Trends and epidemiology of children treated in specialized burn centers in the Netherlands between 2009 and 2022

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The aim of this study is to describe the epidemiology and trends of pediatric burns between 2009–2022 in the three Dutch burn centers. A secondary objective of this study is to evaluate the influence of the COVID-19 pandemic on the pattern of pediatric burns. Methods A register-based cohort study was conducted based on data from the Dutch Burn Repository R3. Patients between 0–17 years at the time of the burn injury admitted between 2009 and 2022 to one of the three burn centers, were included. Descriptive statistics were used to investigate the incidence and patient, burn and treatment characteristics. The COVID-19 pandemic years (2020–2021) were compared with the pooled results from pre-COVID years (2017–2019). Results A total of 4017 patients were included in this study, of which 3085 (77%) were overnight admissions. The incidence and absolute number of pediatric burn admissions gradually increased over the years, with a small temporary decrease in 2020–2021. Patient- and burn characteristics remained relatively consistent over the years. Three quarters of all patients were between 0 and 3 years old and the majority were boys (59%). A decreasing ratio of length of stay per % total burned surface area and an increase in day admissions was observed since 2016 onwards, which intensified during the COVID-19 pandemic. Conclusions There was a slight increase in the number of pediatric admissions to the burn centers between 2009 and 2022. Young children (0–3 years) remain the most frequently affected group. A shorter relative length of stay was observed, as well as an increase in day admissions, which was reinforced by the COVID-19 pandemic. children burns trends epidemiology covid-19 Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 INTRODUCTION Insights in the epidemiology and trends in pediatric burns are of great value to identify patterns, to design prevention programs, to advance medical research and to improve pediatric burn care. This has most often been studied on a national level[ 1 – 10 ] or within single centers [ 11 – 22 ]. Besides studies on burns in all age groups, there has also been attention for epidemiology and trends of burn injuries specifically in children. Although there have been multiple studies on epidemiology and trends of pediatric burns, data regarding pediatric global burn trends is inconsistent and often derived from studies limited to single centers or specific countries [ 6 , 8 , 15 , 18 , 19 , 23 – 29 ]. The World Health Organization (WHO) recently published an article about trends in pediatric burns in 20 (predominantly middle-income) countries, highlighting the significant burden of pediatric burn injuries globally, especially among young children aged 1–5 years, who mainly present with scald burns [ 30 ]. This aligns with findings from numerous other studies [ 7 , 9 , 10 , 14 , 17 , 20 – 22 , 29 , 31 , 32 ]. In the Netherlands there are three dedicated burn centers, located in Beverwijk, Rotterdam, and Groningen. The most recent trend analysis of pediatric admissions to these centers dates from 2011, covering the years 1995–2007 [ 33 ]. They observed that the number of average yearly admissions had increased from 1995 to 2007 by 44% among all ages. Moreover, a shift in burn care towards more admissions in specialized burn care was seen, especially regarding young children with less severe burns. This was probably the result of the implementation of the Emergency Management of Severe Burns (EMSB) guidelines in 1998 which included stricter referral criteria (Supplementary Table 1) [ 33 ]. More recently, van Zoonen et al studied severe burns in children under five years old in the Dutch burn centers, however, this study was focused on the etiology and risk factors in this group [ 34 ]. This study aims to describe the epidemiology and trends of pediatric burn admissions to the three Dutch burn centers from 2009 to 2022, with regards to the number of admissions, patient- and burn characteristics and outcomes. A secondary objective of this study is to evaluate the potential influence of the COVID-19 pandemic. METHODS Design This register-based cohort study was performed using data from the Dutch Burn Repository R3 (DBR-R3) which since 2009 is the uniform clinical registry of the three burn centers. Approval by a Medical Research Ethics Committee was not required according to the Dutch Medical Research with Human Subjects Law. The local institutional review boards of the Red Cross Hospital, Maasstad Hospital, and Martini Hospital approved this study. The Medical Research Ethics Committees United and the Medical Ethics Review Committee of the Amsterdam University Medical Centers ruled that the Medical Research Involving Human Subjects Act (WMO) was not applicable to the current study (AW24.031/W19.140 and 2022 − 0683, respectively). Study population All children up to 18 years of age at the time of the burn injury, admitted to one of the three Dutch burn centers for at least 2 hours between 1 January 2009 to 31 December 2022, were included in this study. Data collection The DBR-R3 is a prospective clinical registry including all patients treated in one of the three dedicated burn centers in the Netherlands (Red Cross Hospital, Beverwijk; Maasstad Hospital, Rotterdam; Martini Hospital, Groningen). The registry includes information on patient, burn injury, treatment characteristics, and clinical outcomes. For children who were also treated in a specialized Pediatric Intensive Care Unit (PICU) in one of the University Medical Centers (UMC) affiliated to the burn centers, additional data on the PICU admission was collected from the medical records. This group was identified through burn center medical record screening of children with a TBSA ≥ 10%, children who were mechanically ventilated, those with a UMC referral, and those transferred to the burn centers by ambulance helicopter or air medical services. Statistical analysis Data were analyzed in SPSS® software version 25.0. Descriptive statistics were used to report on the study parameters. Categorical and continuous data were represented using the mean, standard deviation (SD) or frequency (%). The median and interquartile range (IQR) were presented for data that were not normally distributed. We analyzed the absolute number of pediatric admissions in the three burn centers per calendar year. The incidence of pediatric burn center admissions was calculated by the yearly number of pediatric admissions to the burn centers, divided by the population at risk (total number of children aged 0–17 in the Netherlands) on January 1st in that year. The data on the population was derived from the population’s statistics available on StatLine, Statistics Netherlands [ 35 ]. Since all patients admitted for at least two hours are included in the DBR-R3 database, we differentiated two types of admissions for the analysis: those admitted for < 1 day (outpatients), and those admitted for at least one night (inpatients). The two groups together will be referred to as ‘all admissions’. Additionally, patients were divided into four age groups (0–3 years, 4–9 years, 10–14 years, and 15–17 years) to account for the varying etiology of burns within these age groups [ 14 , 33 , 36 ]. Since children in the Netherlands typically go to school from 4 years old, we focused on differences between before and after this age. Moreover, we differentiated between pre-teenagers (aged 4–9 years), young teenagers (aged 10–14 years) and old teenagers (aged 15–17 years). Etiology of burns were categorized as follows: scald, flame and fire, contact, fat, firework, other (including electricity and chemical burns) and burns with unknown etiology. Surgical treatment was defined as surgery, aimed at primary wound closure, during an acute admission or readmission. Length of stay (LOS) was defined as the length of admission in days from the date of admission to the date of discharge. LOS per percentage Total Burned Surface Area (TBSA) was calculated by dividing the length of stay by the percentage TBSA for each patient, and subsequently calculating the median of the LOS/%TBSA per year. Length of stay and length of stay per percentage TBSA was calculated for inpatients only. The potential impact of the COVID-19 period was analyzed by comparing the data of 2020 and 2021 against the pooled results from 2017, 2018 and 2019. The results of 2017 to 2019 remained relatively consistent, allowing for the use of average results of these years. In March 2022, the remaining COVID restrictions expired. Therefore, 2022 was considered a normal year for this study. RESULTS From 2009 to 2022, 4017 patients admitted to one of the three burn centers were registered in the DBR-R3. Of those patients, 932 (23%) were outpatients and 3085 (77%) were inpatients. The incidence of admissions of pediatric patients to the burn centers slightly increased from 7.1 in 2009 to 9.6 in 2022 (Fig. 1 ). The yearly absolute number of admissions showed a rising trend from 2009 to 2016, increasing from 249 to 302. From 2016 onwards, the number of inpatients decreased from 268 to 156, while the number of outpatients increased from 34 in 2016 to 144 in 2022 (311%). Table 1 Patient and burn characteristics from all admissions (n = 4017), inpatients (n = 3085) and outpatients (n = 932) from 2009 to 2022 2009–2022 All admissions Inpatients Outpatients N = 4017 % * N = 3085 % * N = 932 % * Sex Boys 2385 59 1820 59 565 61 Girls 1632 41 1265 41 367 39 Age (years) 0–3 2623 65 2111 68 512 55 4–9 584 15 430 14 154 17 10–14 487 12 326 11 161 17 15–17 323 8 218 7 105 11 Etiology Scald 2810 70 2282 74 528 57 Flame and flash burn 504 13 399 13 105 11 Contact 226 6 110 4 116 12 Fat 206 5 158 5 48 5 Firework 117 3 57 2 60 6 Electricity 25 < 1 16 1 9 1 Chemical 40 1 23 < 1 17 2 Other 47 1 26 < 1 21 2 Unknown 42 1 14 < 1 28 3 Site of accident In/around the house 1894 47 1458 47 436 47 Kitchen 1086 27 881 29 205 22 Outside 227 6 181 6 46 5 Public road 211 5 129 4 82 9 Bathroom 103 3 91 3 12 1 Campsite 91 2 74 2 17 2 Catering industry 57 1 36 1 21 2 Business 36 1 24 1 12 1 Healthcare institution 24 1 20 1 4 < 1 Open water 14 < 1 12 < 1 2 < 1 Psychiatric institution 5 < 1 1 < 1 4 < 1 Other 100 3 67 2 33 4 Unknown 147 4 105 3 42 5 Not applicable 2 < 1 0 0 2 < 1 Referral Dutch hospital 2452 62 1950 64 502 55 General Practitioner 626 16 378 12 248 27 112 (ambulance/MMT) 497 12 440 14 57 6 Self referral 140 4 98 3 42 5 Foreign hospital 56 1 44 1 12 1 Other burn center 15 < 1 8 10% 309 8 301 10 8 1 * Percentages may not sum to 100% due to rounding differences. MMT: Mobile Medical Team Missing values: site of the accident; all admissions n = 20 (1%), inpatients n = 6 (< 1%), outpatients n = 14 (2%) Missing values: referral; all admissions n = 33 (1%), inpatients n = 19 (1%), outpatients n = 14 (2%) Patient and burn characteristics Patient and burn characteristics are displayed in Table 1 . The highest number of admissions for burn injuries each year occurred among children aged 0–3 years (mean 65% of all admissions), with a clear peak among one year old children (Fig. 2 ). The majority of all admitted burn patients were boys (59%). The boy to girl ratio remained fairly stable over time. Scalds accounted for the majority (70%) of burns in all admissions over the study period. The etiology of burns by age group are displayed in Fig. 3 . The ratio of scalds decreased with age, representing 88% of the cases of 0–3 years, 57% of the cases of 4–9 years and 31% of the cases of 10–14 years (Fig. 3 ). Flame and flash burns were the primary cause in older children and were more common as age increases, accounting for 39% of the cases among 10–14 years old and 47% among 15–17 years old children. Contact burns, often from scooter exhausts, constituted 11% of the burns in the oldest age group. Overall, no notable changes in etiology were observed over the years (Fig. 4 ). Approximately a quarter (27%) of the accidents occurred specifically in the kitchen and almost half of all burns (47%) occurred elsewhere in or around the house. Over the years, there was a slight decrease in accidents occurring in or around the house from a mean of 52% in 2009–2015 to 43% in 2016–2022. The distribution of other sites of the accidents remained consistent over the years (Fig. 