Evidence-based injury prediction data for the water temperature and duration of exposure for clinically relevant deep dermal scald injuries

Abstract

Deep dermal burn injuries require extensive medical care, however, the water temperatures and durations of exposure that result in a severe scald injury are unknown. This study used a porcine burn model to investigate the time and temperature threshold for clinically relevant deep dermal injuries for both immersion (long duration) and spill/splash (short duration) scald events. Scald wounds were created on the flanks of anaesthetised juvenile Large White pigs (27kgs). Acute tissue injury evaluations performed at 1 hour and days 1, 3 and 7 post-burn (16 pigs) included: wound examination, biopsies and Laser Doppler Imaging. Up to 20 burn combinations were tested including: 50 to 60°C water for 1 to 10 minutes (immersion); and 60 to 90°C water for 5 seconds (spill/splash). Burn conditions demonstrating mid-to-deep dermal damage histologically were followed for 21 days to assess time to re-epithelialize (8 pigs). Histologically, depth of damage increased until day 3 post-burn. Damage to ≥ 75% of the depth of dermis was associated with burns taking longer than 3 weeks to fully re-epithelialize. For spill/splash (5 second) scalds, water at ≥ 75°C showed damage to mid-dermis or deeper by day 3, however only burns from water ≥ 85°C were not re-epithelialized by day 21. For immersion scalds of equivalent duration, water at 55°C caused significantly deeper dermal damage than 50°C (p<0.05) at day 3. Immersion scalds which were not fully re-epithelialized by day 21 included: 50°C for > 10 minutes; 55°C for 5 minutes; 60°C for 60 seconds; 70°C for > 15 seconds. This research provides valuable evidence-based injury prediction data which can be used to inform future burn injury prevention guidelines/legislation to reduce the risk of severe scald injuries and support medicolegal opinions for cases where an inflicted mechanism of injury is alleged. This article is protected by copyright. All rights reserved.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wK6fQO