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The epidemiology of scalds to children aged 0-5 years is reviewed. More than two-thirds were below 2 years of age. Most accidents took place in the dining/living room and most were caused by coffee. Awareness by the parents may reduce the number of scalds.
Phagocytic cell function is often suppressed after thermal injury. It has been suggested that one of the mechanisms of suppression is a direct effect of thermal injury upon these cells. In the present study we examined whether bone marrow haemopoietic stem cells were suppressed by thermal injury similar to the effect seen on mature haemopoietic cells. Results of both in vitro bone marrow cell cultures and in vivo spleen colony assays showed that granulopoiesis was not suppressed but activated early on day 3 following scald injury or scald plus wound infection in mice. In the latter group, stimulation of granulopoiesis persisted throughout the entire observation period of 9 days. These studies indicate that bone marrow pluripotent stem cells are capable of modulating their direction of differentiation according to body demand and deviate toward the granulocyte series following thermal injury.
In a randomized controlled clinical trial (RCCT) the healing rate, infection and late cosmetic/functional results were investigated in 48 children admitted to hospital with scalds. They were treated with either exposure treatment (EP) or lyophilized allograft (LA). Healing rate was improved with LA treatment. The infection tendency was identical within the two groups. Late cosmetic/functional results were superior, with LA treatment compared to exposure treatment but only in the subgroup of superficial dermal scalds.
A study of 193 infants admitted for burns over a 4-year period revealed 11 infants (5.7 per cent) had sustained scalds during the process of water aerosol inhalation. The water aerosol inhalation therapy was prescribed for respiratory tract infection and carried out at home using either an electric kettle or a saucepan. It appears that infants are prone to this type of injury because of the difficulty of keeping them still during therapy and their inquisitiveness to explore their surroundings. The resulting scalds added to the morbidity of those children already suffering from respiratory tract infections. These accidents can easily be prevented by the alternative use of a humidifier.
While scalds are the commonest burns within the home, scalds resulting from bleeding domestic central heating radiators have not previously been reported. We have encountered two examples of significant burns to the hands received in this way. The incidence of these injuries in the UK is unknown but several similar cases have been identified by the Consumer Safety Unit of the Department of Trade and Industry. The mechanism of injury is described and recommendations made for safely bleeding domestic central heating radiators.
A 14-month-old girl suffered a 10 per cent scalding injury from hot water of the type sometimes recognized as 'the teapot syndrome'. The hot water also reached the hypopharynx where it caused marked swelling of the mucosa and hence obstruction of the airway. Increasing respiratory distress made endotracheal intubation necessary 4.5 h after the accident. The girl was extubated 26 h later, and breathing was normal. The external burns were initially treated with baths and dressing changes. They healed mostly spontaneously, but four areas had to be grafted. This case report shows that thermal burns of the mouth and pharynx, followed by oedema and upper airway obstruction, can occur also in a minor scalding injury involving the face. Respiratory distress makes intubation necessary.
Tap water scald burns are common injuries to persons with disabilities, young children, and the elderly. A case is reported of an elderly woman with a physical and neurological handicap who while bathing received partial and full thickness (tap water) scald burns covering 20% of her total body surface area. This life-threatening injury could have been prevented with a Shower Safe, Inc. temperature-controlling water valve.
An infant sustained second- and third-degree scald burns of the oropharynx from drinking formula heated in a microwave oven. The circumstances leading to the scald injuries were recreated. Factors contributing to the injury included the volume of formula, the initial temperature of the formula, and the temperature gradient between the liquid core and the bottle surface after microwave heating. These studies indicate that infant formula should be warmed only with extreme care in microwave ovens and should be tested for suitability of temperature prior to feeding.
We report here a case of a childhood scald injury where immediate first aid consisted of the application of fountain pen ink. Continuing education is required to inform parents of the use of cold water in the immediate first aid treatment of scalds.
On the evening of November 12th, 1999, earthquakes stroke the area of Duzce and Bolu in the northwestern part of Turkey. The local medical system, still not recovered completely from the August earthquake, suffered severe damage. An Israeli field hospital was sent to the area to help cope with the earthquake trauma and replace the damaged medical system until it recovered. During the eight days of its active duty, approximately 40 burn patients were seen. Most of the burns were deep partial scald burns of the lower extremity, caused by hot water spill during the quake. Two massive burns were referred to burn centers and the rest were treated either as outpatients, or admitted and underwent daily dressing changes under sedation. All burns improved, and some healed during the hospital's stay in Duzce. Some of the burns needed further skin grafting. Upon disassembling the hospital the burn patients were referred to the recovered local medical system and one child was transferred to continue burn treatment in Israel. The circumstances of evening earthquake and non-industrialized area expressed a new post-earthquake burn syndrome: multiple scald burns due to hot liquid spills. It seems that most of the patients suffering those burns could be treated successfully as outpatients with close follow up.
