Assessment of Prehospital Care for Pediatric Patients with Thermal Injuries: A Retrospective Study

TL;DR

This study finds that prehospital estimates of burn severity in children are often overestimated but don't affect fluid treatment decisions, and analgesic use varies by gender.

Contribution

The study provides new insights into the accuracy of prehospital TBSA-B estimation and its impact on pediatric burn care decisions.

Findings

Prehospital TBSA-B estimates were overestimated by an average of 6.35% compared to in-hospital assessments.

Fluid therapy volumes were not influenced by prehospital TBSA-B estimates.

Hospital stay duration correlated with in-hospital TBSA-B measurements, not prehospital estimates.

Abstract

Background/Objectives: Accurate prehospital assessment of total body surface area burned (TBSA-B) is crucial for pediatric burn management, guiding resuscitation, fluid therapy, and transfer decisions. This study evaluates the accuracy of prehospital TBSA-B estimations compared to in-hospital expert assessment and examines their impact on prehospital management. Methods: This retrospective study analyzed 104 pediatric burn cases (median 17 months; 5 days–14 years) from 2017 to 2021. The primary endpoint was the difference between prehospital TBSA-B estimation and clinical measurement, with a clinically significant discrepancy defined as >5%. Secondary endpoints included the relationship between TBSA-B estimation and fluid therapy, analgesia, and hospital stay duration. Results: Prehospital TBSA-B estimations ranged from 2% to 40% (mean: 13.9%, SD = 4.4%) with scalds being the most common burn type (90.4%). Bland–Altman analysis showed a mean TBSA-B overestimation (bias) of 6.35%, with limits of agreement ranging from −6.97% (CI: −9.42 to −4.51) to 19.67% (CI: 17.21 to 22.12). No significant patterns in overestimation were associated with age, gender, or burn location. Fluid therapy volumes were independent of prehospital TBSA-B estimates, and analgesic administration varied by gender, with girls receiving less analgesia than boys, but showed no association with burn extent or severity. Hospital stay duration correlated proportionally with in-hospital assessed TBSA-B. Conclusions: Prehospital TBSA-B estimation was systematically overestimated, yet it did not influence fluid therapy decisions. Gender differences were observed in analgesic administration, while hospital stay duration was directly related to burn extent. These findings highlight the need for improved training and standardized tools to enhance prehospital burn assessment in pediatric patients.

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