Data-Driven Decision Making in Pediatric Burn Management Without a Burn Center: A Four-Year Retrospective Analysis of 520 Patients

Data-Driven Decision Making in Pediatric Burn Management Without a Burn Center: A Four-Year Retrospective Analysis of 520 Patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Data-Driven Decision Making in Pediatric Burn Management Without a Burn Center: A Four-Year Retrospective Analysis of 520 Patients Volkan Altınok, Onur Yalçın, Aybegüm Kalyoncu Ayçenk, Ecem ipek Altınok This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7931564/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 28 Jan, 2026 Read the published version in BMC Pediatrics → Version 1 posted 13 You are reading this latest preprint version Abstract Background Pediatric burn injuries remain a major global health concern, particularly in low- and middle-income countries. Recent advances in wound care technologies have allowed non-surgical (conservative) management to become an increasingly effective option for partial-thickness burns, even in hospitals without specialized burn centers. Methods This retrospective clinical study included 520 pediatric patients (aged 0–18 years) treated between January 2021 and February 2025 at Ordu University Training and Research Hospital, Türkiye. Patients were categorized according to age, burn etiology, and total body surface area (TBSA). Standardized conservative wound care protocols were applied using advanced dressings such as silver-based materials, hyaluronic acid preparations, enzymatic alginogel, antiseptic Tulle Gras, hydrogel sheets, and hemoglobin spray. Clinical outcomes—including healing rate, graft requirement, hospitalization duration, and complication rates—were analyzed statistically. Results The median age was 4.2 years (IQR 2.0–8.1), with 65% of patients aged 0–6 years. Scald burns were the predominant cause (76.2%). TBSA was ≤ 10% in 65% and 11–20% in 35% of cases. The mean hospital stay was 8.5 ± 2.5 days, which was significantly longer in patients with TBSA > 10% (p < 0.001). Conservative management achieved complete healing in 98% of patients, with only 2% requiring grafting. The rates of keloid and contracture formation were 5% and 0.4%, respectively. No mortality was observed. Conclusions Modern conservative burn care yielded excellent outcomes for pediatric patients with TBSA ≤ 20%, with minimal complications and no mortality. These findings highlight the efficacy, safety, and cost-effectiveness of non-surgical burn management and support its wider use in resource-limited settings through standardized care protocols and improved prevention strategies. Trial registration Not applicable. This was a retrospective observational study that did not involve any prospective intervention or randomization. Pediatric burns Conservative treatment Clinical outcomes Figures Figure 1 Figure 2 Background Burn injuries remain a major global public health concern and are among the leading causes of accidental trauma and mortality in the pediatric population. According to the World Health Organization (WHO), more than 180,000 deaths occur each year due to burns, and a significant proportion of these fatalities involve children under the age of five ( 1 ). Children are particularly vulnerable to severe burn injuries because of their limited motor coordination, underdeveloped hazard perception, and dependence on caregivers ( 2 ). Beyond mortality, pediatric burns often result in long-term complications such as hypertrophic scarring, joint contractures, growth retardation, and profound psychosocial morbidity. These sequelae impose substantial economic and social burdens on families and healthcare systems alike ( 3 ). In low- and middle-income countries, the limited availability of dedicated burn units and rehabilitation services further exacerbates these negative outcomes ( 4 ). Over the past decade, advances in wound care technology have brought non-surgical, conservative approaches to the forefront of pediatric burn management. Silver-impregnated dressings, owing to their antimicrobial properties, reduce infection risk while promoting epithelialization and decreasing dressing frequency ( 5 ). Hyaluronic acid (HA)-based preparations modulate inflammation, stimulate granulation tissue formation, and shorten healing time in partial-thickness burns ( 6 ). Enzymatic alginogel formulations provide a moist environment and enable gentle autolytic debridement, serving as a valuable adjunct in burns requiring exudate control ( 7 ). Antiseptic Tulle Gras dressings, composed of paraffin gauze with low adherence, minimize traumatic dressing changes and offer a cost-effective option for superficial and partial-thickness burns ( 8 ). Similarly, hydrogel-based dressings, due to their high water content, exert a soothing and cooling effect on the wound surface, facilitating pain relief and maintaining an optimal