Abstract
This study aimed to identify some risk factors for post‐burn scarring in children aged 0–18 years. One hundred and eighty two participants were involved in this cohort study. Under the age of 18 who were admitted to the Department of Burn Reconstructive Surgery with a diagnosis of upper and lower extremity burns were followed for 6 months. A total of 182 participants (62.1% male, and 37.9% female participants) enrolled in this study. Age ranged from 1 to 17 and the average age was 3.95 ± 3.35. The degree of burn and the anatomical location of the burn had a statistically significant effect on the development of hypertrophic scars. The length of the patient's hospitalisation days and the area of the burn were statistically correlated with wound healing (P = 000, P = .074). For example, the average length of hospitalisation days was 8 ± 5 days in the hypertrophic scars group of patients, and in the group with normal scars, average bed days were 6 ± 3 days (P = .000). Grade IIIb burns increased the risk of hypertrophic scar development by 4.9 times and grade IV burns increased it by 2.5 times. In addition, when the area of burns was 11% or more, the risk of hypertrophic scar development was increased by 58.8%. In the case of wound swab infection, the risk of hypertrophic scar development was 12.4% higher (B = 1.124, 95 EI = 0.55; 2.28, P = .748). Participants' age, burn area and degree of burn are statistically significant risk factors for post‐burn scarring in children aged 0–18 years.
Keywords: burn, burn wound healing, hypertrophic scar, TBSA
1. INTRODUCTION
According to a WHO study in 2018, about 180 000 people died from burns worldwide each year, and this number is expected to increase in developed and less developed countries. 1
Of the 170 burns reported per 100 000 population in Australia, 36% were in children aged 0–4 years and 34.5% were in children under 15 in Kuwait. 2 , 3 , 4
About 173 000 Bangladeshi children suffer moderate to severe burns each year. In Bangladesh, Colombia, Egypt and Pakistan, 17% of burned children are temporarily disabled and 18% are permanently disabled. Burns is the second most common injury in rural Nepal, accounting for 5% of people with disabilities. 1
In the last 5 years in Mongolia, 31 122 cases of burns were registered nationwide (6224 cases per year on average), of which 54.6% were children aged 0–5 years. As the leading cause of injury, 65.7% were burnt by hot food, tea and hot water, 43.15% were diagnosed by heat and chemical burns of the upper limbs, and 12.6% by hips and lower limbs except for ankles and feet. and in the case of chemical burns, 42.8% had a second‐degree burn. From 2015–2020, 622 people were hospitalised due to residual scars after burns, of which 422 children under the age of 18, or 67.8% underwent scar surgery. 5
The study result of C.A.Ryan et al noted that 583 children (0–18 years old), consisting of 33.4% of all burn inpatients, were admitted to the University of Alberta Hospitals over 11 years (January 1978 to December 1988). Demographic and outcome variables, in addition to aetiological factors, were examined. 48.4% of burns occurred in children <4 years of age, with males predominating in every age group (P < .001). 6
As a result of a study conducted by Nansalmaa Sh, Erdenechimeg E et al, the prevalence of burns in Ulaanbaatar was 2073 per 100 000 children under the age of 5 in the last 8 years (2006–2013). 7
In our country, as the number of burns increases year by year, there is an urgent need to study the risk factors for scarring after burns.
2. MATERIALS AND METHODS
2.1. Study design and sampling
From April 2021 to April 2022, 182 participants under the age of 18 were admitted to the Department of Burn and Reconstructive Surgery of the National Trauma and Orthopedic Research Center of Mongolia with a diagnosis of upper and lower extremity burns and were followed for 6 months. Furthermore, the cause of the burn, area size, severity, wound infection, wound regeneration, and duration of hospitalisation was studied.
2.2. Statistical analysis
All statistical analyses were made with STATA 20 program. P value is less than .05 and is considered statistically significant.