5 ). The majority (62%) of the patients were referred from another hospital within the country, followed by referral by a general practitioner (16%) or directly referred through the emergency number 112 (12%). This referral pattern remained consistent over the years. The course of the %TBSA over the years is displayed in Fig. 6 . The median TBSA of all admitted children changed from 4.0% (IQR 5.0; range 0.1–65.0) in 2009 to 3.0% (IQR 4.5; range 0.1–56.0) in 2022. For inpatients, the median TBSA increased from 4.0% (IQR: 4.5) in 2009 to 5.0% (IQR: 4.2) in 2022 (range 4.0–5.5), whereas the median TBSA for outpatients remained relatively stable around 1.5% (IQR range 1.5–3.0, median range 1.0–2.5). Among inpatients, children aged 0–3 years had the highest median TBSA with 4.5%, while children aged 10–14 years had the lowest median TBSA with 3.5%. Throughout the study period, the percentage of children admitted with a TBSA > 10% variated around 10% of all admissions per year (range 6.5–16.7%) (Fig. 7 ). Intensive Care A total of 77 patients required admission at a Pediatric Intensive Care Unit (PICU) affiliated to the burn centers. This group consisted of 48 boys and 29 girls with a median age of 2 years. The median TBSA was 18.9% (range 0–60%). The three most common causes of the burns were scalds (49%), flame (22%) and flash (12%) burns. The median length of stay at a PICU was 2 nights, and the median duration of mechanical ventilation was 2 days. Surgical treatment Overall, 27% of all children admitted to a burn center during 2009–2022, required surgery for wound closure (Table 2 ). The percentage of children requiring surgery over the years varied around an average of 27%, with a minimum of 22% in 2014 and a maximum of 34% in 2021. Most of the operated children (84%) underwent one surgical procedure. Children undergoing multiple surgeries had a higher median TBSA, as it was 3% for children undergoing one, 8% for two, 9.9% for three and 26% for more than three surgeries. The median TBSA of non-operated children was 3.8%. For children admitted with a TBSA ≤10%, 24% required surgery, of which 90% a single time. For admissions with a TBSA > 10%, 61% required surgery, of which 58% one operation and 42% multiple operations for wound closure. Table 2 Outcomes of all pediatric burn patients at the Dutch burn centers from 2009 to 2022 2009–2022 All admissions Inpatients Outpatients N = 4017 % * N = 3085 % * N = 932 % * Length of stay (days) Median 2.0 NA 4.0 NA NA NA LOS per % TBSA NA NA 1.0 NA NA NA Surgical intervention ** None 2928 73 2342 76 586 63 1 surgery 917 23 593 19 324 35 2 surgeries 101 3 87 3 14 2 3 surgeries 34 1 31 1 3 0 ≥4 surgeries 37 1 32 1 5 1 Discharge destination Home 3898 97 2986 97 912 99 Other hospital 54 1 46 1 8 1 Other burn center 12 < 1 11 < 1 1 < 1 Rehabilitation center 8 < 1 7 < 1 1 < 1 Other *** 27 1 24 1 3 < 1 Deceased 2 < 1 2 < 1 0 0 * Percentages may not sum to 100% due to rounding differences. ** Surgeries displayed in this table do only include surgeries during acute admission and do not include surgical reconstructions *** Including psychiatric institution, nursery home and others Missing values: discharge destination; all admissions n = 18 (< 1%), inpatients n = 11 (< 1%), outpatients n = 7 (1%) Length of hospital stay, mortality, and discharge From 2009 to 2022, the median length of stay (LOS) of all admissions decreased from 4 days to 1 day, and for inpatients from 5 to 4 days. The LOS/TBSA for inpatients is displayed in Fig. 8 and decreased from 1.2 in 2009 to 0.8 in 2022. Two patients died after having sustained extensive burns due to a house fire. Following admission, almost all (97%) of the patients were discharged home. Of the remaining 3%, approximately half of the patients were transferred to another hospital, a smaller group to another burn center, and a few to a rehabilitation center. The COVID-19 pandemic Comparisons between 2017–2019 (pre-COVID-19) and 2020–2021 (COVID-19 era) are displayed in Supplementary Table 2. During the COVID years, the total number of admissions remained stable around 300. However, the number of inpatient admissions dropped from 237 pre-COVID to 171 in 2020 and 126 in 2021, implying a 37% decrease from pre-COVID to 2021. The number of day admissions increased from 62 pre-COVID to 130 in 2020 and 153 in 2021, implicating an increase of 147% from pre-COVID to 2021. There were no differences in the distribution of gender, age and burn etiology in 2020–2021 compared to 2017–2019. The median TBSA of all admitted children during COVID changed from 3.8–3.0%. For inpatients, the median TBSA changed from 4.7–5.5% and for outpatients, the median TBSA remained stable around 1.5%. Outcomes of patients admitted to a burn center during the COVID years are displayed in Supplementary Table 3. For the inpatient group, the median length of stay increased from 4 to 5 days. The LOS/TBSA slightly decreased from 1.0 in 2017–2019 to 0.8 in 2021. Operative intervention was required in 27% of all admitted patients during 2017–2019, 23% in 2020 and 34% in 2021. Both for the inpatient and outpatient group, we observed a decrease in surgeries in 2020, followed by an increase in 2021. Almost all children (98%) were discharged home, as they were before the COVID-period. DISCUSSION The aim of this study was to describe the trends and epidemiology of pediatric burn admissions to the Dutch burn centers during 2009–2022. Secondly, the influence of the COVID-19 pandemic in 2020–2021 was analyzed by comparing with the average results of 2017–2019. A slight increase in admissions of pediatric burn patients to a burn center was noticed from 2009 to 2022. We observed persisted high numbers of young children (0–3 years old) in the 14 years. Our findings highlight a shift in pediatric burn admissions over the years, characterized by a consistent pattern towards shorter lengths of admissions and more day admissions. This trend intensified during the COVID-19 period, as the number of day admissions exceeds the number of inpatient admissions for the first time in 14 years. Patient- and burn characteristics remained consistent during the entire study period, including the COVID-pandemic period. The absolute number of pediatric burn admissions to the burn centers has slightly increased from 2009 to 2016. After 2016, the total number of admissions remained stable, but the number of outpatients increased, while the number of inpatients decreased. In 2021, the number of outpatients surpasses the number of inpatients for the first time. As Vloemans already described in 2011, both the proportion and the incidence of pediatric burn related admissions to a Dutch burn center is increasing since 2000, thus suggesting a shift in pediatric burn care towards a greater volume of admissions, of particularly children with less severe burns, in specialized burn centers [ 33 ]. This course appeared to have been continued since we observed that the incidence of pediatric burn admissions in the burn centers increased from 2009 to 2022. A recent study from Switzerland found a similar increasing incidence in their pediatric burn center, which the authors attributed to centralization of burn treatment [ 21 ]. In most European countries, the incidence of pediatric burns in most European countries is continuously decreasing [ 6 , 8 , 15 , 18 , 19 , 23 – 27 ]. Other countries observed an increase [ 5 , 16 , 37 , 38 ]. These differences in trends may be true but may also be due to differences in the source of the data, the setting of the study and national burn care regulation. In the Netherlands, national data on pediatric burns in hospitals, emergency departments and general practitioners are structured and published separately which hinders direct comparison with our data. Therefore, it is unknown whether the incidence of pediatric burns in the Netherlands is increasing, decreasing, or remaining stable. Patient and burn characteristics Patient- and burn characteristics remained consistent over the past decade. Boys are most frequently affected and most of the burns occurred among children aged 0–3 years. Scalds remain the most common cause of burns in children from 0 to 9 years old. In patients from 10 years old, flame/flash burns were most common, a trend possibly influenced by the media targeting adolescent males and portraying flames and high-risk behavior as cool and consequence free [ 39 ]. Also, the male predominance of burns reflects higher risk activity among older boys [ 40 ]. The pattern of causes of injury aligns with the pattern described in other countries, as well as the preceding years in the Netherlands [ 4 , 6 , 9 , 13 , 14 , 20 , 21 , 31 , 32 , 41 , 42 ]. Notably, in a developed country like the Netherlands, the incidence of scald burns among young children remains persistently high. This is particularly remarkable in an era with parents closely supervising their children and minimizing exposure to risky situations. It underscores the need for renewed focus in burn prevention programs, particularly aimed at protecting the youngest and most vulnerable age groups from scald injuries. The house remains the most common site of the accident, with almost half of the children being injured in or around the house, and approximately a quarter of the children specifically in the kitchen. While Vloemans et al. described a significant decrease in accidents in and around the house during 2000–2007 [ 33 ], we did not observe this decrease in our data. The reduction in median percentage TBSA was already described years ago, following the implementation of the EMSB guidelines in 1998 (Supplementary Table 1). With the minimum TBSA for referral to a specialized burn center lowered from 10–5%, more children with less severe burn wounds are admitted [ 33 , 36 ]. Given the general trend towards more day admissions in hospitals in the Netherlands, with a threefold increase in day-admissions from 1998 to 2007 [ 43 ], and a similar increase observed in our burn centers, more patients with slightly smaller burns are treated in daycare. Consequently, we observed an increase in the median TBSA for the inpatient group from 4% in 2009 to 5% in 2022. Length of hospital stay The median length of stay for all admissions and inpatients decreased over time. The reduction in length of stay in the Netherlands was already described in 2011 and is in line with trends in other developed countries [ 44 – 46 ]. This reduction may be the result of higher admission rates of children with smaller burns, the expansion of outpatient facilities and – possibly because of the aforementioned factors – an increase in day admissions [ 36 ]. Following more day admissions, we observed we observed a slight decrease in the median TBSA. Globally, outpatient care has become increasingly important, as the shift towards more day admissions is not only observed in The Netherlands, but also in the United States[ 47 ] and Australia [ 22 ]. This general trend of hospitalizing patients shorter is for example also seen in pediatric patients treated for acute appendicitis. In the past, patients would be hospitalized for days or weeks, whereas surgeries are now frequently performed in daycare [ 48 , 49 ]. Following less severe burns and shorter admissions, LOS/%TBSA decreased from 1.2 to 0.8 days during the study period, implicating that children are nowadays hospitalized shorter per %TBSA affected, compared to 2009. In other developed countries, a similar reduction in LOS/%TBSA is seen, reducing from 5 to 3 days in the United States[ 29 ] and from 4.6 to 2.5 in Switzerland [ 21 ]. Mortality Worldwide, burn-related mortality has been decreasing for years [ 42 , 50 ]. This decrease is also observed among pediatric burns specifically [ 5 , 6 , 15 , 18 ] with a decrease by as much as 36% globally in the past decade [ 51 ]. The mortality rate of pediatric patients admitted to a burn center in the Netherlands was 0.05% (n = 2) compared to 0.6% (n = 16) in the latest study on pediatric burns in these centers [ 33 ]. Pediatric patients with severe burns (mostly children with a TBSA > 20%) require admission to the PICU. Since none of the three burn centers have their own PICU, these children are often primarily admitted to one of the PICUs affiliated to the burn center, in the university hospitals in the region of the burn center. If they died in the PICU, they will not be registered in the DBR-R3, which potentially leads to an