Assessment of Prehospital Care for Pediatric Patients with Thermal Injuries: A Retrospective Study

Abstract

Background/Objectives: Accurate prehospital assessment of total body surface area burned (TBSA-B) is crucial for pediatric burn management, guiding resuscitation, fluid therapy, and transfer decisions. This study evaluates the accuracy of prehospital TBSA-B estimations compared to in-hospital expert assessment and examines their impact on prehospital management. Methods: This retrospective study analyzed 104 pediatric burn cases (median 17 months; 5 days-14 years) from 2017 to 2021. The primary endpoint was the difference between prehospital TBSA-B estimation and clinical measurement, with a clinically significant discrepancy defined as >5%. Secondary endpoints included the relationship between TBSA-B estimation and fluid therapy, analgesia, and hospital stay duration. Results: Prehospital TBSA-B estimations ranged from 2% to 40% (mean: 13.9%, SD = 4.4%) with scalds being the most common burn type (90.4%). Bland-Altman analysis showed a mean TBSA-B overestimation (bias) of 6.35%, with limits of agreement ranging from -6.97% (CI: -9.42 to -4.51) to 19.67% (CI: 17.21 to 22.12). No significant patterns in overestimation were associated with age, gender, or burn location. Fluid therapy volumes were independent of prehospital TBSA-B estimates, and analgesic administration varied by gender, with girls receiving less analgesia than boys, but showed no association with burn extent or severity. Hospital stay duration correlated proportionally with in-hospital assessed TBSA-B. Conclusions: Prehospital TBSA-B estimation was systematically overestimated, yet it did not influence fluid therapy decisions. Gender differences were observed in analgesic administration, while hospital stay duration was directly related to burn extent. These findings highlight the need for improved training and standardized tools to enhance prehospital burn assessment in pediatric patients.

Keywords: TBSA-B; anesthesiology; emergency medicine; pediatric; thermal injury; total body surface area burned.

Figure 1

Bland–Altman plot comparing prehospital estimation and in-hospital expert estimation of TBSA-B. The solid line represents the mean difference (bias), while the dashed lines indicate the 95% limits of agreement. Data points show the difference between prehospital estimation and the mean of prehospital and in-hospital expert assessment of TBSA-B.

Figure 2

Scatter plot with regression line showing the total body surface area burned (TBSA-B, %, X-axis) and hospital length of stay in days. Circles represent second-degree burns; squares represent third-degree burns.

Figure 3

Distribution of analgesia and sedation regimens in girls and boys.