Children's Hospital Burns Research Institute
Clinical Audits
Axillary Splinting
Anne Darton, Cheri Templeton, Genevieve McInnes
Axillas are a common area of the body to be burnt, particularly in the paediatric population who commonly pull down hot liquids and scald the anterior and posterior folds of the axilla.
At the Children's Hospital at Westmead it has been the physiotherapy practice for the last 24 years to use thermoplastic moulded splints to hold the shoulder at 150-170 degrees abduction with forward flexion. Our practice is to apply these splints, after initial assessment of the burn, in the first 24-48 hours. The splint is initially worn all the time and taken off for dressing changes and physiotherapy exercises only. They are also used post operatively for immobilisation as appropriate. The splints are continued nightly and during the day; on and off as individually appropriate usually for 6 to 10 months. In our experience the children do regain strength and maintain full range of motion of the shoulder with this splinting regime. Over this period there were no complications of neuropathies or avascular necrosis.
Following our retrospective audit, we will be conducting a prospective audit for the next 2-3 years on our current practice and results. We are also currently reviewing the techniques used in axilla burn management, in particular, splinting routines, throughout Australia and New Zealand. The plan is to establish standard outcome measures and practices for both adults and children with burn injuries.
The Significance of Iron Burns
Sarah Clarke, Dr Erik La Hei
Contact burns are the second most common type of burn injury seen at the Children's Hospital at Westmead with a high proportion of these injuries sustained from contact with a hot iron.
Data was collected over a 5 year period (June 1999 to June 2004) and the medical records of all patients who sustained this type of injury were examined. Information collated includes burn depth, incidence of skin grafting, long term treatment required and the safety aspects surrounding the initial injury. The preliminary results indicated that of the 100 patients identified, 25% required skin grafting and a further 25% too longer than 14 days to heal. These findings are significant to the long term functional outcomes of these patients, with most iron burns occurring on the hands.
In conclusion, contact burns from irons have the potential to cause a serious full thickness injury with lifelong implications. Because of the intense nature of treating these injuries and the long term follow up, the cost is immense. There needs to be a more proactive approach to the prevention of these injuries with the improper storage of irons is a major concern. There needs to be more public education on the potential danger of hot irons and the availability of safety devices.
Cap Gun Burns in Children
Deborah Maze, A/Prof Andrew Holland
Exploding caps for a toy or model gun rarely cause injuries, but these may include a burn. This type of injury is potentially preventable. There appear to be no regulations or recommendations regarding the sale of these explosives in NSW.
The Burns Unit database at The Children's Hospital at Westmead (CHW) was interrogated to identify patients treated with cap burns over a five year period (1999-2003). Data was collected on the circumstances of injury, burn depth, treatment and outcome.
Of 2915 burns patients treated during this period, only five were associated with cap guns. All patients were male and aged between 6 and 12 years. The average BSA involved was 2%, with affected areas including the hands, fingers, arms and thighs. All of the burns were flash flame in nature and partial thickness in depth. Four of the five patients healed within 14 days and none required surgical intervention.
Burns associated with cap guns are generally partial thickness in depth and heal without grafting. There remains the potential in children for morbidity and adverse long term sequela. School age boys appear most at risk from this mechanism of injury. Children need to understand the safety instructions supplied with cap guns which should therefore only be used after appropriate directions from an adult. Product safety warning should be displayed on packaging and include information on the safe storage and handling of caps.
Burns Enteral Feeding Audit
Sharon Youde, Jane Stormon
Children with burns injuries need about 2-3 times more energy (calories) and protein than normal. Their need for vitamins and minerals is also increased. Ensuring patients with burns injuries receive sufficient nutrition to meet their requirements is vital for best outcomes. Adequate nutrition improves patient outcomes including improved nutritional status, successful wound healing, less infections and complications leading to a shorter length of stay.
This audit is reviewing the experience of naso-gastric feeding in burned children; assessing the percentage of feeds they receive compared to prescribed volumes, whether they are meeting their estimated requirements for energy and protein and then attempting to elucidate reasons for not achieving these goals. The audit will provide important information to improve our clinical practice of feeding burned children.
This document was published on Friday, 13 May, 2005
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