Exhaust system-related burns affecting children: a UK perspective and literature review.

Burns caused by exhaust systems in children may be associated with considerable morbidity. Current epidemiological data varies, but no data are available for the UK population. We aim to identify the pattern of exhaust-related burns affecting children who presented to a regional centre for paediatric burn care in the UK. Patients who sustained burns related to exhaust mechanisms between May 2005 and August 2012 were identified via the departmental database. Data collected included patient demographics, burn injury information, management and outcomes. Thirty-nine patients sustained 43 burns from contact with exhaust mechanisms, and the majority were less than 5 years of age. 77% of the patients were male. Burns affected critical areas such as the hands and feet in 26% of cases. Most burns involved a total body surface area of ≤1% and were partial thickness in depth. Thirty-three percent of patients required operative intervention. Time to heal was less than 3 weeks in 69% of cases and 3 patients healed with hypertrophic scarring. The majority of burns were small in size and partial thickness in depth. Most were treated conservatively and healed with low complication rates. More than 1 in 5 injuries involved critical burn areas, highlighting the potential for considerable morbidity. The age profile in our study contrasted with other results worldwide. Our study highlights the need for vigilant supervision of children around motorcycles. We recommend the wearing of protective long trousers when riding motorcycles and the fitting of external shields to motorcycle exhaust pipes.

Les brûlures par pot d'échappement chez l'enfant peuvent être responsables d'une morbidité importante. Les données épidémiologiques actuelles sont variables, mais il n'y en a pas au Royaume Uni. Nous avons analysé les circonstances de survenue des brûlures par pot d'échappement touchant les enfants vus dans un CTB régional du Royaume Uni, entre mai 2005 et août 2012, retrouvés via la banque de données régionale. Les variables analysées étaient les données démographiques, le mécanisme précis de la brûlure, la prise en charge et le devenir. Trente neuf patients ont subi 43 brûlures par ce mécanisme, la majorité ayant moins de 5 ans, 77% d'entre eux étant des garçons. Les brûlures atteignaient des régions sensibles (mains, pieds) dans 26% des cas, touchaient moins de 1% de SCT dans la plupart des cas et étaient fréquemment intermédiaires. Trente neuf pour cent des patients on nécessité une intervention chirurgicale. Dans 69% des cas, la cicatrisation était obtenue en moins de 3 semaines, 3 patients ont développé une cicatrice hypertrophique. La majorité des brûlures touchent une petite surface et sont peu profondes, cicatrisant sans chirurgie ni séquelles. Plus d'une brûlure sur 5 touche des zones fonctionnelles, avec un potentiel morbide élevé. La classe d'âge touchée contraste avec les données retrouvées ailleurs et nécessite une vigilance accrue au profit des enfants lorsqu'ils sont autour de 2 roues à moteur. Nous recommandons de porter des pantalons longs et la mise en place de protections autour des pots d'échappement.

The cost of a hot drink scald.

Approximately 6400 children per year are admitted to UK hospitals for treatment of burns [National Burn Care Review Committee Report (NBCRC). Standards and Strategy for Burn Care: a review of burn care in the British Isles. 2001.]. This paper investigates the financial costs involved in the management of uncomplicated, minor paediatric scalds. Three cases (2-4% TBSA scalds) were studied to quantify consumables used, services required during management and costs obtained from appropriate Purchasing Departments and Directorate Accountants. Management in all cases involved a general anaesthetic for cleaning of wounds, application of BioBrane (Bertek Pharmaceuticals) and dressings, observation on Children's Ward and discharge following wound review at 48 h. The calculated mean average cost per case was pound1850. In the period 01/12/2002-30/11/2003, 144 children were admitted to Frenchay hospital, Bristol, for treatment of a minor burn or scald (less than 10%TBSA). This caseload is therefore estimated to currently cost pound266,400 per year. These findings may facilitate improved planning for future resource allocation and could also contribute evidence towards the cost effectiveness of prevention strategies.

A comparison of serial halving and the rule of nines as a pre-hospital assessment tool in burns.