moist environment for epithelial regeneration ( 9 ). Purified hemoglobin spray, by enhancing topical oxygen delivery, improves tissue oxygenation and accelerates wound healing. Recent clinical studies have shown that hemoglobin sprays can shorten re-epithelialization time and reduce infection-related complications in chronic wounds and partial-thickness burns ( 10 ). Collectively, these advanced topical therapies reduce the need for extensive surgical intervention and improve uncomplicated healing rates, particularly in children with ≤ 20% total body surface area (TBSA ) involvement. The present study aims to describe the epidemiological profile of pediatric burn cases managed over a five-year period in a tertiary burn care unit in Ordu, Türkiye, and to evaluate the clinical outcomes and effectiveness of modern conservative treatment approaches in this cohort. Materials and Methods Study Design and Setting This retrospective clinical study aimed to evaluate the epidemiological characteristics and treatment outcomes of pediatric burn patients managed with modern conservative methods. The study included children treated between January 2021 and February 2025 at Ordu University Training and Research Hospital, a tertiary referral center in Türkiye. All patients were managed in the Pediatric Surgery Outpatient Clinic and a dedicated burn treatment room. The study protocol was reviewed and approved by the Ordu University Clinical Research Ethics Committee (Approval No: 172, Date: 09.05.2025). Participants and Burn Classification A total of 520 pediatric patients aged 0–18 years who presented with burn injuries were included. Patients were categorized according to age group (0–6, 7–12, and 13–18 years) and burn etiology (scald from hot liquid or food, contact, flame, or electrical burns). The total body surface area (TBSA) was determined using the Lund–Browder chart and classified as TBSA 1–10% or 11–20%. No patient had TBSA exceeding 20%. Patients with incomplete data or major comorbidities were excluded. Treatment Protocol All patients were managed according to a standardized conservative wound care protocol. Wound cleansing was performed with antiseptic solutions containing active chlorine, followed by the application of modern dressing materials. These included silver-based dressings (Atrauman Ag®), hyaluronic acid (HA) preparations (Hyalomatrix®), enzymatic alginogel (Flaminal®), antiseptic Tulle Gras dressings, hydrogel sheets, and purified hemoglobin spray (Granulox®). When clinically indicated, surgical procedures such as debridement, escharotomy, or escharectomy were performed. Split-thickness skin grafting was reserved for cases unresponsive to conservative therapy. Fluid therapy and antibiotic regimens were individualized according to patient age, clinical presentation, and laboratory findings under pediatric supervision. Statistical Analysis All statistical analyses were performed using SPSS version 26.0 (IBM Corp., Armonk, NY, USA). Continuous variables were expressed as mean ± standard deviation (SD) or median with interquartile range (IQR), while categorical variables were presented as frequencies (n) and percentages (%). Comparisons between subgroups defined by age, etiology, and TBSA were conducted using the Chi-square (χ²) or Fisher’s exact test for categorical data, and the independent-samples t-test or Mann–Whitney U test for continuous variables, as appropriate. For graft requirement and complication rates, relative risk (RR) with 95% confidence intervals (CIs) was calculated. A two-tailed p-value < 0.05 was considered statistically significant. Results Demographic and Clinical Characteristics A total of 520 pediatric patients were included. The median age was 4.2 years (IQR 2.0–8.1), and 65% (n = 338) were in the 0–6-year group, 20% (n = 104) in the 7–12-year group, and 15% (n = 78) in the 13–18-year group. There were 301 boys (57.8%) and 219 girls (42.2%), with a male-to-female ratio of 1.4:1 (Table 1 ). Table 1 Demographic and Clinical Characteristics of Pediatric Burn Patients (n = 520) Variable n % Age Groups 0–6 years 338 65.0 7–12 years 104 20.0 13–18 years 78 15.0 Sex Male 301 57.8 Female 219 42.2 Burn Etiology Scald (hot water/food spill) 396 76.2 Contact burn 98 18.9 Flame burn 15 2.9 Electrical burn 11 2.0 Total Body Surface Area (TBSA) 1–10% 338 65.0 11–20% 182 35.0 Hospitalization Status Inpatient 224 43.0 Outpatient follow-up 296 57.0 Mean Length of Stay (days) 8.5 ± 2.5 – Burn Etiology and TBSA Distribution The leading cause of injury was scald burns due to hot liquid or food, affecting 396 patients (76.2%), followed by contact burns (18.9%), flame burns (2.9%), and electrical burns (2.0%). Most patients (338, 65%) had TBSA 1–10%, while 182 patients (35%) had TBSA 11–20%. No patient had TBSA exceeding 20%. Hospitalization was significantly more frequent among patients with TBSA > 10% compared to those with ≤ 