologic examination showing bacteria invading viable tissue.

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Imaging Studies

Chest radiography can be helpful in patients who are intubated and in patients who have a suspected inhalation injury. Chest radiography is also required as part of a complete fever workup, as indicated.

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Diagnostic Procedures

Calculation of the percentage of TBSA burned can be performed by means of various approaches. The fastest initial estimate of percent BSA burned can be made by employing the pediatric rule of nines (see the image below). This is an adaptation of the adult rule of nines, which takes into consideration the observation that in children, the relative size of the head is larger and the relative size of the lower extremities is smaller.

Pediatric Rule of Nines. Pediatric Rule of Nines.

Next, Lund and Browder charts can be used to more precisely calculate the percentage of TBSA burned by mapping the injured areas of the body on charts detailing age-appropriate measurements (see the image below).

Lund and Browder Chart. Lund and Browder Chart.

Finally, burn involvement can also be calculated by using the patient's palm. This approach is particularly helpful for small scattered burns and is based on the estimate that the patient's palm (excluding the fingers) represents approximately 0.5% of TBSA.

Note that these are estimates and should be revised by burn care providers in order to achieve more precise calculation when necessary.

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Contributor Information and Disclosures
Author

Renata Fabia, MD, PhD Assistant Professor of Clinical Surgery, Ohio State University College of Medicine; Burn Director, Burn Unit, Medical Staff, Department of Pediatric Surgery, Nationwide Children's Hospital

Renata Fabia, MD, PhD is a member of the following medical societies: American Burn Association, American College of Surgeons, American Medical Association, Central Surgical Association, Pediatric Trauma Society, The Zollinger Surgical Society, Association of Polish Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Michael G Caty, MD Professor of Surgery and Pediatrics, State University of New York at Buffalo; Consulting Staff, Department of Pediatric Surgery, Children's Hospital of Buffalo

Michael G Caty, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for Physician Leadership, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, Association for Academic Surgery, Association for Surgical Education

Disclosure: Nothing to disclose.

Chief Editor

Harsh Grewal, MD, FACS, FAAP Professor of Surgery, Cooper Medical School of Rowan University; Chief, Division of Pediatric Surgery, Cooper University Hospital

Harsh Grewal, MD, FACS, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, Association for Surgical Education, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Laparoendoscopic Surgeons, Southwestern Surgical Congress, Eastern Association for the Surgery of Trauma, Children's Oncology Group, International Pediatric Endosurgery Group

Disclosure: Nothing to disclose.

Additional Contributors

Denis D Bensard, MD, FACS, FAAP Director of Pediatric Surgery and Trauma, Attending Surgeon in Adult and Pediatric Acute Care Surgery, Attending Surgeon in Adult and Pediatric Surgical Critical Care, Denver Health Medical Center; Professor of Surgery, University of Colorado School of Medicine; Associate Program Director, General Surgery Residency, Attending Surgeon, Children's Hospital Colorado

Denis D Bensard, MD, FACS, FAAP is a member of the following medical societies: American Association for the Surgery of Trauma, Alpha Omega Alpha, Society of American Gastrointestinal and Endoscopic Surgeons, Southwestern Surgical Congress, American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, Association for Academic Surgery, Society of University Surgeons

Disclosure: Nothing to disclose.

Acknowledgements

Gail E Besner, MD Chief, Department of Pediatric Surgery, Principal Investigator, Center for Perinatal Research, Director, Pediatric Surgery Training Program, Associate Burn Director, Nationwide Children's Hospital; H William Clatworthy, Jr, Professor of Surgery, Department of Surgery, Ohio State University College of Medicine

Gail E Besner, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Burn Association, American College of Surgeons, American Gastroenterological Association, American Medical Association, American Medical Women's Association, American Pediatric Surgical Association, American Surgical Association, Association for Academic Surgery, Federation of AmericanSocieties for Experimental Biology, Society of Critical Care Medicine, Society of Surgical Oncology, and Society of University Surgeons

Disclosure: Nothing to disclose. Iyore Amy Otabor, MD Clinical Instructor House Staff, Department of General Surgery, The Ohio State University College of Medicine

Iyore Amy Otabor, MD is a member of the following medical societies: American College of Surgeons, American Medical Student Association/Foundation, and Student National Medical Association

Disclosure: Nothing to disclose.

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Skin histology diagram.
Superficial partial-thickness burn.
Deep partial-thickness burn.
Full-thickness burn.
Pediatric Rule of Nines.
Lund and Browder Chart.
Endotracheal tube immobilization in children. The figure demonstrates a method using umbilical tape to secure a pediatric endotracheal tube in patients with facial burns.
Dental device to anchor the endotracheal tube.
Application of Mepilex Ag foam dressing.
Aquacel Ag adherent to burn wounds.
Use of Aquacel Ag. Appearance of healed burns 10 days later.
Escharotomy sites.
Left, Arm escharotomy. Right, Leg escharotomy.
Chest wall escharotomy.
 
 
 
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