Cool Running Water First Aid Decreases Skin Grafting Requirements in Pediatric Burns: A Cohort Study of Two Thousand Four Hundred Ninety-five Children

• Published in: Annals of emergency medicine 2020-01, Vol.75 (1), p.75-85
• Main Authors: Griffin, Bronwyn R., Grad Dip Emerg Nursing, PhD, Frear, Cody C., BA, Babl, Franz, MD, Oakley, Ed, MBBS, Kimble, Roy M., DMed(res), MBChB
• Format: Article
• Language: English
• Subjects: Burns - therapy; Child; Child, Preschool; Emergency; Female; First Aid - standards; Humans; Infant; Injury Severity Score; Male; Practice Guidelines as Topic; Registries; Skin Transplantation - statistics & numerical data; Time Factors; Treatment Outcome; Water - administration & dosage
• ISSN: 0196-0644; 1097-6760
• DOI: 10.1016/j.annemergmed.2019.06.028

Study objectiveFirst-aid guidelines recommend the administration of cool running water in the early management of thermal injury. Our objective is to analyze the associations between first aid and skin-grafting requirements in children with burns. MethodsThis cohort study used a prospectively collected registry of patients managed at a tertiary children’s hospital. Multivariate logistic regression models were used to evaluate the relationship between first aid and the requirement for skin grafting. Secondary outcomes included time to re-epithelialization, wound depth, hospital admission and length of stay, and operating room interventions. Adequate first aid was defined as 20 minutes of cool running water within 3 hours of injury. ResultsIn our cohort of 2,495 children, 2,259 (90.6%) received first aid involving running water, but only 1,780 (71.3%) were given the adequate duration. A total of 236 children (9.5%) required grafting. The odds of grafting were decreased in the adequate first aid group (odds ratio [OR] 0.6; 95% confidence interval [CI] 0.4 to 0.8). The provision of adequate running water was further associated with reductions in full-thickness depth (OR 0.4; 95% CI 0.2 to 0.6), hospital admission (OR 0.7; 95% CI 0.3 to 0.9), and operating room interventions (OR 0.7; 95% CI 0.5 to 0.9), but not hospital length of stay (hazard ratio=0.9; 95% CI 0.7 to 1.2; P=.48). ConclusionBurn severity and clinical outcomes improved with the administration of cool running water. Adequate first aid must be prioritized by out-of-hospital and emergency medical services in the preliminary management of pediatric burns.