10% (56.6% vs 35.2%; p < 0.001). Treatment Modalities and Outcomes Overall, 224 patients (43%) were hospitalized, while 296 (57%) were treated on an outpatient basis. The mean hospital stay was 8.5 ± 2.5 days, significantly longer for patients with TBSA > 10% (9.3 ± 2.1 vs 5.2 ± 1.5 days; p < 0.001) (Table 1 , Fig. 1 ). Among modern wound care modalities, silver-based dressings were used in 22%, hyaluronic acid preparations in 18%, enzymatic alginogel in 16%, antiseptic Tulle Gras dressings in 16%, hydrogel in 15%, and hemoglobin spray in 13% of cases (Fig. 2 ). With these combinations, 98% of patients achieved complete healing without grafting, while only 10 patients (2%) required split-thickness skin grafts. All grafted patients had TBSA > 15% or flame/electrical burns. The need for grafting was significantly higher among patients with TBSA > 15% (RR = 8.5; 95% CI: 3.2–22.3; p 10% (p = 0.04). Only two patients (0.4%) developed contractures, successfully managed with physical therapy. No mortality occurred during the study period (0%; 95% CI: 0–0.7) (Table 2 ). Table 2 Treatment Outcomes and Distribution of Complications in Pediatric Burn Cases Variable n % Treatment Success Healing with conservative treatment 510 98.0 Surgical Intervention Split-thickness skin graft 10 2.0 Complications Local keloid formation 26 5.0 Contracture 2 0.4 Mortality 0 0.0 Discussion In this study, the predominance of the 0–6-year age group (65%) among pediatric burn patients aligns with previous reports emphasizing that younger children are at a higher risk of burn injuries. Consistent with earlier studies from developing countries, domestic scald injuries were the most common cause of burns, highlighting the household as the primary setting for pediatric burn accidents ( 1 – 4 ). In our series, scald burns accounted for 76.2% of all etiologies, a rate comparable to that reported by Dissanaike and Rahimi ( 11 ). A major component of our treatment approach was the use of modern conservative wound care modalities, often in combination. Silver-based dressings (22%), hyaluronic acid preparations (18%), enzymatic alginogel (16%), antiseptic Tulle Gras dressings (16%), hydrogel sheets (15%), and hemoglobin spray (13%) were the most frequently applied. This multimodal strategy achieved complete healing without grafting in 98% of patients, closely corresponding to the 2–4% graft requirement reported by Ball et al. in partial-thickness burns involving < 10% TBSA ( 12 ). Likewise, Mistry et al. found that long-term scar outcomes were comparable between conservative and surgical approaches, reinforcing that appropriate wound management can minimize the need for operative intervention ( 13 ). The low grafting rate (2%) observed in our cohort underscores the efficacy of the implemented conservative protocol and supports the feasibility of non-surgical healing in pediatric burns. Similar findings were shown in meta-analyses of advanced dressings—for example, Nherera et al. demonstrated that nanocrystalline silver dressings accelerate healing time in burns ( 14 ). The significantly higher graft requirement among patients with TBSA > 15% or flame/electrical burns (RR ≈ 8.5; 95% CI: 3.2–22.3; p < 0.01) is consistent with the Chinese Burn Association’s 2023 consensus, which recommends early surgery for deep partial-thickness injuries ( 15 ). As expected, grafting is more likely in deep and extensive burns, emphasizing the need for careful monitoring during conservative management in such cases. An additional advantage of modern conservative methods was the reduction in dressing frequency—patients were often treated every 2–3 days, and in some cases up to a week, without requiring daily changes. This significantly decreased pain during dressing procedures, reduced sedation and anesthetic use, and minimized fasting episodes associated with anesthesia. Thus, conservative management not only proved effective but also child-friendly, an observation consistent with Greenhalgh’s statement that “pain-free, minimally invasive wound care improves recovery in pediatric partial-thickness burns” ( 15 ). The low incidence of keloid and contracture formation (5% and 0.4%, respectively) in our study may reflect the benefits of early wound management, appropriate dressing selection, and systematic follow-up. Previous studies have reported higher rates of hypertrophic scarring (17–30%), particularly in children with healing times exceeding 21 days ( 16 , 17 ). The relatively low TBSA involvement (≤ 20%) and shorter healing duration in our cohort likely explain the lower complication rates observed. This study has several limitations, including its retrospective design, which may have led to missing data, and the lack of long-term cosmetic, functional, and psychosocial assessments. Nevertheless, previous research has established that early wound closure time, TBSA, and burn depth are the most critical