ABSTRACT
Background: Optimal resuscitation measures and outcome predictors in cases of burns are not studied in pediatric population, though it accounts for one of the leading causes of non-fatal injuries in the pediatric age group. Objective: We describe the clinical profile and outcome predictors in children admitted with burns. Materials and methods: This retrospective cohort study included all children between 1 month and 18 years admitted to pediatric intensive care unit (PICU) with burns from January 2015 to December 2020. The total burns surface area (TBSA) was assessed and treated as per unit protocol. Illness severity score (PRISM III) and pediatric logistic organ dysfunction (PELOD-II) on day 1 and subsequently was noted. Resuscitation requirements including inotropes and colloids were evaluated. Outcome parameters like need for mechanical ventilation, renal replacement therapy, duration of hospital stay, PICU stay, and mortality were assessed. Results: Of 286 children admitted with burns, 99 had PICU admissions, and of these 59% were males with median (IQR) age 36 (13,72) months. Multivariate logistic regression analysis showed TBSA >40% [adjusted odds ratio (AOR) 4.62 [1.11-19.32] p-value < 0.036]. Cox regression for 28 day mortality was significant only for PELOD day 1 (heart rate (HR) 1.22 [1.05-1.41]). Conclusion: Higher resuscitation requirements with higher organ dysfunction scores may predict mortality in pediatric burns warranting further study for standardization of care. How to cite this article: Yashaswini K, Lalitha AV, Kanna GSN, Kujur AR, Michael Raj JA. Clinical Profile of Children with Burns in a Tertiary Care Hospital. Indian J Crit Care Med 2023;27(12):934-938.
ABSTRACT
After 2 decades as a low-cost transplant centre in India, our rates of kidney transplantation are low compared to the burden of end-stage kidney disease (ESKD). We performed this study to identify possible barriers inhibiting paediatric kidney transplant and to assess the outcomes of paediatric ESKD. A retrospective chart review of ESKD patients (2013 - 2018) at a tertiary paediatric nephrology centre was conducted. Medical/non-medical barriers to transplant were noted. Patient outcomes were classified as "continued treatment," "lost to follow-up (LTFU)" or "died." Of 155 ESKD patients (monthly income 218 USD [146, 365], 94% self-pay), only 30 (19%) were transplanted (28 living donor). Sixty-five (42%) were LTFU, 19 (12%) died, and 71 (46%) continued treatment. LTFU/death was associated with greater travel distance (300 km [60, 400] vs 110 km [20, 250] km, P < .0001) and lower monthly income (145 USD [101, 290] vs 290 USD [159, 681], P < .0001). Among those who continued treatment, 41 proceeded to transplant evaluation of whom 13 had no living donor and remained waitlisted for 27 months (15, 30). The remainder (n = 30) did not proceed to transplant due to unresolved medical issues (n = 10) or a lack of parental interest in pursuing transplant (n = 20). Barriers to transplantation in low-resource setting begin in ESKD. LTFU resulted in withdrawal of care and was associated with low socioeconomic status. Among those who continued treatment, transplant rates were higher but medical challenges and negative attitudes towards transplant and organ donation occurred.