underestimation of our mortality data. Also, these numbers alone do not allow for a conclusion regarding trends in mortality; the absolute numbers are low, and minor variations can create misleading impressions. Additionally, impactful events, such as the Volendam cafe fire in 2001, with high numbers of burn victims and many deaths, influenced the previously reported high mortality rates [ 52 ]. A more relevant approach would be to examine the percentage of mortality within specific subpopulations, such as those with > 20% TBSA. This can be used as an outcome indicator to evaluate the quality of burn care. As many countries do not yet have a national registration system for hospitalized burn patients, data on epidemiology and mortality is heterogenous [ 42 ]. The Global Burn Registry (GBR), established in 2018, is an important step towards uniform global burn registration [ 53 ]. Recently, a comparison was conducted on burn registries globally and the authors recommended the development of common data elements used in an international minimum data set as the next step in achieving burn register data sharing [ 54 ]. The COVID-19 pandemic Both 2020 and 2021 were marked by several social and environmental restrictions and periods of lockdowns. The incidence of pediatric burns in the Dutch emergency departments decreased from 46 in 2019 to 39 in 2021 [ 55 – 57 ]. In the burn centers, the number of inpatients decreased significantly during the COVID-pandemic, while the total number of admissions remained relatively stable. The decrease in inpatients is most likely the result of the intensified shift towards more day admissions during COVID, a shift which already started years before. This decrease in inpatients during COVID was also observed in a burn center in the United Kingdom [ 58 ]. The impact of the COVID-19 pandemic on pediatric burn admissions differs globally. In line with our results, a decreased number of pediatric burn admissions was observed during the pandemic in a burn center in Romania [ 59 ]. Controversially, burn centers in the United States [ 60 – 63 ], Australia [ 22 ] and Spain [ 64 ] noticed an increase in pediatric burn patients admitted. Others burn centers in the United States, as well as in Israel, found no significant increase or decrease regarding pediatric burn admissions during COVID [ 65 , 66 ]. The contradicting results may be the result of differences in study settings: targeted population, study design, variance in health care systems, and the presence or absence of stay-at-home order [ 67 ]. The literature describes contradicting explanations for the changes in pediatric burn admissions during the COVID period. Increased incidence was often attributed to the heightened risk of injury for children during lockdowns as most burn injuries occur at home [ 22 , 32 , 58 , 68 ], and as parents were also concomitantly working from home, they may have not been able to directly supervise their children’s activities [ 68 – 70 ]. However, as we observed a decrease in pediatric burn admissions during COVID, one could consider the ability of parents to supervise their children more as they were working from home, as a possible explanation for a decrease. This underscores the importance of behavioral factors that may influence injury rates besides statistical trends. Insights into this are valuable for preventive measures. We identified no changes in male-to-female ratio and age distribution. Length of stay did not change during the pandemic, in line with results from Australia [ 22 ], but in contrast with shorter length of stays in the United Kingdom [ 58 ] and longer length of stays in Canada [ 71 ], specifically during the lockdown period. The trend of shorter lengths of stays and more day admissions that we observed since 2016 intensified during the COVID-pandemic. After the COVID-pandemic, the incidence of pediatric burns in the Dutch ED rises to 49 per 100.000 in 2022, indicating a return to pre-COVID levels [ 72 ]. Limitations This study has several limitations. Firstly, the database DBR-R3 has undergone several updates over the years, such as more categories used to classify the site of the accident and the etiology of the burn wound, compared to years ago. This makes exact comparisons with previous epidemiologic studies difficult. However, it is important to recognize that the data collection process and the patient population have remained consistent over years. This ensures reliability and validity of the study findings. As small changes in the registration can complicate detailed trend analysis, we refrained from analyzing these detailed changes over time, to maintain consistency and avoid potential biases. Secondly, comparison of data on pediatric burns with national data is complicated due to the differences in registration. Lastly, as this concerns a study based on a registry of electronic patient record data, there is missing data. However, given that the amount of missing data was very small (max. 2%), the impact on results is considered negligible. CONCLUSION Our study provides a comprehensive overview of the epidemiology and trends of pediatric burn admissions in The Netherlands over the past 14 years. We observed an increased number of pediatric patients admitted to a Dutch burn center. Over the years, admissions are shorter per percentage TBSA and there has been a shift towards more day admissions. Burns among young children (0–3 years old) remain a significant problem. Overall, the Netherlands is a relatively safe country with low rates of severely burned children. Burn care in the Netherlands is exceptionally well-organized, with a nationwide alliance of three verified burn centers and affiliated intensive care units in Amsterdam, Rotterdam and Groningen. This network ensures that high quality specialized care for burn patients is available, a level of organization and accessibility which is outstanding worldwide. Targeted prevention campaigns and specialized burn care for children in the Netherlands remains necessary. Frequent research on trends in pediatric burns is crucial for prevention programs, research and innovation, quality improvement, forecasting healthcare demands, and resource allocation. Abbreviations DBR-R3 Dutch Burn Repository R3 EBA European Burns Association ED Emergency Department EMSB Emergency Management of Severe Burns GBR Global Burn Registry IQR Interquartile Range LOS Length of Stay MMT Mobile Medical Team NA Not Applicable PICU Pediatric Intensive Care Unit TBSA Total Burned Surface Area UMC University Medical Center WHO World Health Organization Declarations Acknowledgements Dutch Burns Foundation Beverwijk, Red Cross Hospital Beverwijk, Martini Hospital Groningen, and Maasstad Hospital Rotterdam for their support. H.C.W. Hofland and A.S. Niemeijer for aiding in medical record data collection. Funding: This work was financially supported by the Dutch Burns Foundation but did not receive a specific grant. Competing Interests: The authors declare no competing interests. Author Contributions: Anouk Pijpe, Eline L van den Berg, Margriet E van Baar, Paul PM van Zuijlen, Eelke Bosma and Cees H van der Vlies contributed to the study conception and design. Material preparation and data collection was performed by the Burn Repository R3 group, Frederique M Kemme, Eline L van den Berg, Rolf K Gigengack, Margriet E van Baar, Marianne K Nieuwenhuis and Anouk Pijpe. Analysis was performed by Frederique M Kemme, Eline L van den Berg, Annebeth Meij-de Vries and Anouk Pijpe. The first draft of the manuscript was written by Frederique M Kemme and all authors critically reviewed several draft versions of the manuscript and provided commentary. All authors read and approved the final manuscript. Ethics approval: Approval by a Medical Research Ethics Committee was not required according to the Dutch Medical Research with Human Subjects Law. The local institutional review boards of the Red Cross Hospital, Maasstad Hospital, and Martini Hospital approved this study. The Medical Research Ethics Committees United and the Medical Ethics Review Committee of the Amsterdam University Medical Centers ruled that the Medical Research Involving Human Subjects Act (WMO) was not applicable to the current study (AW24.031/W19.140 and 2022-0683, respectively). Consent to participate: Not applicable. Consent to publish: Not applicable. Dutch Burn Repository group Burn Center Beverwijk: A Boekelaar 1 , A Pijpe 1-3 , D Roodbergen 1 , MM Stoop 1 , PPM van Zuijlen 1-3, 5, 14 Burn Center Rotterdam: A van Es 9 , M Heijblom-van Dinteren 9 , Y Lucas 9 , CH van der Vlies 6, 9, 15 Burn Center Groningen: E Bosma 11 , H Eshuis 11 , SMHJ Scholten-Jaegers 11 Association of Dutch Burn Centers: ME van Baar 9,10 , L van Dammen 16 , E Middelkoop 16 , MK Nieuwenhuis 11-13 , A Novin 16 Alliance of Dutch Burn Care, Burn Center, Red Cross Hospital, Beverwijk, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic Reconstructive and Hand Surgery, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Tissue Function and Regeneration, Amsterdam, the Netherlands. Department of Surgery, Red Cross Hospital, Beverwijk, the Netherlands; Amsterdam UMC location University of Amsterdam, Pediatric Surgical Center, Emma Children’s Hospital, Amsterdam, the Netherlands. Departments of Trauma and Burn Surgery, Maasstad Hospital, Rotterdam, the Netherlands. Amsterdam UMC location VU Medical Center, Amsterdam, Department of Intensive Care, Amsterdam, the Netherlands. Amsterdam UMC location VU Medical Center, Amsterdam, Department of Anesthesiology, Amsterdam, the Netherlands. Alliance of Dutch Burn Care, Burn Center, Maasstad Hospital, Rotterdam, the Netherlands; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. Alliance of Dutch Burn Care, Burn Center, Martini Hospital, Groningen, the Netherlands; University of Groningen, University Medical Centre Groningen, Department of Human Movement Sciences, Groningen, the Netherlands; Hanze University of Applied Sciences, Groningen Research Group Healthy Ageing Allied Health Care and Nursing, Groningen, the Netherlands. Department of Plastic Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, the Netherlands. 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Additional Declarations No competing interests reported. Supplementary Files KemmeSupplementarytables.docx Cite Share Download PDF Status: Published Journal Publication published 02 Jan, 2025 Read the published version in European Journal of Pediatrics → Version 1 posted Editorial decision: Revision requested 18 Nov, 2024 Reviews received at journal 10 Nov, 2024 Reviews received at journal 28 Oct, 2024 Reviewers agreed at journal 25 Oct, 2024 Reviewers agreed at journal 21 Oct, 2024 Reviewers agreed at journal 17 Oct, 2024 Reviewers invited by journal 03 Oct, 2024 Editor assigned by journal 30 Sep, 2024 Submission checks completed at journal 30 Sep, 2024 First submitted to journal 24 Sep, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5147493","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":379672341,"identity":"1f90426b-be62-43be-a673-7afe8988ef54","order_by":0,"name":"Frederique M 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1","display":"","copyAsset":false,"role":"figure","size":160049,"visible":true,"origin":"","legend":"\u003cp\u003eIncidence of pediatric burn center admissions in the Netherlands; all admissions (blue), overnight admissions (orange) and day admissions (grey) from 2009 to 2022\u003c/p\u003e","description":"","filename":"Fig1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5147493/v1/094b602f8f633f334461a092.jpg"},{"id":70949267,"identity":"1d5fad42-59bd-4383-98d5-d744e8998748","added_by":"auto","created_at":"2024-12-09 13:24:40","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":55329,"visible":true,"origin":"","legend":"\u003cp\u003eNumber of admissions by age during 2009-2022\u003c/p\u003e","description":"","filename":"Fig2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5147493/v1/f464978b372a8c25473e31f3.jpg"},{"id":70948147,"identity":"0930d9ed-7bde-4fbf-aff4-c80f6b25b12e","added_by":"auto","created_at":"2024-12-09 13:16:40","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":44203,"visible":true,"origin":"","legend":"\u003cp\u003eNumber of admissions per etiology of burns among age groups during 2009-2022\u003c/p\u003e","description":"","filename":"Fig3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5147493/v1/7b9400f24cdc4b543b312fbe.jpg"},{"id":70948153,"identity":"04efa626-9956-459e-8af2-28d2cd0609c4","added_by":"auto","created_at":"2024-12-09 13:16:41","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":160409,"visible":true,"origin":"","legend":"\u003cp\u003eEtiology of burns of all admissions during 2009-2022\u003c/p\u003e","description":"","filename":"Fig4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5147493/v1/75bca1281e3ae7308e6180af.jpg"},{"id":70948148,"identity":"1772b058-13c4-4928-9139-c762474981f3","added_by":"auto","created_at":"2024-12-09 13:16:40","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":209377,"visible":true,"origin":"","legend":"\u003cp\u003eYearly number of admissions per site of the accident during 2009-2022\u003c/p\u003e","description":"","filename":"Fig5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5147493/v1/b42ab5c6da8ac4ad2d2c643b.jpg"},{"id":70949264,"identity":"7a9bc7f8-2ecd-487b-912f-786d7bebf3ec","added_by":"auto","created_at":"2024-12-09 13:24:40","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":129093,"visible":true,"origin":"","legend":"\u003cp\u003eMedian TBSA (%) over the years for all admissions (blue), overnight admissions (orange) and day admissions (grey)\u003c/p\u003e","description":"","filename":"Fig6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5147493/v1/eff87d835e14365f6c6e7bd0.jpg"},{"id":70949555,"identity":"8a5c5b23-8362-414c-9165-5b61030e461b","added_by":"auto","created_at":"2024-12-09 13:32:40","extension":"jpg","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":165218,"visible":true,"origin":"","legend":"\u003cp\u003eAbsolute number of children admitted with a TBSA \u0026gt;10% (orange) and percentage of children admitted with a TBSA \u0026gt;10% relative to all admissions (yellow)\u003c/p\u003e","description":"","filename":"Fig7.