determinants of scar quality and long-term outcomes. Future prospective, multicenter studies should therefore focus on objective evaluation of long-term results of conservative treatment protocols. Conclusion Our findings demonstrate that in pediatric patients with TBSA ≤ 20%, modern conservative wound management can achieve excellent healing outcomes without surgical intervention, with minimal complications and no mortality. This underscores the cost-effectiveness and clinical utility of conservative burn care, particularly in resource-limited settings, while also highlighting its humane and child-centered nature. Furthermore, community education, early presentation, and improved healthcare personnel training are essential to further enhance pediatric burn care quality. Abbreviations TBSA Total Body Surface Area WHO World Health Organization HA Hyaluronic Acid RR Relative Risk CI Confidence Interval IQR Interquartile Range SD Standard Deviation SPSS Statistical Package for the Social Sciences Ag Silver (from silver-based dressings) Declarations Ethics approval and consent to participate This study was approved by the Ordu University Clinical Research Ethics Committee (Approval No: 172, Date: 09.05.2025). Written informed consent was waived due to the retrospective design of the study. All procedures were conducted in accordance with the ethical standards of the institutional and national research committees and with the 1964 Helsinki Declaration and its later amendments. Consent for publication Not applicable. This manuscript does not contain any individual person’s data in any form (including individual details, images, or videos). Availability of data and materials The datasets generated and/or analyzed during the current study are not publicly available due to institutional privacy restrictions but are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding The authors received no external funding for this research. Authors’ contributions VA and OY conceptualized the study and supervised patient management. AKA and EA collected and analyzed clinical data. EA performed the statistical analyses and drafted the manuscript. All authors contributed to the interpretation of results, critically revised the manuscript for important intellectual content, and approved the final version. Acknowledgements The authors thank the staff of the Pediatric Surgery Clinic at Ordu University Training and Research Hospital for their contribution to patient care and data collection. Authors’ information (optional) Ecem İpek Altınok (EA) is an Assistant Professor at the Department of Pediatrics, Faculty of Medicine, Ordu University, Türkiye. Volkan Altınok (VA), Onur Yalçın (OY), and Aybegüm Kalyoncu Ayçenk (AKA) are Assistant Professors at the Department of Pediatric Surgery, Faculty of Medicine, Ordu University, Türkiye. References World Health Organization. Burns. World Health Organization. 2022. https://www.who.int/news-room/fact-sheets/detail/burns . Accessed October 2025. Ciornei B, David VL, Popescu D, Boia ES. Pain management in pediatric burns: a review of the science behind it. Glob Health Epidemiol Genom. 2023;2023:9950870. 10.1155/2023/9950870 . Ahuja RB, Bhattacharya S. Burns in the developing world and burn disasters. BMJ. 2004;329(7463):447–9. 10.1136/bmj.329.7463.447 . Peck MD. Epidemiology of burns throughout the world. Part I: distribution and risk factors. Burns. 2011;37(7):1087–100. 10.1016/j.burns.2011.06.005 . Günaydin K, Koçak S, Acar B. Pediatric burns and conservative treatment methods: a literature review. J Burn Care Res. 2022;43(3):189–96. 10.1097/BCR.0000000000000918 . Kamdem A, Parmentier A-L, Soriano E, Mauny F. Assessment of care protocol using hyaluronic acid dressing in second-degree burns in children. Burns Open. 2021. 10.1016/j.burnso.2021.05.001 . Kee EG, Kimble RM, Cuttle L, Stockton K. Randomized controlled trial of three burn dressings for partial-thickness burns in children (FLAM Trial). Burns. 2015;41(5):946–55. 10.1016/j.burns.2014.11.005 . Heitzmann W, Mossing M, Fuchs PC, Akkan J, Seyhan H, Grieb G, et al. Comparative clinical study of Suprathel® and Jelonet® wound dressings in burn wound healing after enzymatic debridement. Biomedicines. 2023;11(10):2593. 10.3390/biomedicines11102593 . Surowiecka A, Strużyna J, Winiarska A, Korzeniowski T. Hydrogels in burn wound management: a review. Gels. 2022;8(2):122. 10.3390/gels8020122 . Tayyib N. Use of topical haemoglobin spray in hard-to-heal wound management: a systematic review. J Wound Care. 2022;31(6):520–31. 10.12968/jowc.2022.31.6.520 . Dissanaike S, Rahimi M. Epidemiology of burn injuries: highlighting cultural and socio-demographic aspects. Int Rev Psychiatry. 2009;21(6):505–11. 10.3109/09540260903340865 . Ball S, Wicks S, Thomas R, Toose C, Gray K, Pacey V. Scar outcomes for conservatively managed children post burn injury: a retrospective study. Int Wound J. 2024;21(7):e14959. 