Standardized deep partial-thickness burns were inflicted on domestic pigs by scalding 30 per cent of the skin surface for 25 s with 75 degrees C hot water. The animals (n = 18; weight 25-35 kg) were divided into three groups: I, control group (n = 6), Ringer's lactate only; II, haemodialysate group (n = 6), Ringer's lactate and a protein-free haemodialysate of calf-blood (ACTIHAEMYL20%; AH) and III, C1-inhibitor group (n = 6), Ringer's lactate and C1-inhibitor (C1-INH; BERINERT). Skin biopsies were taken at defined time points (4, 28, 52 and 76 h) and investigated histologically. Depth of burn was determined morphometrically after coloration with a modified MTT-staining on frozen sections of the skin biopsies. Fluid therapy with C1-INH decelerated significantly the progression of the burn wound in the postburn-period compared to Ringer's lactate alone. In comparison with C1-INH, the treatment with AH demonstrated a less beneficial influence on the depth of scald burns. The favourable effects of C1-INH are explained by the protection of the dermal microcirculation during the acute phase of thermal injury.
This report describes 141 scalded children admitted from January 1993 to June 1995. The mean age of patients was 2 yr 11 months. The average burn size was 11.4 percent TBSA. The male to female ratio was 1.6:1 (87:54). One hundred and six of the children were initially diagnosed as suffering from superficial or medium partial-thickness burns. After proper evaluation and resuscitation, all of them received immediate debridement and Biobrane coverage. This biosynthetic dressing was fixed with adhesive tape and compressive dressing. No splints were used. Pain tolerance was good and these children were able to resume their daily activities as early as possible. If vital signs were stable and Biobrane adherence occurred, the patients were discharged. The dressings were easily changed on an out-patient basis; therefore, the hospital stay and ultimate cost of burn care both decreased. This experience confirmed that Biobrane is quite suitable for consideration in treating pediatric scalds. Accurate diagnosis of depth is very important. The best results can be obtained only on superficial partial-thickness burns. A high wound infection rate occurred in the medium partial-thickness burn wounds (7.8 vs. 62.1 percent).
A retrospective review of admissions to the Wessex Regional Burn Centre was made to determine the incidence and causes of childhood scalds during the periods 1960-65 and 1979-84. No reduction in numbers injured or significant change in causes were observed. Children aged 1-2 years old are still the most prone to scalding injury.
The present study was conducted to determine whether local production of neutrophil chemoattractant cytokines preceded the influx of neutrophils following dermal scald injury. To accomplish this, dermal tissue was examined for inflammatory infiltrate and the level of KC, a murine homolog of human interleukin-8, at various time points after scald injury. The studies reveal that there was a largely neutrophilic infiltrate at 1 day post-injury which persisted for 4 days. Dermal KC levels increased significantly at 4 h, returned to baseline at 8 h and were elevated again from 1 to 3 days post-burn (P < 0.01). At 3 days post-burn, KC was elevated 15-fold above the level in sham treated mice (P < 0.01). These observations demonstrate that the influx of neutrophils into the skin follows the expression of KC in the skin. This suggests that it should be possible to alter neutrophil accumulation at the wound site by manipulating the local chemokine signal.
Koebner's phenomenon is an uncommon postburn complication. The following report describes a female child who sustained an 80% total body surface area scald which healed with conservative treatment. She developed a cutaneous Aspergillus infection involving only the previously scalded areas. The uninjured skin remained normal. She went on to develop systemic aspergillosis and died of multi-organ failure.
Two cases of "scalded mouth syndrome" are presented and discussed. This condition is a rare side effect of angiotensin converting enzyme inhibitors. Angiotensin converting enzyme inhibitors are known to cause several other oral and extra-oral side effects. In scalded mouth syndrome, the patient's complaints concern a burning pain of the oral soft tissues. There are no clinical findings.
Every year about a hundred children with burns and scalds are hospitalised in the Burns Unit of the University Children's Hospital in Zürich. 15% of these patients are children between 1/2 to 4 years old with isolated burns and scalds of their hands. The experience gained in the treatment of 53 such children during 4 years is described. The burn healed spontaneously in 31 patients; in 22 cases Thiersch grafts had to be used. In the follow-up treatment compression suits and special splints to prevent secondary contractures were employed. The results of this treatment using splints and compression suits are discussed.
Treatment of scalds in children with human allografts offers the following advantages: 1. Essential relief of pain. 2. Prevention of deepening of scalds by desiccation. 3. Fewer autografting procedures. 4. Shorter hospital stay. 5. Considerably less hypertrophic scarring.