The risk of scarring in paediatric burn injury

Prof. Fiona Wood, Hilary  Wallace2, Mark Fear2, Lisa Martin2

1Burns Service Wa, City Beach, Australia, 2Burn Injury Research Unit UWA, Perth, Australia

Improved clinical decision-making to reduce the health burden due to post-burn scarring in children will be guided by evidence on risk factors and risk stratification.

The study examined the association between selected patient, injury and clinical factors and the development of raised scar after burn injury. Novel patient factors were investigated including selected immunological comorbidities

Including the incidence of asthma, eczema diabetes and skin pigmentation.

A prospective study was conducted among 186 children who sustained a burn injury in Western Australia. Logistic regression was used to explore the relationship between explanatory variables and a defined outcome measure: scar height measured by a modified Vancouver Scar Scale (mVSS).

The overall correct prediction rate of the model was 80.6%; 80.9% for children with raised scars (> 1mm) and 80.4% for children without raised scars (≤ 1mm). After adjustment for other variables each 1% increase in burn %TBSA increased the odds of raised scar by 15.8% (95% CI = 4.4% – 28.5%). Raised scar was also predicted by time to healing of longer than 14 days (OR=11.621; 95% CI= 3.727-36.234) and multiple surgical procedures (OR=11.521; 1.994-66.566).

Greater burn surface area, time to healing of longer than 14 days and multiple operations are independently associated with raised scar in children after burn injury. Scar prevention strategies should be targeted to children with these risk factors. Cell based therapies facilitating dermal salvage and donor site reduction has the potential to reduce the time to healing.

Fiona Wood has been  the Director of the burns service of WA

since 1991 and been actively involved in all aspects of burn care and research

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