The Iceberg Effect: The hidden morbidity of burn injuries in patients with sensorimotor deficits

Dr Michael Taylor1, Dr Hannah Woodford2, Dr Monique  Bertinetti1

1Children’s Hospital Westmead, Westmead, Australia, 2Nepean Hospital , Penrith, Australia

Abstract:

Introduction: Children with sensorimotor deficits present treating teams with additional complex challenges in the coordination of their care.
The epidemiology of burns in children with sensorimotor deficits is anecdotally established to be more prevalent, complex and resource intensive, however minimal data of the incidence and sequelae has been collected.

Method: We performed a 15 year retrospective analysis of all paediatric burn patients under the age of 16 in the NSW ACI database. A cohort identified to have sensorimotor deficits including cerebral palsy, trisomy 21, spina bifida, global developmental delay, and neural-sensorimotor deficits resulting from trauma, was analysed against a control population.
The outcomes measured included TBSA, mechanism, length of stay (LOS), graft and re-graft rates, wound infection, additional visits to theatre, ICU/ventilation requirements, and outpatient follow-up. Linear regression was used to analyse the correlation between the presence of sensorimotor deficit and subsequent outcomes.

Results: 13,011 burn injuries were identified. 95 occurred in patients with an established sensorimotor deficit.
The sensorimotor deficit cohort was older (6.93 years (±4.1) vs 4.0 (±3.9)), had a greater TBSA (4.72% (±10.3) vs 2.48% (±3.9)) and an increased LOS (8.6 days (±13.1) vs 3.1 days (±7.9)) when compared to the control group. 48.5% of cohort patients required more than 1 nights admission. Flame burns were overrepresented in the cohort 11% vs 6%.
6% of cohort patients required ICU admission, and 2.1% required intubation and ventilatory support, compared to only 1% and 0.08% respectively in the control group.
Grafting was required in 39% of sensorimotor deficit patients, opposed to only 19.9% in the control group. Regrafting and wound infection rates were 3 times more likely in the cohort group.

Conclusion: Children with sensorimotor deficits have a higher TBSA, are at greater risk of complications, and experience prolonged and more complex admissions when compared to their non-disabled peers. Future research into improving care and targeted prevention strategies is required for this resource rich, high-risk group.

Biography:

Dr Michael Taylor is a Paediatric Surgery SRMO at the Children’s Hospital Westmead. His research interests lie Paediatric Surgery, Trauma, and Burns.

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ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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