Implementing a burns treatment protocol for paediatric patients in secondary hospital settings

PURPOSE: This study aimed to assess the impact of a defined treatment protocol for burns treatment in paediatric patients, who are admitted to the paediatric department and are managed by paediatricians and paediatric nurse staff, without surgical consultations. METHODS: Using a retrospective cohort design, we analysed paediatric patients admitted to Hillel-Yaffe Medical Centre for partial-thickness burns from January 2019 to December 2023. The treatment protocol was established in May 2020. All patients admitted before were treated according to general surgical consultation. From May 2020, treatment was conducted according to the local protocol developed. Data were initially analysed using descriptive statistics, including year-over-year analysis, and further examined with the patient-level interrupted time-series method. RESULTS: Patient numbers increased from 13 during the 16 months prior to May 2020 to 139 during the 44 months thereafter, with non-opioid analgesic treatment extending from 0.7 to 2.7 days. Opioid usage declined from 2.5 doses per patient in 2020 to 0.24 in 2023 as non-opioid use rose. All patients received procedural sedation according to protocol, compared to no sedation (from any type) beforehand. Burn site infections declined from 38.4% to 25.1%, while transfers to the burn centre remained similar (7.6-8.6%), and caregiver treatment refusal decreased from 38.5% to 8.6%. Patient-level interrupted time-series analysis suggested immediate increases in opioid doses, procedural sedations, and length of stay at protocol implementation (all p < 0.08), but no significant change in burn-site infection rate (adjusted OR 0.49, 95% CI 0.04-6.05, p = 0.581). CONCLUSION: Treatment of paediatric patients with partial-thickness burns by paediatricians in secondary hospital settings is feasible with a defined protocol, resulting in marked increases in analgesic use, and the use of mechanical debridement and advanced dressing technology. There has been no rise in the need for burn centre transfers due to complications, and parental trust has increased, as evidenced by declining treatment refusals.