2.3. Ethical statement
Ethical approval for this study was acquired from the Research Ethics Committee of the Mongolian National University of Medical Sciences on 4th June 2021 with the 7th order. Before data collection, the participants signed written, informed consent.
3. RESULTS
One hundred and eighty two participants (62.1% male, 37.9% female participants) enrolled in this study. Age ranged from 1 to 17 and the average age was 3.95 ± 3.35. The degree of burn and the anatomical location of the burn site had a statistically significant effect on the development of hypertrophic scars. On the contrary, there was no statistically significant difference between the type of wound healing and age, sex, or cause after 6 months (Table 1).
TABLE 1.
Paediatric patient's general characteristics
| Variables | Scar types | P value | |||||
|---|---|---|---|---|---|---|---|
| Normal scar | Hypertrophic scar | Total | |||||
| n | % | N | % | n | % | ||
| Gender | .738 | ||||||
| Male | 61 | 61.0% | 52 | 63.4% | 113 | 62.1 | |
| Female | 39 | 39.0% | 30 | 36.6% | 69 | 37.9 | |
| Age, mean ± SD | 3.87 ± 3.62 | 4.05 ± 3.03 | .722 | 3.95 ± 3.35 | |||
| Cause of burn injury | .548 | ||||||
| Scald | 84 | 84.0% | 73 | 89.0% | 157 | 86.3 | |
| Electrical | 5 | 5.0% | 4 | 4.9% | 9 | 4.9 | |
| Contact | 9 | 9.0% | 3 | 3.7% | 12 | 6.6 | |
| Others (fire and flame) | 2 | 2.0% | 2 | 2.4% | 4 | 2.2 | |
The cause of burns varies significantly by age group (P = .042). For example, the median age for children with electrical burns is 5, and the median age for children with burns from scalds is 3 (Figure 1).
FIGURE 1.
Age in burn cause of paediatric patients
Several paediatric cases in histograms for each wound healing group. The prevalence of case differences between the two groups, and the likelihood of hypertrophic scarring increases with age (Figures 2 and 3).
FIGURE 2.
The age of the child and the number of cases, in the form of wound healing
FIGURE 3.
Percentage of burns in children surveyed
The degree of burn and the anatomical location of the burn site had a statistically significant effect on hypertrophic scarring (Table 2 and Figure 4).
TABLE 2.
Effect of burn degree and burn site on hypertrophic scarring
| Variables | Scar types | P value | |||||
|---|---|---|---|---|---|---|---|
| Normal scar | Hypertrophic scar | Total | |||||
| n | % | n | % | n | % | ||
| Burn degree | |||||||
| 2 | 10 | 10.0% | 2 | 2.4% | .000 | 12 | 6.6% |
| 3A | 44 | 44.0% | 10 | 12.2% | 54 | 29.7% | |
| 3B | 45 | 45.0% | 69 | 84.1% | 114 | 62.6% | |
| 4 | 1 | 1.0% | 1 | 1.2% | 2 | 1.1% | |
| Anatomical location of paediatric burn patients | .071 | ||||||
| Upper | 47 | 47.0% | 32 | 39.0% | 79 | 43.4% | |
| Lower | 52 | 52.0% | 44 | 53.7% | 96 | 52.7% | |
| Lower and upper | 1 | 1.0% | 6 | 7.3% | 7 | 3.8% | |
| Scar infection | .210 | ||||||
| No | 69 | 69.0% | 49 | 59.8% | 118 | 64.8% | |
| MRSA | 15 | 15.0% | 15 | 18.3% | 30 | 16.5% | |
| Staphylococcus | 10 | 10.0% | 16 | 19.5% | 26 | 14.3% | |
| Enterobacter | 2 | 2.0% | 0 | 0.0% | 2 | 1.1% | |
| Others | 4 | 4.0% | 2 | 2.4% | 6 | 3.3% | |
| Burn wound healing | |||||||
| Dressing | 89 | 89.0% | 52 | 63.4% | .000 | 141 | 77.5% |
| STSG | 11 | 11.0% | 30 | 36.6% | 41 | 22.5% | |
FIGURE 4.
