Advances in the care of burn injured pediatric patients has improved mortality over the last 20 years. However, massive burn injuries (50% total body surface area or greater) in pediatric patients, while overall rare, have a significant morbidity and mortality. The primary aim for this study is to analyze treatment and outcomes in massive pediatric burn injuries. A retrospective study of children with burn injuries 50% TBSA or greater who were admitted to Shriners Hospital for Children Northern California, from May 1, 2009 to May 22, 2020 was conducted. Data was collected from the electronic health records through a comprehensive chart review that included: patient demographics, past medical history, treatment interventions and outcomes. This study included 69 patients (59.4% male) with a mean age of 8.7 ± 6 years old. The median time from injury to admission was 2 (1- 4) days. 63.8% of patients were from Mexico, 34.8% were from the United States and 1 patient was from American Samoa. The median time from injury to admission was 2 (1- 4) days. Mean TBSA was 66 ± 12 %. The median TBSA of second-degree burns was 0 (0- 6)%, and the mean TBSA of third-degree burns was 60 ± 16%. 40% of patients suffered an inhalation injury and 83% of patients received a tracheostomy. The median number of days requiring ventilator assistance was 26 (12-58) days. Mean length of hospitalization was 90 ± 60 days, with 61 ± 41 days spent in the ICU. The mean number surgical procedures were 6 ± 4. The time between surgical procedures was 12 ± 6 days. The median time from admission to the first surgical procedure was 1 (0-2) day. At the first procedure, a mean 42 ± 15% TBSA of the burn injury was excised. 62% of patients received autografting (22 ± 11% TBSA) and 52% of patients received allografting (27 ± 17% TBSA) during the first procedure. For survivors, the median number of inpatient occupational therapy encounters were 143.5 (83-215) and inpatient physical therapy encounters were 139.5 (81-215). 25% of the patients included in this study died as a result of their burn injury. Multivariate regression revealed that sustaining an inhalation injury was a significant and independent predictor of death (OR- 3.4, (1.05-11 95% CI), p=0.04). Massive burn injuries in children required a very high number of surgical procedures and hospital resources. Most children who died as a result of their massive burn injury, died within the first month of admission. Inhalation independently increases the risk of dying in pediatric patients with a massive burn injury.

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