New Topical Agents for Treatment of Partial-thickness Burns in Children: A Review of Published Outcome Studies
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Abstract: Evidence-based choices for treating burns in children are not well defined. Skin substitutes and contemporary dressings offer potential advantages over traditional treatment with topical antimicrobial agents in treating partial-thickness burns. Newer treatment modalities may reduce morbidity, financial burdens, and scarring by accelerating healing.
Reports of pediatric burn management from 1997 to 2007 were reviewed to compare agent performance with outcome measures such as healing time, pain moderation, cosmetic results, and hospital costs. Transcyte™ (Smith & Nephew, London), Biobrane® (Bertek Pharmaceuticals Inc, Morgantown, WV), beta-glucan collagen, and Mepitel® (Mölnlycke, Göteborg, Sweden) have been reported as superior to silver sulfadiazine (SSD) in achieving faster healing times and decreased pain in pediatric patients.
Initial reports describing the outcomes achieved with these new agents indicate that they may offer clinical advantages in the treatment of partial-thickness burns in children. Increased costs of the new products appeared to be offset by decreases in hospital stay, nursing care time and pain medications. The existing literature is not conclusive, and prospective trials with standardized outcome measures are needed to better define the role of these agents.
Address correspondence to:
Wanda A. Dorsett-Martin, DVM
Division of Plastic Surgery
University of Mississippi Medical Center
2500 N. State Street
Jackson, MS 39216-4505
Children, especially those younger than 2 years, are at high risk for burn injury.1 Of 126,642 records of acute burn hospital admissions in the United States between 1995 and 2005, approximately 32% were younger than 20 years of age. 1 In the 6-year period from 1997 to 2002, there was an annual average of 78,000 children (birth–4 years old) treated in US ambulatory settings for injuries resulting from contact with a hot object or substance. 2 Natural curiosity, impulsiveness, lack of awareness of potential dangers, and limited ability to respond to a precarious situation in a prompt, appropriate manner, are factors leading to the high occurrence of burns in the pediatric population. 3,4
Scalding is the leading cause of burns in children younger than 3 years, and fire is the major cause of burns in older children. 5 Scald injuries usually occur in the home as a result of cooking accidents or use of excessively hot water during bathing. 6,7Accidental and neglect-related burns, although common, are not the only problem for the medical community; child abuse is the cause for many admissions. 5 Approximately 20% of pediatric burns are caused intentionally by a caregiver or parent. 8
The sheer volume of burn incidents, especially within a vulnerable population such as children, necessitates major medical resources dedicated to burn care. The ever-increasing financial pressures associated with health care also contribute to the need for effective, cost-efficient treatment options for burns. 9
Treatment of partial-thickness burns customarily involves early debridement of nonviable tissue. After debridement, the wound may be dressed with any of numerous dressings, which can be either biological, nonbiological, or a combination of these elements, in an effort to stimulate healing and provide protective covering for the wound. Pediatric burns traditionally have been treated with daily cleansing of the burn wound and application of topical antimicrobial agents. 10 Numerous carriers can be useful for burn treatment.
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