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5147493/v1/72e7b8b72c207a20c07d6673.jpg"},{"id":70948152,"identity":"f6bc594c-f5c1-4c29-b641-df9247ab0571","added_by":"auto","created_at":"2024-12-09 13:16:40","extension":"jpg","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":130731,"visible":true,"origin":"","legend":"\u003cp\u003eCourse of length of stay in days per percentage total burned surface area (TBSA) for all admissions over the years\u003c/p\u003e","description":"","filename":"Fig8.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5147493/v1/eef0f8398f1fb4b1d499bead.jpg"},{"id":73093158,"identity":"a062d4ad-d346-48da-9e89-da2e96be07ec","added_by":"auto","created_at":"2025-01-06 16:08:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2004347,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5147493/v1/2e6c07f6-d138-4c3d-a82d-8cf5ec7f4d86.pdf"},{"id":70948155,"identity":"37ffc26a-50c4-4237-98de-b16c5c5d3560","added_by":"auto","created_at":"2024-12-09 13:16:41","extension":"docx","order_by":11,"title":"","display":"","copyAsset":false,"role":"supplement","size":55235,"visible":true,"origin":"","legend":"","description":"","filename":"KemmeSupplementarytables.docx","url":"https://assets-eu.researchsquare.com/files/rs-5147493/v1/776ca9f267589202ec7f5b0e.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Trends and epidemiology of children treated in specialized burn centers in the Netherlands between 2009 and 2022","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eInsights in the epidemiology and trends in pediatric burns are of great value to identify patterns, to design prevention programs, to advance medical research and to improve pediatric burn care. This has most often been studied on a national level[\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5 CR6 CR7 CR8 CR9\" citationid=\"CR74\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e10\u003c/span\u003e] or within single centers [\u003cspan additionalcitationids=\"CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19 CR20 CR21\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Besides studies on burns in all age groups, there has also been attention for epidemiology and trends of burn injuries specifically in children. Although there have been multiple studies on epidemiology and trends of pediatric burns, data regarding pediatric global burn trends is inconsistent and often derived from studies limited to single centers or specific countries [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan additionalcitationids=\"CR24 CR25 CR26 CR27 CR28\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. The World Health Organization (WHO) recently published an article about trends in pediatric burns in 20 (predominantly middle-income) countries, highlighting the significant burden of pediatric burn injuries globally, especially among young children aged 1\u0026ndash;5 years, who mainly present with scald burns [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. This aligns with findings from numerous other studies [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the Netherlands there are three dedicated burn centers, located in Beverwijk, Rotterdam, and Groningen. The most recent trend analysis of pediatric admissions to these centers dates from 2011, covering the years 1995\u0026ndash;2007 [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. They observed that the number of average yearly admissions had increased from 1995 to 2007 by 44% among all ages. Moreover, a shift in burn care towards more admissions in specialized burn care was seen, especially regarding young children with less severe burns. This was probably the result of the implementation of the Emergency Management of Severe Burns (EMSB) guidelines in 1998 which included stricter referral criteria (Supplementary Table\u0026nbsp;1) [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. More recently, van Zoonen et al studied severe burns in children under five years old in the Dutch burn centers, however, this study was focused on the etiology and risk factors in this group [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study aims to describe the epidemiology and trends of pediatric burn admissions to the three Dutch burn centers from 2009 to 2022, with regards to the number of admissions, patient- and burn characteristics and outcomes. A secondary objective of this study is to evaluate the potential influence of the COVID-19 pandemic.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign\u003c/h2\u003e \u003cp\u003eThis register-based cohort study was performed using data from the Dutch Burn Repository R3 (DBR-R3) which since 2009 is the uniform clinical registry of the three burn centers. Approval by a Medical Research Ethics Committee was not required according to the Dutch Medical Research with Human Subjects Law. The local institutional review boards of the Red Cross Hospital, Maasstad Hospital, and Martini Hospital approved this study. The Medical Research Ethics Committees United and the Medical Ethics Review Committee of the Amsterdam University Medical Centers ruled that the Medical Research Involving Human Subjects Act (WMO) was not applicable to the current study (AW24.031/W19.140 and 2022\u0026thinsp;\u0026minus;\u0026thinsp;0683, respectively).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy population\u003c/h3\u003e\n\u003cp\u003eAll children up to 18 years of age at the time of the burn injury, admitted to one of the three Dutch burn centers for at least 2 hours between 1 January 2009 to 31 December 2022, were included in this study.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eThe DBR-R3 is a prospective clinical registry including all patients treated in one of the three dedicated burn centers in the Netherlands (Red Cross Hospital, Beverwijk; Maasstad Hospital, Rotterdam; Martini Hospital, Groningen). The registry includes information on patient, burn injury, treatment characteristics, and clinical outcomes. For children who were also treated in a specialized Pediatric Intensive Care Unit (PICU) in one of the University Medical Centers (UMC) affiliated to the burn centers, additional data on the PICU admission was collected from the medical records. This group was identified through burn center medical record screening of children with a TBSA\u0026thinsp;\u0026ge;\u0026thinsp;10%, children who were mechanically ventilated, those with a UMC referral, and those transferred to the burn centers by ambulance helicopter or air medical services.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData were analyzed in SPSS\u0026reg; software version 25.0. Descriptive statistics were used to report on the study parameters. Categorical and continuous data were represented using the mean, standard deviation (SD) or frequency (%). The median and interquartile range (IQR) were presented for data that were not normally distributed. We analyzed the absolute number of pediatric admissions in the three burn centers per calendar year. The incidence of pediatric burn center admissions was calculated by the yearly number of pediatric admissions to the burn centers, divided by the population at risk (total number of children aged 0\u0026ndash;17 in the Netherlands) on January 1st in that year. The data on the population was derived from the population\u0026rsquo;s statistics available on StatLine, Statistics Netherlands [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Since all patients admitted for at least two hours are included in the DBR-R3 database, we differentiated two types of admissions for the analysis: those admitted for \u0026lt;\u0026thinsp;1 day (outpatients), and those admitted for at least one night (inpatients). The two groups together will be referred to as \u0026lsquo;all admissions\u0026rsquo;. Additionally, patients were divided into four age groups (0\u0026ndash;3 years, 4\u0026ndash;9 years, 10\u0026ndash;14 years, and 15\u0026ndash;17 years) to account for the varying etiology of burns within these age groups [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Since children in the Netherlands typically go to school from 4 years old, we focused on differences between before and after this age. Moreover, we differentiated between pre-teenagers (aged 4\u0026ndash;9 years), young teenagers (aged 10\u0026ndash;14 years) and old teenagers (aged 15\u0026ndash;17 years). Etiology of burns were categorized as follows: scald, flame and fire, contact, fat, firework, other (including electricity and chemical burns) and burns with unknown etiology. Surgical treatment was defined as surgery, aimed at primary wound closure, during an acute admission or readmission. Length of stay (LOS) was defined as the length of admission in days from the date of admission to the date of discharge. LOS per percentage Total Burned Surface Area (TBSA) was calculated by dividing the length of stay by the percentage TBSA for each patient, and subsequently calculating the median of the LOS/%TBSA per year. Length of stay and length of stay per percentage TBSA was calculated for inpatients only.\u003c/p\u003e \u003cp\u003eThe potential impact of the COVID-19 period was analyzed by comparing the data of 2020 and 2021 against the pooled results from 2017, 2018 and 2019. The results of 2017 to 2019 remained relatively consistent, allowing for the use of average results of these years. In March 2022, the remaining COVID restrictions expired. Therefore, 2022 was considered a normal year for this study.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eFrom 2009 to 2022, 4017 patients admitted to one of the three burn centers were registered in the DBR-R3. Of those patients, 932 (23%) were outpatients and 3085 (77%) were inpatients. The incidence of admissions of pediatric patients to the burn centers slightly increased from 7.1 in 2009 to 9.6 in 2022 (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The yearly absolute number of admissions showed a rising trend from 2009 to 2016, increasing from 249 to 302. From 2016 onwards, the number of inpatients decreased from 268 to 156, while the number of outpatients increased from 34 in 2016 to 144 in 2022 (311%).