55 Utilization of Z-Scores to Identify Malnutrition in the Pediatric Burn Abuse and Neglect Population

• Published in: Journal of burn care & research 2018-04, Vol.39 (suppl_1), p.S32-S32
• Main Authors: Sunderman, C, Gottschlich, M, Allgeier, C, James, L, Boerger, L, Warner, P
• Format: Article
• Language: English
• ISSN: 1559-047X; 1559-0488
• DOI: 10.1093/jbcr/iry006.058

Abstract Introduction Nutritional management of a burn injury is a complexity that is challenged further in the presence of malnutrition. Appropriate nutrition screening techniques are imperative to perform identification and documentation of malnutrition, especially in vulnerable pediatric populations. The purpose of this study was to assess the prevalence and severity of malnutrition among pediatric burn patients with a history of maltreatment. Methods A retrospective chart review was conducted on patients (≤18 yo) admitted for treatment of a burn injury between 2011–2015 with a history of maltreatment. The existence of abuse and/or neglect was identified and documented through interdisciplinary assessment involving both social work and psychology. Demographics, clinical and discharge disposition data were obtained. Anthropometric z-score data were generated from standardized growth charts and analyzed to identify malnutrition using the current 2015 guidelines from the Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition. Statistical procedures included Student’s t-tests and χ 2 tests. Results Eighty-eight pediatric burn patients with a history of maltreatment were admitted during the 5-year period with a mean age of 3.0 ± 0.4 years and burn size of 20.4 ± 2.0% TBSA, with scald being the primary mechanism of injury. Malnutrition was identified in 21 (23.8%) patients, with the highest occurrence (95%) in the youngest age group (0–3 yo). Despite the non-malnutrition group having a significantly higher %TBSA 3rd degree burn size (p=0.0487), both groups had similar lengths of stay (25.4 ± 2.5 vs 21.7 ± 5.3 days). The malnutrition group had significantly lower z-scores for weight, BMI and weight for length, however they gained significantly more weight (p=0.0144) than the non-malnutrition group during their hospital course. Conclusions Appropriate screening for malnutrition in pediatric burn patients can proliferate awareness, especially in young vulnerable children with a history of maltreatment and can assist in the tailoring and implementation of medical nutrition therapy to support both wound healing and growth. Applicability of Research to Practice Utilizing established diagnostic criteria to detect malnutrition is an important component of the nutrition care plan in the pediatric burn population. Table 1. Clinical Data N=67 (no malnutrition) N=21 (malnutrition) p-value % TBSA 25.4 ± 3.2 21.7 ± 5.3 NS % TBSA 3rd de