Elsevier

Burns

Volume 28, Issue 2, March 2002, Pages 173-176
Burns

The importance of immediate cooling—a case series of childhood burns in Vietnam

https://doi.org/10.1016/S0305-4179(01)00094-8Get rights and content

Abstract

Numerous experimental studies have shown several benefits of treating burns by the immediate application of cool water. In this study of 695 children with burns, treated in the National Burn Institute (NBI), Hanoi, Vietnam, patients were assessed on admission according to first aid measures at the time of injury, i.e. the removal of the cause and immediate cooling with cold water. A total of 33% of the children who had had immediate cooling of the burn with water had deep burns, compared with 49% of the children who had not had immediate cooling. The prevalence ratio of deep burns was thus 0.68 (95% confidence interval (CI) 0.55–0.85); that is, there was an estimated reduction of 32% in the need for skin grafting, a reduction which was statistically significant. After adjusting for the effect of cooling the burn, removal of the causal agent reduced the odds of requiring skin grafting, but the reduction was not statistically significant. It is concluded that early cooling will prevent a significant percentage of superficial burns from progressing to deep burns. This will not only reduce the probability that skin grafting and expensive treatment will be required, but will reduce the risk of other consequences of deep burns, which may be fatal. Public health programs to promote immediate cooling of burns with cool water are at least as important as subsequent medical and surgical treatment in determining the outcome of burns in children.

Introduction

Cooling the burn surface is one of the oldest methods of treatment. It was recommended by Galen (129–199 a.d.), Rhazes (852–923 a.d.), and many others since then [1]. It is now encouraged all over the world on the basis of demonstrated benefits including reduction in tissue temperature, pain relief, and reduction of oedema formation [2], [3], [4], [5].

In the study described here, the relationship between early cooling and the occurrence of deep burns was examined. The outcome measure was the need for skin grafting, which was taken as a surrogate measure of occurrence of a deep burn.

Section snippets

Methods

This analysis was conducted as part of a retrospective study of burns outcomes of children transferred to the National Burn Institute (NBI), Hanoi, Vietnam, from peripheral hospitals within 72 h of injury, over the 3-year period 1997–1999.

Results

Seventy-four percent of the children with superficial partial thickness burns had the cause removed at the injury location (Table 1), compared with 63% of the children with deep burns. The difference was statistically significant (rate ratio=1.16, P=0.003).

As shown in Table 2, 33% of the children who had had immediate cooling of the burn with water had deep burns, compared with 49% of the children who had not had immediate cooling. The prevalence ratio of deep burns was, thus, 0.68 (95% CI

Discussion

The inverse association between early cooling and the need for subsequent skin grafting is consistent with a therapeutic effect of cooling, by preventing superficial burns from developing into deep burns. Since this was a retrospective study it is not possible to prove that the inverse association is causal. However, there is no apparent confounding factor which would lead to a greater likelihood of early cooling being applied to superficial burns than to deep burns. Accordingly the probable

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