10.1111/iwj.14959 . Mistry R, Issa F. No statistically significant difference in long-term scarring outcomes of pediatric burns patients treated surgically vs those treated conservatively. Front Surg. 2022;9:727983. 10.3389/fsurg.2022.727983 . Nherera LM, Trueman P, Roberts CD, Berg L. A systematic review and meta-analysis of clinical outcomes associated with nanocrystalline silver use compared to alternative silver delivery systems in the management of superficial and deep partial thickness burns. Burns. 2017;43(5):939–48. 10.1016/j.burns.2017.01.004 . Liu Y, Chinese Burn Association. Chinese expert consensus on the management of pediatric deep partial-thickness burn wounds (2023 edition). Burns Trauma. 2023;11:tkad053. 10.1093/burnst/tkad053 . Greenhalgh DG. Management of burns. N Engl J Med. 2019;380(24):2349–59. 10.1056/NEJMra1807442 . Chipp E, Charles L, Thomas C, Whiting K, Moiemen N, Wilson Y. A prospective study of time to healing and hypertrophic scarring in paediatric burns. Burns Trauma. 2017;5:1–8. 10.1186/s41038-016-0068-2 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 28 Jan, 2026 Read the published version in BMC Pediatrics → Version 1 posted Editorial decision: Revision requested 17 Nov, 2025 Reviews received at journal 02 Nov, 2025 Reviewers agreed at journal 02 Nov, 2025 Reviews received at journal 31 Oct, 2025 Reviewers agreed at journal 30 Oct, 2025 Reviews received at journal 29 Oct, 2025 Reviewers agreed at journal 29 Oct, 2025 Reviewers agreed at journal 29 Oct, 2025 Reviewers invited by journal 28 Oct, 2025 Editor invited by journal 28 Oct, 2025 Editor assigned by journal 28 Oct, 2025 Submission checks completed at journal 28 Oct, 2025 First submitted to journal 23 Oct, 2025 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-7931564","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":533913619,"identity":"ac340464-93a5-4814-bfe4-ba7aa96acf6d","order_by":0,"name":"Volkan Altınok","email":"","orcid":"","institution":"Ordu University","correspondingAuthor":false,"prefix":"","firstName":"Volkan","middleName":"","lastName":"Altınok","suffix":""},{"id":533913620,"identity":"8a187409-4731-41d8-aeba-30a00e6364ff","order_by":1,"name":"Onur Yalçın","email":"","orcid":"","institution":"Ordu 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1","display":"","copyAsset":false,"role":"figure","size":17547,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of the mean hospital stay duration between study groups.\u003cbr\u003e\nGroup 1 (n=182) represents patients with TBSA \u0026gt;10%, while Group 2 (n=42) includes those with TBSA ≤10%. The mean length of stay was significantly longer in Group 1 (9.3 ± 2.1 days) compared to Group 2 (5.2 ± 1.5 days, \u003cem\u003ep\u003c/em\u003e\u0026lt; 0.001). The overall mean hospital stay for all inpatients was 8.5 ± 2.5 days\u003c/p\u003e","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7931564/v1/5d5c86b499fc61a1120b59a0.png"},{"id":94632115,"identity":"6bd8277f-d104-41b0-8064-1fb7f55e24a7","added_by":"auto","created_at":"2025-10-29 06:26:51","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":43378,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of modern wound care products used in the study.\u003cbr\u003e\nAmong the pediatric burn patients, silver-containing dressings were used in 22% of cases, followed by hyaluronic acid-based preparations (18%), enzymatic alginogel (16%), antiseptic Tulle Gras (16%), hydrogel (15%), and hemoglobin spray (13%). In some cases, multiple products were applied concurrently. Overall, 98% of patients achieved complete recovery with conservative management, highlighting the effectiveness of these modern wound care approaches.\u003c/p\u003e","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7931564/v1/56d2374090514a0ecf4d8a0e.png"},{"id":101690459,"identity":"0feec566-d118-4e21-9cff-0f6f072a9092","added_by":"auto","created_at":"2026-02-02 16:03:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":815379,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7931564/v1/2ab5f6dc-98b8-4d58-8a70-ca08f20ccbd8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Data-Driven Decision Making in Pediatric Burn Management Without a Burn Center: A Four-Year Retrospective Analysis of 520 Patients","fulltext":[{"header":"Background","content":"\u003cp\u003eBurn injuries remain a major global public health concern and are among the leading causes of accidental trauma and mortality in the pediatric population. According to the World Health Organization (WHO), more than 180,000 deaths occur each year due to burns, and a significant proportion of these fatalities involve children under the age of five (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Children are particularly vulnerable to severe burn injuries because of their limited motor coordination, underdeveloped hazard perception, and dependence on caregivers (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eBeyond mortality, pediatric burns often result in long-term complications such as hypertrophic scarring, joint contractures, growth retardation, and profound psychosocial morbidity. These sequelae impose substantial economic and social burdens on families and healthcare systems alike (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). In low- and middle-income countries, the limited availability of dedicated burn units and rehabilitation services further exacerbates these negative outcomes (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e Over the past decade, advances in wound care technology have brought non-surgical, conservative approaches to the forefront of pediatric burn management. Silver-impregnated dressings, owing to their antimicrobial properties, reduce infection risk while promoting epithelialization and decreasing dressing frequency (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Hyaluronic acid (HA)-based preparations modulate inflammation, stimulate granulation tissue formation, and shorten healing time in partial-thickness burns (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Enzymatic alginogel formulations provide a moist environment and enable gentle autolytic debridement, serving as a valuable adjunct in burns requiring exudate control (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Antiseptic Tulle Gras dressings, composed of paraffin gauze with low adherence, minimize traumatic dressing changes and offer a cost-effective option for superficial and partial-thickness burns (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSimilarly, hydrogel-based dressings, due to their high water content, exert a soothing and cooling effect on the wound surface, facilitating pain relief and maintaining an optimal moist environment for epithelial regeneration (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Purified hemoglobin spray, by enhancing topical oxygen delivery, improves tissue oxygenation and accelerates wound healing. Recent clinical studies have shown that hemoglobin sprays can shorten re-epithelialization time and reduce infection-related complications in chronic wounds and partial-thickness burns (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eCollectively, these advanced topical therapies reduce the need for extensive surgical intervention and improve uncomplicated healing rates, particularly in children with \u0026le;\u0026thinsp;20% total body surface area (TBSA\u003cb\u003e)\u003c/b\u003e involvement.\u003c/p\u003e\u003cp\u003e The present study aims to describe the epidemiological profile of pediatric burn cases managed over a five-year period in a tertiary burn care unit in Ordu, T\u0026uuml;rkiye, and to evaluate the clinical outcomes and effectiveness of modern conservative treatment approaches in this cohort.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design and Setting\u003c/h2\u003e\u003cp\u003eThis retrospective clinical study aimed to evaluate the epidemiological characteristics and treatment outcomes of pediatric burn patients managed with modern conservative methods. The study included children treated between January 2021 and February 2025 at Ordu University Training and Research Hospital, a tertiary referral center in T\u0026uuml;rkiye. All patients were managed in the Pediatric Surgery Outpatient Clinic and a dedicated burn treatment room. The study protocol was reviewed and approved by the Ordu University Clinical Research Ethics Committee (Approval No: 172, Date: 09.05.2025).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eParticipants and Burn Classification\u003c/h3\u003e\n\u003cp\u003eA total of 520 pediatric patients aged 0\u0026ndash;18 years who presented with burn injuries were included. Patients were categorized according to age group (0\u0026ndash;6, 7\u0026ndash;12, and 13\u0026ndash;18 years) and burn etiology (scald from hot liquid or food, contact, flame, or electrical burns). The total body surface area (TBSA) was determined using the Lund\u0026ndash;Browder chart and classified as TBSA 1\u0026ndash;10% or 11\u0026ndash;20%. No patient had TBSA exceeding 20%. Patients with incomplete data or major comorbidities were excluded.\u003c/p\u003e\n\u003ch3\u003eTreatment Protocol\u003c/h3\u003e\n\u003cp\u003eAll patients were managed according to a standardized conservative wound care protocol. Wound cleansing was performed with antiseptic solutions containing active chlorine, followed by the application of modern dressing materials. These included silver-based dressings (Atrauman Ag\u0026reg;), hyaluronic acid (HA) preparations (Hyalomatrix\u0026reg;), enzymatic alginogel (Flaminal\u0026reg;), antiseptic Tulle Gras dressings, hydrogel sheets, and purified hemoglobin spray (Granulox\u0026reg;).