Consensus on the management of pediatric deep partial-thickness burn wounds (2023 edition)
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Abstract: Burns are a main cause of accidental injuries among children in China. Because of the unique wound repair capacity and demand for growth in pediatric patients, the management of pediatric deep partial-thickness burn wounds involves a broader range of treatment options and controversy. We assembled experts from relevant fields in China to reach a consensus on the key points of thermal-induced pediatric deep partial-thickness burn-wound management, including definition and diagnosis, surgical treatments, nonsurgical treatment, choice of wound dressings, growth factor applications, infectious wound treatment, scar prevention and treatment. The committee members hope that the Expert Consensus will provide help and guiding recommendations for the treatment of pediatric deep partial-thickness burn wounds.
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Key words:
- Deep partial sickness burns /
- Pediatric /
- Wound management /
- Expert consensus
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参考文献
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Table 1. 2001 edition of the grading criteria from the Oxford Center for Evidence-based Medicine
Evidence grade Definition Ⅰa Systematic reviews of homogeneous RCTs Ⅰb Single RCT (with narrow confidence interval) Ⅰc Full or no case series Ⅱa Systematic reviews of homogeneous cohort studies Ⅱb Single cohort studies (including low-quality RCT, e.g. follow-up rate < 80%) Ⅱc Outcome studies, ecological studies Ⅲa Systematic reviews of homogeneous case–control studies Ⅲb Single case control Ⅳ Case series studies (including low-quality cohort and case–control studies) Ⅴ Expert opinions based on experience without rigorous argument 
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Table 2. A summary of 18 consensus recommendations
Consensus recommendations Key words Recommendation level Key notes Clinical Issue 1: Definition and diagnosis of pediatric deep partial-thickness burn wounds 1 Definition and diagnosis Highly recommended Subjective + specialist physical examination Clinical Issue 2: Surgical treatments of pediatric deep partial-thickness burn wounds 2 Surgical principle Highly recommended 24 hours, 15% TBSA 3 Surgical option Highly recommended 15% TBSA, eschar grinding or tangential excision 4 Surgical timing Recommended 3 to 5 days, one week, two weeks 5 Surgical indication Highly recommended 3 to 4 weeks 6 Surgical scope Highly recommended Surgery on the functional sites Clinical Issue 3: Nonsurgical treatment of pediatric deep partial-thickness burn wounds 7 Fresh and clean wound Recommended Preservation of epidermis + drainage 8 Soiled/infected/large wounds Highly recommended Topical antibacterial 9 Pain management Highly recommended Comfort Clinical Issue 4: Dressing for pediatric deep partial-thickness burn wounds 10 Frequency of dressing changes Highly recommended Combined with the characteristics of wound and dressing 11 Coverings for wounds at special sites Highly recommended Face and perineum 12 Selection of coverings for nonsurgical treatment Highly recommended Modern wound dressing Clinical Issue 5: Treatment of infectious pediatric deep partial-thickness burn wounds 13 Timing of pathogenic examination of wound Recommended Wound bacterial culture + drug sensitivity 14 Timing of pathogenic examination of medium to large-area burn wounds Highly recommended The first dressing change + regular collection 15 Timing of pathogenic examination of infected wounds Highly recommended Signs of infection/3–5 days after anti-inflammatory therapy 16 Frequency of dressing change for infected wounds Highly recommended Dynamic evaluation and timely adjustment 17 Wounds with high risk of infection Highly recommended Topical antibacterial and dynamic adjustment Clinical Issue 6: Prevention and treatment of scars from pediatric deep partial-thickness burn wounds 18 Scar prevention Highly recommended Informed, early and comprehensive
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