Does Mixing Acute Medical Admissions with Burn Patients Increase Infective Complications from Paediatric Thermal Injuries?

Abstract

Objectives In the winter of 2005-2006 the management at our children's hospital elected to admit ‘overspill’ acute medical admissions to the ward used for plastic surgery and burns for logistical reasons. This study was conducted to assess the effects of that change on the incidence of infective complications in thermally injured patients. Design We conducted a retrospective study by reviewing the case-notes. The data gathered included days on IV fluids and antibiotics, transfer to the Paediatric Intensive Care Unit (PICU), microbiology and a ‘septic signs score’ – based on pyrexia, irritability, diarrhoea/vomiting, wound colonization, bacteraemia. We compared the study winter (when mixed with the medical admissions) to the two preceding winters (control). Setting Royal Hospital of Sick Children in Edinburgh. Participants Seventy-three patients were studied, 23 in the sample winter and 50 in the two preceding control winters. Main outcome measures The outcomes studied were the maximum ‘septic signs score’; patients with a score ≥3; wound colonization; PICU admission; days on antibiotics and IV fluids. Results A statistically significant increase in patients with septic episodes was demonstrated by an increase in the mean septic signs score (0.66 to 1.48, p = 0.044) and the number of patients with a score ≥3 (4% to 22%, p = 0.017). Other analysed variables did not reach statistical significance although the raw data suggested a trend. Conclusion It was concluded that there is an association between mixing acute medical admissions with thermally injured patients and an increase in the incidence of infective complications in the latter group.