ABSTRACT
Objective:
To investigate the scientificity and feasibility of the ten-fold
rehydration formula for
emergency resuscitation of pediatric
patients after extensive
burns.
Methods:
A retrospective
observational study was conducted. The total
burn area of 30%-100% total
body surface area (TBSA) and
body weight of 6-50 kg in 433 pediatric
patients (250
males and 183
females,
aged 3 months to 14 years) with extensive
burns who met the inclusion criteria and admitted to the
burn departments of 72 Class A
tertiary hospitals were collected. The 6 319 pairs of simulated data were constructed after pairing each
body weight of 6-50 kg (programmed in steps of 0.5 kg) and each total
burn area of 30%-100% TBSA (programmed in steps of 1%TBSA). They were put into three accepted pediatric
rehydration formulae, namely the commonly used domestic pediatric
rehydration formula for
burn patients (hereinafter referred to as the domestic
rehydration formula), the Galveston formula, and the Cincinnati formula, and the two
rehydration formulae for pediatric
emergency, namely the simplified
resuscitation formula for
emergency care of
patients with extensive
burns proposed by the
World Health Organization's Technical Working Group on
Burns (TWGB, hereinafter referred to as the TWGB formula) and the pediatric ten-fold
rehydration formula proposed by the author of this article--
rehydration rate (mL/h)=
body weight (kg) × 10 (mL·kg-1·h-1) to calculate the
rehydration rate within 8 h post
injury (hereinafter referred to as the
rehydration rate). The range of the results of the 3 accepted pediatric
rehydration formulae ±20% were regarded as the reasonable
rehydration rate, and the accuracy rates of
rehydration rate calculated using the two pediatric
emergency rehydration formulae were compared. Using the maximum
burn areas (55% and 85% TBSA) corresponding to the reasonable
rehydration rate calculated by the pediatric ten-fold
rehydration formula at the
body weight of 6 and 50 kg respectively, the total
burn area of 30% to 100% TBSA was divided into 3 segments and the accuracy rates of the
rehydration rate calculated using the 2 pediatric
emergency rehydration formulae in each segment were compared. When neither of the
rehydration rates calculated by the 2 pediatric
emergency rehydration formulae was reasonable, the differences between the two
rehydration rates were compared. The distribution of 433 pediatric
patients in the 3 previous total
burn area segments was counted and the accuracy rates of the
rehydration rate calculated using the 2 pediatric
emergency rehydration formulae were calculated and compared. Data were statistically analyzed with McNemar test.
Results:
Substitution of 6 319 pairs of simulated data showed that the accuracy rates of the
rehydration rates calculated by the pediatric ten-fold
rehydration formula was 73.92% (4 671/6 319), which was significantly higher than 4.02% (254/6 319) of the TWGB formula (χ2=6 490.88,P<0.05). When the total
burn area was 30%-55% and 56%-85% TBSA, the accuracy rates of the
rehydration rates calculated by the pediatric ten-fold
rehydration formula were 100% (2 314/2 314) and 88.28% (2 357/2 670), respectively, which were significantly higher than 10.98% (254/2 314) and 0 (0/2 670) of the TWGB formula (with χ2 values of 3 712.49 and 4 227.97, respectively, P<0.05); when the total
burn area was 86%-100% TBSA, the accuracy rates of the
rehydration rates calculated by the pediatric ten-fold
rehydration formula and the TWGB formula were 0 (0/1 335). When the
rehydration rates calculated by the 2 pediatric
emergency rehydration formulae were unreasonable, the
rehydration rates calculated by the pediatric ten-fold
rehydration formula were all higher than those of the TWGB formula. There were 93.07% (403/433), 5.77% (25/433), and 1.15% (5/433)
patients in the 433 pediatric
patients had total
burn area of 30%-55%, 56%-85%, and 86%-100% TBSA, respectively, and the accuracy rate of the
rehydration rate calculated using the pediatric ten-fold
rehydration formula was 97.69% (423/433), which was significantly higher than 0 (0/433) of the TWGB formula (χ2=826.90, P<0.05).
Conclusions:
The application of the pediatric ten-fold
rehydration formula to estimate the
rehydration rate of pediatric
patients after extensive
burns is more accurate and convenient, superior to the TWGB formula, suitable for application by front-line
healthcare workers that are not specialized in
burns in pre-admission rescue of pediatric
patients with extensive
burns, and is worthy of promotion.