700 A Comparison of Pediatric Burn Injuries Based on Cultural Environment

Abstract

Abstract Introduction The Amish maintain cultural customs that preserve their identity minimizing assimilation into American culture and selectively use technology. Cultural beliefs and environmental situations can predispose the Amish, especially children to burn injuries. As a burn center it is important to examine demographics, incidence and causes of burn injury to bring awareness for prevention efforts. The purpose of this study was to determine if burns in Amish children are associated with greater severity when compared to non-Amish children. Methods A retrospective analysis of the burn registry at a verified burn center collected data on inpatient children < 14 years with an acute burn injury from 2012 through 2018. Children with frostbite and non-accidental burn trauma were excluded. Results Of the 273 children, 16 (5.9%) Amish children were similar to the 257 (94.1%) non-Amish children in age (mean age 4.8y, SD=3.8 vs. 4.0y, SD=3.7), male gender (63% vs. 59%) and percent needing surgery (44% vs. 26%, p=0.14). However, Amish children had a greater median injury severity score (ISS) (9.0, IQR [1, 25] vs. 1.0, [1, 4], p< 0.0001), median TBSA (19.5% [5.2, 52] vs. 4.0 [1.7, 7], p< 0.0001), median length of stay (LOS) (10.5 days [4, 50] vs. 2.0 days [1, 8], p< 0.0001), and median number of surgeries (0.5 [0, 6.5] vs. 0 [0, 1], p< 0.0074). Complications of ARDS (25%), sepsis (25%), compartment syndrome (18.8%), acute renal injury/failure (12.5%) and amputation (18.8%) were more prevalent among Amish children (all p< 0.0033) and non-existent in the non-Amish group. Amish children had a higher incidence of fire/flame burn (43.8% vs. 19.5%) and need for rehabilitation (37.5% vs. 0.8%). Conclusions In this study, Amish children had greater burn area, severity, longer LOS, more surgical interventions and complications than non-Amish children. Applicability of Research to Practice Culturally appropriate prevention efforts and education are needed to enhance existing care and burn or fire awareness with the Amish population.