Major paediatric burns: Review of number and nature of medical procedures by serial case study

Dr Kathryn Russell1, Deborah Murray2

1 Counties Manukau Health, Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland 1642,
2 Counties Manukau Health, Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland 1642,

Major paediatric burn patients experience many procedures while in hospital.  Dressing changes alone have been identified as contributing to psychological trauma.  There is no research which plots frequency and type of procedures over time in these patients, or documents what pain mitigation or support methods have been used.

This serial case audit aims to gain an understanding of the pattern of interventions for major paediatric burn patients, and review mitigation measures for pain to improve future patient outcomes.

The last ten NZ paediatric patients who have been treated at the National Burn Centre with above 30% TBSA were chosen for audit. The number and nature of medical procedures were recorded from medical notes.    In addition other aspects of the procedure were audited; location, record of emotional distress, record of pain score and documented pain management used (pharmaceutical and non-pharmaceutical).

All patients had a large number of procedures daily during the initial part of their stay. Daily procedures tended to continue for weeks and months, often only dropping off in the week before discharge or transfer to a regional unit. Patients that underwent skin grafting had more procedures than those who did not.  Patients often had pain medications prior to procedures, but often did not have non-pharmaceutical interventions, and pain scores were infrequently recorded for procedures.  Distress or lack of distress was seldom recorded in the notes.

More consideration needs to be taken in developing an overall procedure plan rather than reacting on a procedure by procedure basis.

Key Words

Procedural Pain, Medical Trauma, Paediatric Burn


Kathryn Russell, PhD is a Consultant Paediatric Psychologist at Counties Manukau Health. Kathryn has been working in the National Burn Centre as part of her role for more than 10 years. She has a special interest in procedural pain management and psychological trauma from both the burn event and subsequent treatment period.

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