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient and burn characteristics from all admissions (n\u0026thinsp;=\u0026thinsp;4017), inpatients (n\u0026thinsp;=\u0026thinsp;3085) and outpatients (n\u0026thinsp;=\u0026thinsp;932) from 2009 to 2022\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e2009\u0026ndash;2022\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAll admissions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eInpatients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eOutpatients\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;4017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;3085\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;932\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSex\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoys\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2385\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e59\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1820\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e59\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e565\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e61\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGirls\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1632\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e41\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1265\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e41\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e367\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e39\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAge (years)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2623\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e65\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e68\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e512\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e55\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u0026ndash;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e584\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e15\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e430\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e14\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e17\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u0026ndash;14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e487\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e12\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e326\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e11\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e17\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e323\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e11\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eEtiology\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScald\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2810\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e70\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2282\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e74\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e528\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e57\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFlame and flash burn\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e504\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e13\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e399\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e13\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e11\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eContact\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e226\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e12\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirework\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElectricity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChemical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSite of accident\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn/around the house\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1894\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e47\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1458\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e47\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e436\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e47\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKitchen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1086\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e27\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e881\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e29\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e205\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e22\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutside\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e227\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e181\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePublic road\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e211\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e9\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBathroom\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCampsite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCatering industry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBusiness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealthcare institution\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOpen water\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychiatric institution\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eReferral\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDutch hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2452\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e62\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1950\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e64\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e502\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e55\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral Practitioner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e626\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e16\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e378\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e12\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e27\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e112 (ambulance/MMT)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e497\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e12\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e440\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e14\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf referral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eForeign hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther burn center\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e198\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eTBSA\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eNA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eNA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eNA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;10%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3708\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e92\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2784\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e90\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e924\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e99\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;10%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e309\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e10\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003e*\u003c/sup\u003ePercentages may not sum to 100% due to rounding differences.\u003c/p\u003e \u003cp\u003eMMT: Mobile Medical Team\u003c/p\u003e \u003cp\u003eMissing values: site of the accident; all admissions n\u0026thinsp;=\u0026thinsp;20 (1%), inpatients n\u0026thinsp;=\u0026thinsp;6 (\u0026lt;\u0026thinsp;1%), outpatients n\u0026thinsp;=\u0026thinsp;14 (2%)\u003c/p\u003e \u003cp\u003eMissing values: referral; all admissions n\u0026thinsp;=\u0026thinsp;33 (1%), inpatients n\u0026thinsp;=\u0026thinsp;19 (1%), outpatients n\u0026thinsp;=\u0026thinsp;14 (2%)\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePatient and burn characteristics\u003c/h2\u003e \u003cp\u003ePatient and burn characteristics are displayed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The highest number of admissions for burn injuries each year occurred among children aged 0\u0026ndash;3 years (mean 65% of all admissions), with a clear peak among one year old children (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The majority of all admitted burn patients were boys (59%). The boy to girl ratio remained fairly stable over time.\u003c/p\u003e \u003cp\u003eScalds accounted for the majority (70%) of burns in all admissions over the study period. The etiology of burns by age group are displayed in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The ratio of scalds decreased with age, representing 88% of the cases of 0\u0026ndash;3 years, 57% of the cases of 4\u0026ndash;9 years and 31% of the cases of 10\u0026ndash;14 years (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Flame and flash burns were the primary cause in older children and were more common as age increases, accounting for 39% of the cases among 10\u0026ndash;14 years old and 47% among 15\u0026ndash;17 years old children. Contact burns, often from scooter exhausts, constituted 11% of the burns in the oldest age group. Overall, no notable changes in etiology were observed over the years (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eApproximately a quarter (27%) of the accidents occurred specifically in the kitchen and almost half of all burns (47%) occurred elsewhere in or around the house. Over the years, there was a slight decrease in accidents occurring in or around the house from a mean of 52% in 2009\u0026ndash;2015 to 43% in 2016\u0026ndash;2022. The distribution of other sites of the accidents remained consistent over the years (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). The majority (62%) of the patients were referred from another hospital within the country, followed by referral by a general practitioner (16%) or directly referred through the emergency number 112 (12%). This referral pattern remained consistent over the years.\u003c/p\u003e \u003cp\u003eThe course of the %TBSA over the years is displayed in Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e. The median TBSA of all admitted children changed from 4.0% (IQR 5.0; range 0.1\u0026ndash;65.0) in 2009 to 3.0% (IQR 4.5; range 0.1\u0026ndash;56.0) in 2022. For inpatients, the median TBSA increased from 4.0% (IQR: 4.5) in 2009 to 5.0% (IQR: 4.2) in 2022 (range 4.0\u0026ndash;5.5), whereas the median TBSA for outpatients remained relatively stable around 1.5% (IQR range 1.5\u0026ndash;3.0, median range 1.0\u0026ndash;2.5). Among inpatients, children aged 0\u0026ndash;3 years had the highest median TBSA with 4.5%, while children aged 10\u0026ndash;14 years had the lowest median TBSA with 3.5%. Throughout the study period, the percentage of children admitted with a TBSA\u0026thinsp;\u0026gt;\u0026thinsp;10% variated around 10% of all admissions per year (range 6.5\u0026ndash;16.7%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eIntensive Care\u003c/h3\u003e\n\u003cp\u003eA total of 77 patients required admission at a Pediatric Intensive Care Unit (PICU) affiliated to the burn centers. This group consisted of 48 boys and 29 girls with a median age of 2 years. The median TBSA was 18.9% (range 0\u0026ndash;60%). The three most common causes of the burns were scalds (49%), flame (22%) and flash (12%) burns. The median length of stay at a PICU was 2 nights, and the median duration of mechanical ventilation was 2 days.\u003c/p\u003e\n\u003ch3\u003eSurgical treatment\u003c/h3\u003e\n\u003cp\u003eOverall, 27% of all children admitted to a burn center during 2009\u0026ndash;2022, required surgery for wound closure (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The percentage of children requiring surgery over the years varied around an average of 27%, with a minimum of 22% in 2014 and a maximum of 34% in 2021. Most of the operated children (84%) underwent one surgical procedure. Children undergoing multiple surgeries had a higher median TBSA, as it was 3% for children undergoing one, 8% for two, 9.9% for three and 26% for more than three surgeries. The median TBSA of non-operated children was 3.8%. For children admitted with a TBSA \u0026le;10%, 24% required surgery, of which 90% a single time. For admissions with a TBSA\u0026thinsp;\u0026gt;\u0026thinsp;10%, 61% required surgery, of which 58% one operation and 42% multiple operations for wound closure.