421 Pediatric Treadmill Friction Burns: Outcomes of an Initial Non-operative Approach

• Published in: Journal of burn care & research 2018-04, Vol.39 (suppl_1), p.S182-S182
• Main Authors: Ahmed, O Z, Cheng, M, Burd, R S
• Format: Article
• Language: English
• ISSN: 1559-047X; 1559-0488
• DOI: 10.1093/jbcr/iry006.343

Abstract Introduction Treadmill injury is a common cause of contact hand burns in children. Previous studies have shown that these injuries are more severe than thermal contact burns. The purpose of this study was to evaluate the presentation, management and outcome of this class of injury using an initial non-operative approach. Methods We reviewed the charts of children evaluated in the emergency department or burn clinic at a pediatric burn center over a five year period. Patient features studied included age, depth and total body surface area of injury and time until complete epithelialization. Management approaches evaluated included treatment used and consultations obtained. Multivariate regression was used to identify the association between patient features and management strategies with time to healing and injury sequelae using an initial non-operative approach for wound healing. Results Sixty-seven patients were identified with a treadmill friction burn, with an average age of 4.0 ± 2.7 years and an average of 1.1 ± 0.9 percent total body surface area affected. Most children sustained a full thickness (41.5%) or deep partial thickness injury (36.9%). Hand injuries were most common (79.1%), usually involving at least one of the middle three digits (84.7%). Almost 60% of patients had two adjacent fingers injured and 37% had three adjacent fingers injured. The most common treatment in the emergency department and at the initial clinic visit was silver sulfadiazine (56.5% and 69.7%, respectively). Over 60% of patients were evaluated by at least one consult service, including occupational therapy (45.5%), physical therapy (24.2%) and plastic surgery (31.8%). The median time to complete healing was 24 days (interquartile range 12–37 days), with patients being seen for an average of 3.4 ± 2.5 clinic visits until complete epithelialization. Complications of the burn injury included contracture (19.2%), scar hypertrophy (7.7%) and delayed healing requiring skin grafting (1.9%). Among the15 patients with wound complications, seven (46.7%) underwent surgical management (contracture release for five patients, scar revision due to hypertrophy for one patient and skin grafting for one patient). Surgery was recommended but not performed at our institution in two patients. Complications of wound healing were associated with a longer time to epithelialization (OR 0.3, 95% CI (0.02–0.5) p=0.03). Conclusions Pediatric friction burns from treadmills are often full t