Advertisement

Cool Running Water First Aid Decreases Skin Grafting Requirements in Pediatric Burns: A Cohort Study of Two Thousand Four Hundred Ninety-five Children

      Study objective

      First-aid guidelines recommend the administration of cool running water in the early management of thermal injury. Our objective is to analyze the associations between first aid and skin-grafting requirements in children with burns.

      Methods

      This cohort study used a prospectively collected registry of patients managed at a tertiary children’s hospital. Multivariate logistic regression models were used to evaluate the relationship between first aid and the requirement for skin grafting. Secondary outcomes included time to re-epithelialization, wound depth, hospital admission and length of stay, and operating room interventions. Adequate first aid was defined as 20 minutes of cool running water within 3 hours of injury.

      Results

      In our cohort of 2,495 children, 2,259 (90.6%) received first aid involving running water, but only 1,780 (71.3%) were given the adequate duration. A total of 236 children (9.5%) required grafting. The odds of grafting were decreased in the adequate first aid group (odds ratio [OR] 0.6; 95% confidence interval [CI] 0.4 to 0.8). The provision of adequate running water was further associated with reductions in full-thickness depth (OR 0.4; 95% CI 0.2 to 0.6), hospital admission (OR 0.7; 95% CI 0.3 to 0.9), and operating room interventions (OR 0.7; 95% CI 0.5 to 0.9), but not hospital length of stay (hazard ratio=0.9; 95% CI 0.7 to 1.2; P=.48).

      Conclusion

      Burn severity and clinical outcomes improved with the administration of cool running water. Adequate first aid must be prioritized by out-of-hospital and emergency medical services in the preliminary management of pediatric burns.
      To read this article in full you will need to make a payment
      ACEP Member Login
      ACEP Members, full access to the journal is a member benefit. Use your society credentials to access all journal content and features.
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Purchase one-time access:

