What are the stages of pediatric burn injury classification?

From the Guidelines

Pediatric burn staging should be categorized into four degrees based on the depth of tissue damage, and assessment should include the burn depth, percentage of body surface area affected using the Lund-Browder chart, and location, as this approach is supported by the most recent and highest quality study 1. When assessing pediatric burns, it is crucial to consider the depth of tissue damage, which categorizes burns into four degrees.

• First-degree burns affect only the epidermis, appearing red and painful but without blisters.
• Second-degree burns involve the epidermis and part of the dermis, presenting with blisters, severe pain, and possible swelling.
• Third-degree burns destroy the entire epidermis and dermis, appearing white or charred with no pain due to nerve destruction.
• Fourth-degree burns extend beyond the skin into underlying tissues like muscle and bone. The Lund-Browder chart is the most accurate method for measuring the percentage of body surface area affected, especially in children, as it takes into account the different body proportions at various ages 1. The rule of nines, although useful for quick estimation, is less accurate in children and should be used with caution 1. Treatment of pediatric burns varies by severity:
• First-degree burns typically require pain management and moisturizers.
• Second-degree burns need wound cleaning, antimicrobial dressings, and possibly debridement.
• Third and fourth-degree burns require immediate hospitalization, fluid resuscitation, and often surgical intervention. Burns affecting more than 10% of body surface area in children, or those involving critical areas like the face, hands, feet, genitalia, or major joints, should be referred to specialized burn centers for comprehensive care, as recommended by the most recent guidelines 1. In the initial management of pediatric burns, covering the burn with a nonadherent bandage or clean cloth can protect the wound, reduce pain, and avoid heat entrapment until a healthcare professional can assess the burn 1.

From the Research

Pediatric Burn Staging

• Burn injuries in children are classified based on the total body surface area involved and the depth of injury 2
• The classification of burn injuries is crucial in determining the management and treatment of pediatric burn patients
• Pediatric burn injuries can be caused by scald injury, fire injury, and child abuse, among other factors 2

Assessment and Management

• The assessment of pediatric burn injuries requires immediate attention in the emergency department 3
• The main aim of treatment is to restore form, function, and feeling to burn-injured skin and to enable physical and psychological recovery 3
• Management of burn injuries requires intensive medical therapy for multi-organ dysfunction/failure, and aggressive surgical therapy to prevent sepsis and secondary complications 2

Resuscitation and Fluid Management

• Children with major burns require emergent resuscitation, including pain control, airway management, and administration of intravenous fluid 4
• Fluid resuscitation is needed for burns greater than or equal to 15% of total body surface area (TBSA) in children, compared to burns greater than or equal to 20% TBSA in adults 4
• Accurate calculation of the percentage of total burned surface area (TBSA) in children with changing body proportions is crucial to determine resuscitation parameters, prognosis, and disposition 4

Unique Considerations in Pediatrics

• Pediatric burn patients have unique pathophysiologic responses to burn injury, requiring an understanding of the differences in fluid resuscitation requirements, airway management, and burn and wound care 5
• Assessment for non-accidental injury is also a crucial consideration in pediatric burn patients 4