What is the disposition for pediatric patients with palm burns?

From the Guidelines

For pediatric patients with palm burns, disposition should be based on the severity of the burn, with minor burns managed on an outpatient basis and more severe burns requiring hospital admission, as evidenced by recent studies 1. When evaluating the severity of palm burns in pediatric patients, it is crucial to consider the total body surface area (TBSA) affected, the depth of the burn, and the presence of any signs of infection.

• Minor first-degree burns (redness without blisters) and small second-degree burns (with blisters) that are less than 1-2% of TBSA can typically be managed on an outpatient basis with close follow-up within 24-48 hours.
• Treatment for minor burns includes gentle cleansing with mild soap and water, application of a thin layer of antibiotic ointment such as bacitracin, and non-adherent dressing coverage.
• Pain can be managed with acetaminophen (10-15 mg/kg/dose every 4-6 hours) or ibuprofen (5-10 mg/kg/dose every 6-8 hours). However, children with deeper second-degree burns, third-degree burns, burns covering more than 5% of TBSA, burns involving the entire palm, or those with signs of infection require hospital admission, as these factors can significantly impact morbidity, mortality, and quality of life 1. Palm burns are particularly concerning because they can affect hand function and lead to contractures if not properly managed, highlighting the importance of specialized care for these injuries 1. Additionally, any burn in a child with suspected abuse, inadequate home care, or significant comorbidities should prompt consideration for admission regardless of burn severity, emphasizing the need for a comprehensive approach to patient care 1.

From the FDA Drug Label

Prompt institution of appropriate regimens for care of the burned patient is of prime importance and includes the control of shock and pain. The burn wounds are then cleansed and debrided; silver sulfadiazine cream, USP 1% is then applied under sterile conditions.

The disposition for palm burns in pediatrics is to prioritize prompt care, including:

• Control of shock and pain
• Cleansing and debridement of the burn wound
• Application of silver sulfadiazine cream, USP 1% under sterile conditions 2

From the Research

Palm Burn Pediatrics Disposition

• The disposition of pediatric patients with palm burns depends on the severity and depth of the burn, with burns that will not heal within 2 weeks being at least second-degree and requiring referral to a burn surgeon for possible excision and grafting 3.
• A study of 120 pediatric patients with isolated palm burns found that 91.7% had partial-thickness burns, and 8.3% had full-thickness burns, with only 3.3% requiring excision and skin autografting 4.
• The same study found that palm burns that healed in more than 3 weeks developed scarring and sequelae, and that excision and autografting should be performed on wounds that take over 3 weeks to heal, but it does not prevent late sequelae 4.
• A 10-year review of pediatric palm contact burns found that 87% of patients healed without need for surgery, and that aggressive hand therapy and conservative surgical management is recommended 5.
• The management of pediatric burn injuries, including palm burns, requires intensive medical therapy and aggressive surgical therapy to prevent sepsis and secondary complications, as well as specialized burn centers with multidisciplinary teams 6.
• Topical antimicrobial therapy, such as silver sulfadiazine, is an important component of wound care in hospitalized burn patients, and can help control microbial colonization and prevent burn wound infection 7.

Treatment Options

• Topical antimicrobial agents, such as bacitracin, neomycin, silver sulfadiazine, and mafenide, can be used to decrease wound-related infections and morbidity in burn wounds 3.
• Excision and skin autografting may be necessary for burns that will not heal within 2 weeks, or for burns that have developed scarring and sequelae 4.
• Aggressive hand therapy and conservative surgical management is recommended for pediatric palm burns, with reconstructive procedures such as full-thickness skin grafts and z-plasty available for late reconstruction 5.

Complications and Sequelae

• Palm burns that heal in more than 3 weeks can develop scarring and sequelae, including contractures and limited range of motion 4.
• Excision and autografting can help prevent late sequelae, but it is not a guarantee, and reconstructive procedures may still be necessary 4.
• Infections and sepsis are major complications of burn injuries, and require prompt and aggressive treatment 6.