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