Following endorsement of serial halving by the Faculty of Pre-Hospital Care of the Royal College of Surgeons of Edinburgh this study aimed to determine whether the technique was comparable to the rule of nines in making initial assessments of body surface area burned. Ten 'casualties' were made up to represent burn victims (range 6-61%). An external panel of six consultants and one specialist registrar in plastic surgery were invited to assess the simulated casualties. They gave individual and a consensus estimate of the burned areas. One hundred and twenty-five members of local emergency services and military paramedical staff were given a brief video and slide presentation describing either the rule of nines or serial halving method of burn area assessment. These techniques were then used to assess the 10 simulated casualties, giving 1250 estimates of burn surface area. The understanding of both techniques appeared adequate in both test groups. Estimates from serial halving and rule of nines groups differed from the assessments of the external panel. No statistical difference was demonstrated between serial halving and the rule of nines as an initial assessment tool when determining disposal. Serial halving has an inherent weakness when assessing certain sizes of burn. The rule of nines requires that the assessor knows and understands the proportionate areas of the body. The mathematics of percentages and fractions appeared to confuse some assessors.

Distally based double paddle fasciocutaneous island flap following lower limb trauma.

We report a modification of the distally based islanded fasciocutaneous flap that is suited to cover two separate defects following lower limb trauma.

A dermoid of the eye in a blue-fronted Amazon parrot (Amazona aestiva).

A corneo-conjunctival dermoid is reported in a blue-fronted Amazon parrot (Amazona aestiva). After laminar keratectomy, histology showed the epidermis with feather follicles and dermal connective tissue with lymph follicles and sebaceous glands.

Refinement of blood sampling from the sublingual vein of rats.

A refined method of repeated blood sampling is described: the tongue of the anaesthetized rat is pulled forward with the fingers and the sublingual vein is punctured with a 23 gauge hypodermic needle. Based on the requirement of a pharmacokinetic study, 0.5 or 1 ml of blood was collected 7 times at 0, 0.5, 1, 2, 4, 8 and 24 h. The degree of suffering was judged by determining the body weight and food and water consumption. All animals showed an increase in body weight already after 24 h and, therefore, the method of collecting blood from the sublingual vein can be recommended for repeated blood sampling. The haematological evaluation of groups of animals with differing body weight showed that sample volumes of up to 15% of the total blood volume lead to haematocrit values of approximately 40%. A remarkable initial drop in white blood cell counts followed by a marked rise 2 h after first sampling to values partly above the pre-test could not be directly related to the extracted blood volume.

Body habitus as a predictor of burn risk in children: do fat boys still get burned?

Previous research at this institute has demonstrated that heavy-for-age boys are more burn prone than their normal sized counterparts. As this study is now 26 years old, we reexamined the anthropomorphic indices of 372 children admitted to one burn center between January 1991 and July 1997 to determine if this trend was still evident. Male children were over-represented in the < or =5th and >95th percentiles for both height (p < 0.001, p < 0.05) and weight (p < 0.01, p < 0.001). Female children were over-represented in the < or =5th and > 95th percentiles for height (p < 0.01, p < 0.05). Twenty-eight percent of boys at or below the 5th percentile for weight were burned as a result of known or suspected intentional injury, compared to 5.9% of the entire pediatric burn population. (p < 0.0004). 'Fat boys' continue to be over-represented in the pediatric burn population. Additionally, in the more recent time period, boys at or below the 5th percentile for height or weight and girls= < 5th percentile or >95th percentile for height are also over-represented. The increased frequency of burn injury in small-for-age children may reflect an increased risk of burn injury secondary to neglect or nonaccidental trauma.

Necrotizing fasciitis--the hazards of delay.

Necrotizing fasciitis was first described in a specific body region by Fournier in 1883 and as a more generalized condition by Meleney in 1924. The use of the term 'necrotizing fasciitis' can be attributed to Wilson in 1952. It is perceived as a rare condition, causing potentially devastating morbidity and frequent mortality. Prompt surgical management is generally accepted as the mainstay of treatment. This report illustrates the relationship between delay in definitive treatment and morbidity. Management options are also reviewed.