608 Timing of Nanocrystalline Silver-based Dressing Application – a Retrospective Single-center Pediatric Cohort Study

TL;DR

This study found that applying nanocrystalline silver dressings within 24 hours of a burn injury in children does not reduce the need for surgery.

Contribution

The study is the first to investigate the impact of early nanocrystalline silver dressing application on surgical treatment rates in pediatric burn patients.

Findings

Immediate application of nanocrystalline silver-based dressings did not reduce surgical treatment rates in pediatric burn patients.

Age, TBSA, and burns to the buttocks/lower extremities were significant predictors of surgical treatment.

No significant differences were found in surgical treatment rates, age, sex, or injury characteristics between the groups on bivariate analysis.

Abstract

Nanocrystalline silver-based dressings (NSBD) are commonly used at different stages of the treatment of burn wounds. They have been shown to reduce the incidence of surgical procedures, time to re-epithelialization in partial thickness burn injuries, and decrease pain with dressing changes compared to silver sulfadiazine in adult and pediatric populations. Recent evidence has demonstrated anti-inflammatory properties in addition to the known antimicrobial properties. We hypothesized that the timing of nanocrystalline silver-based dressings application ( < 24h after burn injury) may impact surgical treatment rates.

This study was a retrospective single-center cohort study. All pediatric patients ( < 18 years old) treated at a single academic pediatric center for acute partial thickness burn injuries, between January 1, 2020 and December 31, 2021 were included. Bivariate analysis and multivariable logistic regression were used to compare timing of nanocrystalline silver application and surgical treatment rates.

Four hundred seventy-six patients were included for analysis. One hundred four (21.85%) had NSBD and 372 (78.11%) had non-silver non-adherent dressings applied within the first 24 hours post injury. No statistically significant difference was found in surgical treatment, age, sex, mechanism, anatomic location, or total body surface area (TBSA) on bivariate analysis. The multivariable logistic regression identified three statistically significant variables as predictors for surgical treatment: age (OR = 1.14, 95% CI [1.06-1.23]), TBSA (OR = 1.15, 95% CI [1.06-1.25]), and burns to buttocks/lower extremity burns (excluding feet) (OR = 2.39, 95% CI [1.26-4.53]). Immediate ( < 24h) application of NSBD has not been demonstrated to decrease the likelihood of surgical treatment.

Immediate ( < 24h) application of nanocrystalline silver-based dressings does not affect surgical treatment rates. Prospective randomized studies are required to investigate the potential anti-inflammatory benefits of early nanocrystalline silver-based dressings in the treatment of pediatric burn injuries.

Use of nanocrystalline silver should be recommended as per clinical indications.