959 Retrospective Descriptive Study of Scalp Burns at Urban Level 1 Pediatric Trauma Center

TL;DR

This study examines scalp burns in children at a major trauma center, finding that few receive reconstructive surgery despite risks of long-term disfigurement and psychological effects.

Contribution

The study provides new insights into the underutilization of reconstructive surgery for pediatric scalp burns and suggests strategies to improve patient outcomes.

Findings

Only 7.4% of 175 scalp burn patients had third-degree burns, with just 53.4% of those receiving skin grafts.

Only 15.4% of patients who received skin grafts had post-burn alopecia reconstruction.

Scalp burn patients were predominantly African American (112 out of 175), and most cases were due to scalds.

Abstract

Pediatric burns account for a significant number of injuries reported to emergency departments nationwide. Although scalp burns are relatively uncommon, they carry high risk for long-term disfigurement and increased psychosocial burned. Management can be complex, and reconstruction of post-burn alopecia is an option in select patients. Timely, definitive care is therefore critical to minimize patient morbidity and optimize long-term, aesthetic outcomes. Therefore, we conducted a descriptive study to understand patient demographics and resource allocation at our high-volume urban Level 1 pediatric trauma center to understand and improve scalp burn outcomes.

This study is a retrospective analysis of pediatric patient scalp burns, as identified with ICD-10 codes. All relevant patient records from our institution between January 2016 to February 2024 were analyzed using descriptive statistics.

During this 8-year 2-month period, we identified 4,791 pediatric patients with burn injuries that were treated at our institution. Of these, 175 patients (3.65%) suffered from scalp burns. Our patient population encompassed 112 African American, 51 Caucasian, 2 Asian, and 7 other ethnicity patients. Primary etiologies were scald (59.4%), flame (19.4%), and friction (15.4%). Overall, we identified 170 reported cases of second-degree burns (total body surface area TBSA 5.9% ± 6.9) and 23 reported cases of third-degree burns (TBSA 12.7% ± 17.9). The majority of scalp burn patients (51%) were brought from an outside referring facility. On average, length of hospitalization was 7.4 days, with 21 readmissions (12%). Thirteen patients with scalp burns (7.4%) had the diagnostic of 3rd degree burn. Seven patients of them (53.4%) needed skin graft and the rest of them healed by secondary intention. Only 2 patients with skin grafts (15.4%) had reconstruction of their postburn alopecia.

Our study reports an unexpectedly low proportion of pediatric reconstruction for post-traumatic scalp burn alopecia. High-fidelity regeneration of injured scalp tissue, relatively small scar size, or ease of scar concealment at the hairline or with long hair reduce desire for reconstruction. A patient’s family’s lack of knowledge of reconstructive options and perceived lack of surgical necessity would also significantly affect reconstruction efforts. Without timely reconstruction, however, pediatric scalp burns can result in long-term psychological burden. Education of patient families and inclusion of plastic surgeons on a multi-disciplinary burn team could therefore improve long-term patient outcomes.

Elucidation of patient demographics, burn etiologies, and care management can shape resource allocation and reduce barriers to receiving proficient longitudinal burn care for pediatric scalp injuries.

The authors received no external funding for this study.