Paediatric burns: 20 minutes of cool running water reduces grafting requirement

Takeaway

• For children who are burned, irrigation for a full 20 minutes with cool running water correlates with multiple improved outcomes.
• Authors: “any duration of cool running water appears to be better than none.”

Why this matters

• Multiple guidelines call for treating burns with cool running water, but recommended duration varies.
  • US calls for 5 minutes.
  • Europe, UK, Australia call for 20 minutes.

Study design

• Prospective cohort study of burn victims at pediatric burn center (n=2495).
• Authors assessed whether they received adequate first aid (irrigation with cool running water for 20 minutes within 3 hours of injury).
• Outcome: skin grafting requirement.
• Funding: None.

Key results

• Adequate vs other first aid (95% CIs):
  • Skin grafting: OR, 0.6 (0.4-0.8; P<.001).
  • Re-epithelialisation: HR, 1.3 (1.1-1.5; P=.003).
  • Full-thickness burn: OR, 0.4 (0.2-0.6; P<.001).
  • Admission: OR, 0.7 (0.3-0.9; P=.006).
  • Surgical intervention: OR, 0.7 (0.5-0.9; P=.004).
• Adequate first aid vs shorter durations of running water:
  • Skin grafting: OR, 0.6 (0.4-0.9; P=.007).
• There was an inverse dose-response relationship between irrigation duration and likelihood of skin grafting, full thickness, admission, and surgery.
• Lengths of hospital stay did not correlate with adequate first aid.

Limitations

• Single-centre study.
• Only thermal burns assessed.