The patient's length of hospitalisation days and the size of the burn area were compared with the extent of scarring after wound healing
The size of the patient's length of hospitalisation and the area of the burn were statistically significant in terms of wound healing (P = .000, P = .074). For example, in the group with hypertrophic scars, the length of hospitalisation days was 8 ± 5 days, and in the group with normal scars, the length of hospitalisation days was 6 ± 3 days (P = .000). The average burn area percentage was 4.7% in the hypertrophic scar group and 6.8% in the normal scar group (P = .074) (Figure 4).
The results of the logistic regression analysis of some of the factors contributing to hypertrophic scarring are shown in Table 3.
TABLE 3.
The results of some of the factors contributing to hypertrophic scarring
| Variables | Scar types | Total | P‐value | |
|---|---|---|---|---|
| Normal scar | Hypertrophic scar | |||
| Mean ± SD | Mean ± SD | |||
| Duration of medical care | 1.6 ± 1.51 | 3.9 ± 5.9 | 2.7 ± 4.2 | .000 |
| Duration of wound heal | 8.1 ± 3.65 | 15.4 ± 17.0 | 11.4 ± 12.3 | .001 |
The risk of scarring from hypertrophic is 4.9 times higher for grade IIIb burns and 2.5 times higher for grade IV burns. In addition, when the area of burns was 11% or more, the risk of scarring from hypertrophic increased by 58.8%. In the case of wound swab infection, the risk of scarring from hypertrophic is 12.4% higher (B = 1.124, 95 EI = 0.55; 2.28, P = .748) (Table 4).
TABLE 4.
The risk of hypertrophic scarring depends on the degree of burn and burn surface area and infection
| Variables | AOR | 95% CI | Sig | |
|---|---|---|---|---|
| Lower | Upper | |||
| Degree of burn | ||||
| II | 1 | |||
| IIIA | 0.842 | 0.155 | 4.577 | 0.842 |
| IIIB | 4.933 | 1.015 | 23.978 | 0.048 |
| IV | 2.547 | 0.090 | 72.076 | 0.584 |
| Body surface area | 0.902 | |||
| <10% | 1 | |||
| >11% | 1.588 | 0.482 | 5.238 | 0.447 |
| Infection | ||||
| No | 1 | |||
| Yes | 1.124 | 0.552 | 2.289 | 0.748 |
Abbreviations: AOR, adjusted odds ratio; CI, confidence interval; Sig, significance level.
4. DISCUSSION
The study result of Hilary J. Wallace et al, noted bigger areas of the burn, longer than 14 days of wound healing, and repeated surgeries cause scarring in children after the burn. It was also studied that the probability of scarring increases by 15.8% as the total body surface area (% TBSA) of the burn increases by 1%. 8
In our study, 89% of burns were caused by hot fluid and 43.4% were upper extremity burns. Researchers AD Cohen et al, reported that 67.4% of burns, Researchers Sielu Alemayehu et al, reported 70% of burns were caused by hot fluids, and 45.3% of upper extremity burns were recorded. 9 , 10 These results are similar to our study results.
5. CONCLUSIONS
Age, burn area, and degree of burn are statistically significant risk factors for post‐burn scarring in children aged 0–18 years.
CONFLICT OF INTEREST
The authors do not have any conflicts of interest related to this research work.
Enkhtuvshin S, Odkhuu E, Batchuluun K, Chimeddorj B, Yadamsuren E, Lkhagvasuren N. Children's post‐burn scars in Mongolia. Int Wound J. 2023;20(6):2082‐2086. doi: 10.1111/iwj.14077
DATA AVAILABILITY STATEMENT
Research data may be used by others
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Data Availability Statement
Research data may be used by others