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOutcomes of all pediatric burn patients at the Dutch burn centers from 2009 to 2022\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e2009\u0026ndash;2022\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAll admissions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eInpatients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eOutpatients\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;4017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;3085\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;932\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eLength of stay (days)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eNA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eNA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eNA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLOS per % TBSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eNA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eNA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eNA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSurgical intervention\u003c/em\u003e\u003csup\u003e\u003cem\u003e**\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2928\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e73\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2342\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e76\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e586\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e63\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e917\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e23\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e593\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e19\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e324\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e35\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 surgeries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3 surgeries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;4 surgeries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eDischarge destination\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3898\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e97\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2986\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e97\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e912\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e99\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther burn center\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRehabilitation center\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eDeceased\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003e*\u003c/sup\u003ePercentages may not sum to 100% due to rounding differences.\u003c/p\u003e \u003cp\u003e \u003csup\u003e**\u003c/sup\u003eSurgeries displayed in this table do only include surgeries during acute admission and do not include surgical reconstructions\u003c/p\u003e \u003cp\u003e \u003csup\u003e***\u003c/sup\u003eIncluding psychiatric institution, nursery home and others\u003c/p\u003e \u003cp\u003eMissing values: discharge destination; all admissions n\u0026thinsp;=\u0026thinsp;18 (\u0026lt;\u0026thinsp;1%), inpatients n\u0026thinsp;=\u0026thinsp;11 (\u0026lt;\u0026thinsp;1%), outpatients n\u0026thinsp;=\u0026thinsp;7 (1%)\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eLength of hospital stay, mortality, and discharge\u003c/h2\u003e \u003cp\u003eFrom 2009 to 2022, the median length of stay (LOS) of all admissions decreased from 4 days to 1 day, and for inpatients from 5 to 4 days. The LOS/TBSA for inpatients is displayed in Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003e and decreased from 1.2 in 2009 to 0.8 in 2022. Two patients died after having sustained extensive burns due to a house fire.\u003c/p\u003e \u003cp\u003eFollowing admission, almost all (97%) of the patients were discharged home. Of the remaining 3%, approximately half of the patients were transferred to another hospital, a smaller group to another burn center, and a few to a rehabilitation center.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eThe COVID-19 pandemic\u003c/h2\u003e \u003cp\u003eComparisons between 2017\u0026ndash;2019 (pre-COVID-19) and 2020\u0026ndash;2021 (COVID-19 era) are displayed in Supplementary Table\u0026nbsp;2. During the COVID years, the total number of admissions remained stable around 300. However, the number of inpatient admissions dropped from 237 pre-COVID to 171 in 2020 and 126 in 2021, implying a 37% decrease from pre-COVID to 2021. The number of day admissions increased from 62 pre-COVID to 130 in 2020 and 153 in 2021, implicating an increase of 147% from pre-COVID to 2021.\u003c/p\u003e \u003cp\u003eThere were no differences in the distribution of gender, age and burn etiology in 2020\u0026ndash;2021 compared to 2017\u0026ndash;2019. The median TBSA of all admitted children during COVID changed from 3.8\u0026ndash;3.0%. For inpatients, the median TBSA changed from 4.7\u0026ndash;5.5% and for outpatients, the median TBSA remained stable around 1.5%.\u003c/p\u003e \u003cp\u003eOutcomes of patients admitted to a burn center during the COVID years are displayed in Supplementary Table\u0026nbsp;3. For the inpatient group, the median length of stay increased from 4 to 5 days. The LOS/TBSA slightly decreased from 1.0 in 2017\u0026ndash;2019 to 0.8 in 2021. Operative intervention was required in 27% of all admitted patients during 2017\u0026ndash;2019, 23% in 2020 and 34% in 2021. Both for the inpatient and outpatient group, we observed a decrease in surgeries in 2020, followed by an increase in 2021. Almost all children (98%) were discharged home, as they were before the COVID-period.\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe aim of this study was to describe the trends and epidemiology of pediatric burn admissions to the Dutch burn centers during 2009\u0026ndash;2022. Secondly, the influence of the COVID-19 pandemic in 2020\u0026ndash;2021 was analyzed by comparing with the average results of 2017\u0026ndash;2019. A slight increase in admissions of pediatric burn patients to a burn center was noticed from 2009 to 2022. We observed persisted high numbers of young children (0\u0026ndash;3 years old) in the 14 years. Our findings highlight a shift in pediatric burn admissions over the years, characterized by a consistent pattern towards shorter lengths of admissions and more day admissions. This trend intensified during the COVID-19 period, as the number of day admissions exceeds the number of inpatient admissions for the first time in 14 years. Patient- and burn characteristics remained consistent during the entire study period, including the COVID-pandemic period.\u003c/p\u003e \u003cp\u003eThe absolute number of pediatric burn admissions to the burn centers has slightly increased from 2009 to 2016. After 2016, the total number of admissions remained stable, but the number of outpatients increased, while the number of inpatients decreased. In 2021, the number of outpatients surpasses the number of inpatients for the first time. As Vloemans already described in 2011, both the proportion and the incidence of pediatric burn related admissions to a Dutch burn center is increasing since 2000, thus suggesting a shift in pediatric burn care towards a greater volume of admissions, of particularly children with less severe burns, in specialized burn centers [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. This course appeared to have been continued since we observed that the incidence of pediatric burn admissions in the burn centers increased from 2009 to 2022. A recent study from Switzerland found a similar increasing incidence in their pediatric burn center, which the authors attributed to centralization of burn treatment [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn most European countries, the incidence of pediatric burns in most European countries is continuously decreasing [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan additionalcitationids=\"CR24 CR25 CR26\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Other countries observed an increase [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. These differences in trends may be true but may also be due to differences in the source of the data, the setting of the study and national burn care regulation. In the Netherlands, national data on pediatric burns in hospitals, emergency departments and general practitioners are structured and published separately which hinders direct comparison with our data. Therefore, it is unknown whether the incidence of pediatric burns in the Netherlands is increasing, decreasing, or remaining stable.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003ePatient and burn characteristics\u003c/h2\u003e \u003cp\u003ePatient- and burn characteristics remained consistent over the past decade. Boys are most frequently affected and most of the burns occurred among children aged 0\u0026ndash;3 years. Scalds remain the most common cause of burns in children from 0 to 9 years old. In patients from 10 years old, flame/flash burns were most common, a trend possibly influenced by the media targeting adolescent males and portraying flames and high-risk behavior as cool and consequence free [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Also, the male predominance of burns reflects higher risk activity among older boys [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. The pattern of causes of injury aligns with the pattern described in other countries, as well as the preceding years in the Netherlands [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Notably, in a developed country like the Netherlands, the incidence of scald burns among young children remains persistently high. This is particularly remarkable in an era with parents closely supervising their children and minimizing exposure to risky situations. It underscores the need for renewed focus in burn prevention programs, particularly aimed at protecting the youngest and most vulnerable age groups from scald injuries.\u003c/p\u003e \u003cp\u003eThe house remains the most common site of the accident, with almost half of the children being injured in or around the house, and approximately a quarter of the children specifically in the kitchen. While Vloemans et al. described a significant decrease in accidents in and around the house during 2000\u0026ndash;2007 [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], we did not observe this decrease in our data.\u003c/p\u003e \u003cp\u003e The reduction in median percentage TBSA was already described years ago, following the implementation of the EMSB guidelines in 1998 (Supplementary Table\u0026nbsp;1). With the minimum TBSA for referral to a specialized burn center lowered from 10\u0026ndash;5%, more children with less severe burn wounds are admitted [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Given the general trend towards more day admissions in hospitals in the Netherlands, with a threefold increase in day-admissions from 1998 to 2007 [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e], and a similar increase observed in our burn centers, more patients with slightly smaller burns are treated in daycare. Consequently, we observed an increase in the median TBSA for the inpatient group from 4% in 2009 to 5% in 2022.