      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • American Burn Association
        Initial First Aid Treatment for Minor Burns.
        The Association, Chicago, IL2017 (Available at:)
        • Stiles K.
        • Goodwin N.
        First Aid Clinical Practice Guidelines.
        British Burn Association, London, UK2018 (Available at:)
        • Australian and New Zealand Burn Association
        First Aid.
        Melbourne, Victoria, Australia: The Association, 2018 (Available at:)
        https://anzba.org.au/care/first-aid/
        Date accessed: July 29, 2019
        • Cuttle L.
        • Kempf M.
        • Kravchuk O.
        • et al.
        The optimal temperature of first aid treatment for partial thickness burn injuries.
        Wound Repair Regen. 2009; 16: 626-634
        • Cuttle L.
        • Kempf M.
        • Kravchuk O.
        • et al.
        The efficacy of aloe vera, tea tree oil and saliva as first aid treatment for partial thickness burn injuries.
        Burns. 2008; 34: 1176-1182
        • Davies M.
        • Maguire S.
        • Okolie C.
        • et al.
        How much do parents know about first aid for burns?.
        Burns. 2013; 39: 1083-1090
        • Rose H.W.
        Initial cold water treatment for burns.
        Northwest Med. 1936; 35: 267-270
        • Shulman A.G.
        Ice water as primary treatment of burns: simple method of emergency treatment of burns to alleviate pain, reduce sequelae, and hasten healing.
        JAMA. 1960; 173: 1916-1919
        • ÓJ Ófeigsson
        Observations and experiments on the immediate cold-water treatment for burns and scalds.
        Br J Plast Surg. 1959; 12: 104-119
        • Bartlett N.
        • Yuan J.
        • Holland A.J.
        • et al.
        Optimal duration of cooling for an acute scald contact burn injury in a porcine model.
        J Burn Care Res. 2008; 29: 828-834
        • Yuan J.
        • Wu C.
        • Holland A.J.
        • et al.
        Assessment of cooling on an acute scald burn injury in a porcine model.
        J Burn Care Res. 2007; 28: 514-520
        • Cuttle L.
        • Kempf M.
        • Liu P.Y.
        • et al.
        The optimal duration and delay of first aid treatment for deep partial thickness burn injuries.
        Burns. 2009; 36: 673-679
        • European Burns Association
        European Practice Guidelines for Burn Care.
        4th ed. The Association, Barcelona, Spain2017: 119-120
        • Skinner A.
        • Peat B.
        Burns treatment for children and adults: a study of initial burns first aid and hospital care.
        N Z Med J. 2002; 115: U199
        • Tung K.Y.
        • Chen M.L.
        • Wang H.J.
        • et al.
        A seven-year epidemiology study of 12,381 admitted burn patients in Taiwan—using the Internet registration system of the Childhood Burn Foundation.
        Burns. 2005; 31: S12-S17
        • Nguyen N.L.
        • Gun R.T.
        • Sparnon A.L.
        • et al.
        The importance of immediate cooling—a case series of childhood burns in Vietnam.
        Burns. 2002; 28: 173-176
        • Cuttle L.
        • Kravchuk O.
        • Wallis B.
        • et al.
        An audit of first-aid treatment of pediatric burns patients and their clinical outcome.
        J Burn Care Res. 2009; 30: 1028-1034
        • Wood F.M.
        • Phillips M.
        • Jovic T.
        • et al.
        Water first aid is beneficial in humans post-burn: evidence from a bi-national cohort study.
        PLoS One. 2016; 11e0147259
        • Harish V.
        • Tiwari N.
        • Fisher O.M.
        • et al.
        First aid improves clinical outcomes in burn injuries: evidence from a cohort study of 4918 patients.
        Burns. 2018; 45: 433-439
        • Emond A.
        • Sheahan C.
        • Mytton J.
        • et al.
        Developmental and behavioural associations of burns and scalds in children: a prospective population-based study.
        Arch Dis Child. 2017; 102: 428-483
        • Passaretti D.
        • Billmire D.A.
        Management of pediatric burns.
        J Craniofac Surg. 2003; 14: 713-718
        • Birchenough S.A.
        • Gampper T.J.
        • Morgan R.F.
        Special considerations in the management of pediatric upper extremity and hand burns.
        J Craniofac Surg. 2008; 19: 933-941
        • Stamatas G.N.
        • Nikolovski J.
        • Luedtke M.A.
        • et al.
        Infant skin microstructure assessed in vivo differs from adult skin in organization and at the cellular level.
        Pediatr Dermatol. 2009; 27: 125-131
        • Frear C.C.
        • Griffin B.
        • Watt K.
        • et al.
        Barriers to adequate first aid for paediatric burns at the scene of the injury.
        Health Promot J Austr. 2018; 29: 160-166
        • Doctor N.
        • Yang S.
        • Maerzacker S.
        • et al.
        Socioeconomic status and outcomes after burn injury.
        J Burn Care Res. 2015; 37: e56-e62
        • Census of Population and Housing
        The Index of Relative Socio-Economic Advantage and Disadvantage.
        Australian Bureau of Statistics, Canberra, Australia2013 (Available at:)
        • Shakespeare P.G.
        Standards and quality in burn treatment.
        Burns. 2001; 27: 791-792
        • Lund C.
        • Browder N.C.
        The estimation of areas of burns.
        Surg Gynecol Obstet. 1944; 79: 352-358
        • Cubison T.C.
        • Pape S.A.
        • Parkhouse N.
        Evidence for the link between healing time and the development of hypertrophic scars (HTS) in paediatric burns due to scald injury.
        Burns. 2006; 32: 992-999
        • Cepeda M.S.
        • Boston R.
        • Farrar J.
        • et al.
        Comparison of logistic regression versus propensity score when the number of events is low and there are multiple confounders.
        Am J Epidemiol. 2003; 158: 280-287
        • McCormack R.A.
        • La Hei E.R.
        • Martin H.C.
        First-aid management of minor burns in children: a prospective study of children presenting to the Children's Hospital at Westmead, Sydney.
        Med J Aust. 2002; 178: 31-33
        • Chipp E.
        • Charles L.
        • Thomas C.
        • et al.
        A prospective study of time to healing and hypertrophic scarring in paediatric burns: every day counts.
        Burns Trauma. 2017; 5: e1-e6
        • British Red Cross
        First Aid for Someone Who Has a Burn.
        Red Cross, London, UK2018 (Available at:)
        • St John Ambulance (UK)
        Burns and Scalds.
        St John Ambulance, London, UK2018 (Available at:)
        • Jackson D.M.
        The diagnosis of the depth of burning.
        Br J Surg. 1953; 40: 588-596
        • Wright E.H.
        • Harris A.L.
        • Furniss D.
        Cooling of burns: mechanisms and models.
        Burns. 2015; 41: 882-889
        • Cuttle L.
        • Pearn J.
        • McMillan J.R.
        • et al.
        A review of first aid treatments for burn injuries.
        Burns. 2009; 35: 768-775