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eLength of hospital stay\u003c/h2\u003e \u003cp\u003eThe median length of stay for all admissions and inpatients decreased over time. The reduction in length of stay in the Netherlands was already described in 2011 and is in line with trends in other developed countries [\u003cspan additionalcitationids=\"CR45\" citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. This reduction may be the result of higher admission rates of children with smaller burns, the expansion of outpatient facilities and \u0026ndash; possibly because of the aforementioned factors \u0026ndash; an increase in day admissions [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Following more day admissions, we observed we observed a slight decrease in the median TBSA. Globally, outpatient care has become increasingly important, as the shift towards more day admissions is not only observed in The Netherlands, but also in the United States[\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e] and Australia [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. This general trend of hospitalizing patients shorter is for example also seen in pediatric patients treated for acute appendicitis. In the past, patients would be hospitalized for days or weeks, whereas surgeries are now frequently performed in daycare [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Following less severe burns and shorter admissions, LOS/%TBSA decreased from 1.2 to 0.8 days during the study period, implicating that children are nowadays hospitalized shorter per %TBSA affected, compared to 2009. In other developed countries, a similar reduction in LOS/%TBSA is seen, reducing from 5 to 3 days in the United States[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] and from 4.6 to 2.5 in Switzerland [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eMortality\u003c/h2\u003e \u003cp\u003eWorldwide, burn-related mortality has been decreasing for years [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. This decrease is also observed among pediatric burns specifically [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] with a decrease by as much as 36% globally in the past decade [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe mortality rate of pediatric patients admitted to a burn center in the Netherlands was 0.05% (n\u0026thinsp;=\u0026thinsp;2) compared to 0.6% (n\u0026thinsp;=\u0026thinsp;16) in the latest study on pediatric burns in these centers [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePediatric patients with severe burns (mostly children with a TBSA\u0026thinsp;\u0026gt;\u0026thinsp;20%) require admission to the PICU. Since none of the three burn centers have their own PICU, these children are often primarily admitted to one of the PICUs affiliated to the burn center, in the university hospitals in the region of the burn center. If they died in the PICU, they will not be registered in the DBR-R3, which potentially leads to an underestimation of our mortality data. Also, these numbers alone do not allow for a conclusion regarding trends in mortality; the absolute numbers are low, and minor variations can create misleading impressions. Additionally, impactful events, such as the Volendam cafe fire in 2001, with high numbers of burn victims and many deaths, influenced the previously reported high mortality rates [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. A more relevant approach would be to examine the percentage of mortality within specific subpopulations, such as those with \u0026gt;\u0026thinsp;20% TBSA. This can be used as an outcome indicator to evaluate the quality of burn care. As many countries do not yet have a national registration system for hospitalized burn patients, data on epidemiology and mortality is heterogenous [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. The Global Burn Registry (GBR), established in 2018, is an important step towards uniform global burn registration [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Recently, a comparison was conducted on burn registries globally and the authors recommended the development of common data elements used in an international minimum data set as the next step in achieving burn register data sharing [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eThe COVID-19 pandemic\u003c/h2\u003e \u003cp\u003eBoth 2020 and 2021 were marked by several social and environmental restrictions and periods of lockdowns. The incidence of pediatric burns in the Dutch emergency departments decreased from 46 in 2019 to 39 in 2021 [\u003cspan additionalcitationids=\"CR56\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]. In the burn centers, the number of inpatients decreased significantly during the COVID-pandemic, while the total number of admissions remained relatively stable. The decrease in inpatients is most likely the result of the intensified shift towards more day admissions during COVID, a shift which already started years before. This decrease in inpatients during COVID was also observed in a burn center in the United Kingdom [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe impact of the COVID-19 pandemic on pediatric burn admissions differs globally. In line with our results, a decreased number of pediatric burn admissions was observed during the pandemic in a burn center in Romania [\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]. Controversially, burn centers in the United States [\u003cspan additionalcitationids=\"CR61 CR62\" citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e], Australia [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] and Spain [\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e] noticed an increase in pediatric burn patients admitted. Others burn centers in the United States, as well as in Israel, found no significant increase or decrease regarding pediatric burn admissions during COVID [\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e]. The contradicting results may be the result of differences in study settings: targeted population, study design, variance in health care systems, and the presence or absence of stay-at-home order [\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e]. The literature describes contradicting explanations for the changes in pediatric burn admissions during the COVID period. Increased incidence was often attributed to the heightened risk of injury for children during lockdowns as most burn injuries occur at home [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e], and as parents were also concomitantly working from home, they may have not been able to directly supervise their children\u0026rsquo;s activities [\u003cspan additionalcitationids=\"CR69\" citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e]. However, as we observed a decrease in pediatric burn admissions during COVID, one could consider the ability of parents to supervise their children more as they were working from home, as a possible explanation for a decrease. This underscores the importance of behavioral factors that may influence injury rates besides statistical trends. Insights into this are valuable for preventive measures.\u003c/p\u003e \u003cp\u003eWe identified no changes in male-to-female ratio and age distribution. Length of stay did not change during the pandemic, in line with results from Australia [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], but in contrast with shorter length of stays in the United Kingdom [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e] and longer length of stays in Canada [\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e], specifically during the lockdown period. The trend of shorter lengths of stays and more day admissions that we observed since 2016 intensified during the COVID-pandemic. After the COVID-pandemic, the incidence of pediatric burns in the Dutch ED rises to 49 per 100.000 in 2022, indicating a return to pre-COVID levels [\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study has several limitations. Firstly, the database DBR-R3 has undergone several updates over the years, such as more categories used to classify the site of the accident and the etiology of the burn wound, compared to years ago. This makes exact comparisons with previous epidemiologic studies difficult. However, it is important to recognize that the data collection process and the patient population have remained consistent over years. This ensures reliability and validity of the study findings. As small changes in the registration can complicate detailed trend analysis, we refrained from analyzing these detailed changes over time, to maintain consistency and avoid potential biases.\u003c/p\u003e \u003cp\u003eSecondly, comparison of data on pediatric burns with national data is complicated due to the differences in registration.\u003c/p\u003e \u003cp\u003eLastly, as this concerns a study based on a registry of electronic patient record data, there is missing data. However, given that the amount of missing data was very small (max. 2%), the impact on results is considered negligible.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eOur study provides a comprehensive overview of the epidemiology and trends of pediatric burn admissions in The Netherlands over the past 14 years. We observed an increased number of pediatric patients admitted to a Dutch burn center. Over the years, admissions are shorter per percentage TBSA and there has been a shift towards more day admissions. Burns among young children (0\u0026ndash;3 years old) remain a significant problem. Overall, the Netherlands is a relatively safe country with low rates of severely burned children. Burn care in the Netherlands is exceptionally well-organized, with a nationwide alliance of three verified burn centers and affiliated intensive care units in Amsterdam, Rotterdam and Groningen. This network ensures that high quality specialized care for burn patients is available, a level of organization and accessibility which is outstanding worldwide. Targeted prevention campaigns and specialized burn care for children in the Netherlands remains necessary. Frequent research on trends in pediatric burns is crucial for prevention programs, research and innovation, quality improvement, forecasting healthcare demands, and resource allocation.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eDBR-R3\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eDutch Burn Repository R3\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEBA\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003eEuropean Burns Association\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eED\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eEmergency Department\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEMSB\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eEmergency Management of Severe Burns\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGBR\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Global Burn Registry\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIQR\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eInterquartile Range\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLOS\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003eLength of Stay\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMMT\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Mobile Medical Team\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNA\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Not Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePICU\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003ePediatric Intensive Care Unit\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTBSA\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003eTotal Burned Surface Area\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUMC\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eUniversity Medical Center\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWHO\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003eWorld Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDutch Burns Foundation Beverwijk, Red Cross Hospital Beverwijk, Martini Hospital Groningen, and Maasstad Hospital Rotterdam for their support. H.C.W. Hofland and A.S. Niemeijer for aiding in medical record data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis work was financially supported by the Dutch Burns Foundation but did not receive a specific grant.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u0026nbsp;\u003c/strong\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u0026nbsp;\u003c/strong\u003eAnouk Pijpe, Eline L van den Berg, Margriet E van Baar, Paul PM van Zuijlen, Eelke Bosma and Cees H van der Vlies contributed to the study conception and design. Material preparation and data collection was performed by the Burn Repository R3 group, Frederique M Kemme, Eline L van den Berg, Rolf K Gigengack, Margriet E van Baar, Marianne K Nieuwenhuis and Anouk Pijpe. Analysis was performed by Frederique M Kemme, Eline L van den Berg, Annebeth Meij-de Vries and Anouk Pijpe. The first draft of the manuscript was written by Frederique M Kemme and all authors critically reviewed several draft versions of the manuscript and provided commentary. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval:\u0026nbsp;\u003c/strong\u003eApproval by a Medical Research Ethics Committee was not required according to the Dutch Medical Research with Human Subjects Law. The local institutional review boards of the Red Cross Hospital, Maasstad Hospital, and Martini Hospital approved this study. The Medical Research Ethics Committees United and the Medical Ethics Review Committee of the Amsterdam University Medical Centers ruled that the Medical Research Involving Human Subjects Act (WMO) was not applicable to the current study (AW24.031/W19.140 and 2022-0683, respectively).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003cp\u003e\u003cb\u003eConsent to publish:\u0026nbsp;\u003c/b\u003e Not applicable.\u003c/p\u003e\u003cp\u003e\u003cem\u003eDutch Burn Repository group\u003c/em\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eBurn Center Beverwijk: A Boekelaar\u003csup\u003e1\u003c/sup\u003e, A Pijpe\u003csup\u003e1-3\u003c/sup\u003e, D Roodbergen\u003csup\u003e1\u003c/sup\u003e, MM Stoop\u003csup\u003e1\u003c/sup\u003e, PPM van Zuijlen\u003csup\u003e1-3, 5, 14\u003c/sup\u003e\u003c/li\u003e\n \u003cli\u003eBurn Center Rotterdam: A van Es\u003csup\u003e9\u003c/sup\u003e, M Heijblom-van Dinteren\u003csup\u003e9\u003c/sup\u003e, Y Lucas\u003csup\u003e9\u003c/sup\u003e, CH van der Vlies\u003csup\u003e6, 9, 15\u003c/sup\u003e\u003c/li\u003e\n \u003cli\u003eBurn Center Groningen: E Bosma\u003csup\u003e11\u003c/sup\u003e, H Eshuis\u003csup\u003e11\u003c/sup\u003e, SMHJ Scholten-Jaegers\u003csup\u003e11\u003c/sup\u003e\u003c/li\u003e\n \u003cli\u003eAssociation of Dutch Burn Centers: ME van Baar\u003csup\u003e9,10\u003c/sup\u003e, L van Dammen\u003csup\u003e16\u003c/sup\u003e, E Middelkoop\u003csup\u003e16\u003c/sup\u003e, MK Nieuwenhuis\u003csup\u003e11-13\u003c/sup\u003e, A Novin\u003csup\u003e16\u003c/sup\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003col\u003e\n \u003cli\u003eAlliance of Dutch Burn Care, Burn Center, Red Cross Hospital, Beverwijk, the Netherlands;\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAmsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic Reconstructive and Hand Surgery, Amsterdam, the Netherlands;\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAmsterdam Movement Sciences,\u0026nbsp;Tissue Function and Regeneration,\u0026nbsp;Amsterdam, the Netherlands.\u003c/li\u003e\n \u003cli\u003eDepartment of Surgery, Red Cross Hospital, Beverwijk, the Netherlands;\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAmsterdam UMC location University of Amsterdam, Pediatric Surgical Center, Emma Children\u0026rsquo;s Hospital, Amsterdam, the Netherlands.\u003c/li\u003e\n \u003cli\u003eDepartments of Trauma and Burn Surgery, Maasstad Hospital, Rotterdam, the Netherlands.\u003c/li\u003e\n \u003cli\u003eAmsterdam UMC location VU Medical Center, Amsterdam, Department of Intensive Care, Amsterdam, the Netherlands.\u003c/li\u003e\n \u003cli\u003eAmsterdam UMC location VU Medical Center, Amsterdam, Department of Anesthesiology, Amsterdam, the Netherlands.\u003c/li\u003e\n \u003cli\u003eAlliance of Dutch Burn Care, Burn Center, Maasstad Hospital, Rotterdam, the Netherlands;\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eDepartment of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.\u003c/li\u003e\n \u003cli\u003eAlliance of Dutch Burn Care, Burn Center, Martini Hospital, Groningen, the Netherlands;\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eUniversity of Groningen, University Medical Centre Groningen, Department of Human Movement Sciences, Groningen, the Netherlands;\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eHanze University of Applied Sciences, Groningen Research Group Healthy Ageing Allied Health Care and Nursing, Groningen, the Netherlands.\u003c/li\u003e\n \u003cli\u003eDepartment of Plastic Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, the Netherlands.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.\u003c/li\u003e\n \u003cli\u003eAssociation of Dutch Burn Centres, Beverwijk, The Netherlands\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eCrowe CS, Massenburg BB, Morrison SD, et al (2019) Trends of burn injury in the United States 1990 to 2016. 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Journal of Burn Care \u0026amp; Research. https://doi.org/10.1093/jbcr/iraa164\u003c/li\u003e\n \u003cli\u003eWilliams FN, Chrisco L, Nizamani R, King BT (2020) COVID-19 related admissions to a regional burn center: The impact of shelter-in-place mandate. Burns Open 4:158\u0026ndash;159. https://doi.org/10.1016/j.burnso.2020.07.004\u003c/li\u003e\n \u003cli\u003eSanford EL, Zagory J, Blackwell JM, et al (2021) Changes in pediatric trauma during COVID-19 stay-at-home epoch at a tertiary pediatric hospital. J Pediatr Surg 56:918\u0026ndash;922. https://doi.org/10.1016/j.jpedsurg.2021.01.020\u003c/li\u003e\n \u003cli\u003eGeorgeades CM, Collings AT, Farazi M, et al (2023) A Multi-institutional Study Evaluating Pediatric Burn Injuries During the COVID-19 Pandemic. J Burn Care Res 44:399\u0026ndash;407. https://doi.org/10.1093/jbcr/irac118\u003c/li\u003e\n \u003cli\u003eMonte-Soldado A, L\u0026oacute;pez-Masramon B, Rivas-Nicolls D, et al (2022) Changes in the epidemiologic profile of burn patients during the lockdown in Catalonia (Spain): A warning call to strengthen prevention strategies in our community. Burns 48:228\u0026ndash;233. https://doi.org/10.1016/j.burns.2021.03.006\u003c/li\u003e\n \u003cli\u003eCodner JA, De Ayala R, Gayed RM, et al (2021) The Impact of the COVID-19 Pandemic on Burn Admissions at a Major Metropolitan Burn Center. In: Journal of Burn Care and Research. Oxford University Press, pp 1103\u0026ndash;1109\u003c/li\u003e\n \u003cli\u003eKruchevsky D, Arraf M, Levanon S, et al (2021) Trends in Burn Injuries in Northern Israel during the COVID-19 Lockdown. Journal of burn care \u0026amp; research 42:135\u0026ndash;140. https://doi.org/https://doi.org/10.1093/jbcr/iraa154\u003c/li\u003e\n \u003cli\u003eYamamoto R, Sato Y, Matsumura K, Sasaki J (2021) Characteristics of burn injury during COVID-19 pandemic in Tokyo: A descriptive study. Burns Open 5:40\u0026ndash;45. https://doi.org/10.1016/j.burnso.2021.06.007\u003c/li\u003e\n \u003cli\u003eCharvillat O, Plancq MC, Haraux E, et al (2021) Epidemiological analysis of burn injuries in children during the first COVID-19 lockdown, and a comparison with the previous five years. Annales de Chirurgie Plastique Esthetique 66:285\u0026ndash;290. https://doi.org/10.1016/j.anplas.2021.06.001\u003c/li\u003e\n \u003cli\u003eAmin D, Manhan AJ, Mittal R, Abramowicz S (2022) Pediatric head and neck burns increased during early COVID-19 pandemic. Oral Surg Oral Med Oral Pathol Oral Radiol 134:528\u0026ndash;532. https://doi.org/10.1016/j.oooo.2022.03.013\u003c/li\u003e\n \u003cli\u003eKawalec AM (2020) The changes in the number of patients admissions due to burns in Paediatric Trauma Centre in Wroclaw (Poland) in March 2020. Burns 46:1713\u0026ndash;1714. https://doi.org/10.15585/mmwr\u003c/li\u003e\n \u003cli\u003eRogers AD, Cartotto R (2021) The Impact of COVID-19 on Burn Care at a Major Regional Burn Center. Journal of Burn Care and Research 42:110\u0026ndash;111. https://doi.org/10.1093/jbcr/iraa181\u003c/li\u003e\n \u003cli\u003eVeiligheid NL (2023) Letsels 2022. https://www.veiligheid.nl/kennisaanbod/cijferrapportage/letsels-2022-kerncijfers-lis. Accessed 4 Mar 2024\u003c/li\u003e\n \u003cli\u003eThe Education Committee of the Australian and New Zealand Burn Association. (2009) Emergency management of severe burns (EMSB) course manual, Dutch version.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejpe","sideBox":"Learn more about [European Journal of Pediatrics](https://www.springer.com/journal/431)","snPcode":"431","submissionUrl":"https://submission.nature.com/new-submission/431/3","title":"European Journal of Pediatrics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"children, burns, trends, epidemiology, covid-19","lastPublishedDoi":"10.21203/rs.3.rs-5147493/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5147493/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eKnowledge about trends and epidemiology of pediatric burns is useful to identify patterns, to advance medical research, to design prevention programs and resource allocation. The aim of this study is to describe the epidemiology and trends of pediatric burns between 2009\u0026ndash;2022 in the three Dutch burn centers. A secondary objective of this study is to evaluate the influence of the COVID-19 pandemic on the pattern of pediatric burns.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA register-based cohort study was conducted based on data from the Dutch Burn Repository R3. Patients between 0\u0026ndash;17 years at the time of the burn injury admitted between 2009 and 2022 to one of the three burn centers, were included. Descriptive statistics were used to investigate the incidence and patient, burn and treatment characteristics. The COVID-19 pandemic years (2020\u0026ndash;2021) were compared with the pooled results from pre-COVID years (2017\u0026ndash;2019).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 4017 patients were included in this study, of which 3085 (77%) were overnight admissions. The incidence and absolute number of pediatric burn admissions gradually increased over the years, with a small temporary decrease in 2020\u0026ndash;2021. Patient- and burn characteristics remained relatively consistent over the years. Three quarters of all patients were between 0 and 3 years old and the majority were boys (59%). A decreasing ratio of length of stay per % total burned surface area and an increase in day admissions was observed since 2016 onwards, which intensified during the COVID-19 pandemic.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThere was a slight increase in the number of pediatric admissions to the burn centers between 2009 and 2022. Young children (0\u0026ndash;3 years) remain the most frequently affected group. A shorter relative length of stay was observed, as well as an increase in day admissions, which was reinforced by the COVID-19 pandemic.\u003c/p\u003e","manuscriptTitle":"Trends and epidemiology of children treated in specialized burn centers in the Netherlands between 2009 and 2022","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-09 13:16:35","doi":"10.21203/rs.3.rs-5147493/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-18T20:46:59+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-11T03:41:03+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-28T21:16:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"26186762213508482921979103701339916722","date":"2024-10-25T06:23:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"137270837501815397581441235817491807410","date":"2024-10-22T03:52:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"213804326517485211274696843970968865334","date":"2024-10-17T22:45:36+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-10-03T10:02:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-09-30T09:53:56+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-09-30T09:40:07+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Journal of Pediatrics","date":"2024-09-24T20:10:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejpe","sideBox":"Learn more about [European Journal of Pediatrics](https://www.springer.com/journal/431)","snPcode":"431","submissionUrl":"https://submission.nature.com/new-submission/431/3","title":"European Journal of Pediatrics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"0e4c1f64-1c95-4d52-9e11-93ebae59c3dc","owner":[],"postedDate":"December 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-01-06T15:59:07+00:00","versionOfRecord":{"articleIdentity":"rs-5147493","link":"https://doi.org/10.1007/s00431-024-05923-7","journal":{"identity":"european-journal-of-pediatrics","isVorOnly":false,"title":"European Journal of Pediatrics"},"publishedOn":"2025-01-02 15:56:52","publishedOnDateReadable":"January 2nd, 2025"},"versionCreatedAt":"2024-12-09 13:16:35","video":"","vorDoi":"10.1007/s00431-024-05923-7","vorDoiUrl":"https://doi.org/10.1007/s00431-024-05923-7","workflowStages":[]},"version":"v1","identity":"rs-5147493","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5147493","identity":"rs-5147493","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}