\u003c/p\u003e\u003cp\u003eWhen clinically indicated, surgical procedures such as debridement, escharotomy, or escharectomy were performed. Split-thickness skin grafting was reserved for cases unresponsive to conservative therapy. Fluid therapy and antibiotic regimens were individualized according to patient age, clinical presentation, and laboratory findings under pediatric supervision.\u003c/p\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eAll statistical analyses were performed using SPSS version 26.0 (IBM Corp., Armonk, NY, USA). Continuous variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) or median with interquartile range (IQR), while categorical variables were presented as frequencies (n) and percentages (%).\u003c/p\u003e\u003cp\u003eComparisons between subgroups defined by age, etiology, and TBSA were conducted using the Chi-square (χ\u0026sup2;) or Fisher\u0026rsquo;s exact test for categorical data, and the independent-samples t-test or Mann\u0026ndash;Whitney U test for continuous variables, as appropriate. For graft requirement and complication rates, relative risk (RR) with 95% confidence intervals (CIs) was calculated. A two-tailed p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eDemographic and Clinical Characteristics\u003c/h2\u003e\u003cp\u003eA total of 520 pediatric patients were included. The median age was 4.2 years (IQR 2.0\u0026ndash;8.1), and 65% (n\u0026thinsp;=\u0026thinsp;338) were in the 0\u0026ndash;6-year group, 20% (n\u0026thinsp;=\u0026thinsp;104) in the 7\u0026ndash;12-year group, and 15% (n\u0026thinsp;=\u0026thinsp;78) in the 13\u0026ndash;18-year group.\u003c/p\u003e\u003cp\u003eThere were 301 boys (57.8%) and 219 girls (42.2%), with a male-to-female ratio of 1.4:1 (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\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\u003eDemographic and Clinical Characteristics of Pediatric Burn Patients (n\u0026thinsp;=\u0026thinsp;520)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge Groups\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0\u0026ndash;6 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e338\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u0026ndash;12 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e104\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e13\u0026ndash;18 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e301\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e57.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e219\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBurn Etiology\u003c/b\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eScald (hot water/food spill)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e396\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e76.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eContact burn\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFlame burn\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\u003e2.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eElectrical burn\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal Body Surface Area (TBSA)\u003c/b\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u0026ndash;10%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e338\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u0026ndash;20%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e182\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHospitalization Status\u003c/b\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInpatient\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e224\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOutpatient follow-up\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e296\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e57.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMean Length of Stay (days)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.5 \u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eBurn Etiology and TBSA Distribution\u003c/h3\u003e\n\u003cp\u003eThe leading cause of injury was scald burns due to hot liquid or food, affecting 396 patients (76.2%), followed by contact burns (18.9%), flame burns (2.9%), and electrical burns (2.0%).\u003c/p\u003e\u003cp\u003eMost patients (338, 65%) had TBSA 1\u0026ndash;10%, while 182 patients (35%) had TBSA 11\u0026ndash;20%. No patient had TBSA exceeding 20%.\u003c/p\u003e\u003cp\u003eHospitalization was significantly more frequent among patients with TBSA\u0026thinsp;\u0026gt;\u0026thinsp;10% compared to those with \u0026le;\u0026thinsp;10% (56.6% vs 35.2%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n\u003ch3\u003eTreatment Modalities and Outcomes\u003c/h3\u003e\n\u003cp\u003eOverall, 224 patients (43%) were hospitalized, while 296 (57%) were treated on an outpatient basis.\u003c/p\u003e\u003cp\u003eThe mean hospital stay was 8.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5 days, significantly longer for patients with TBSA\u0026thinsp;\u0026gt;\u0026thinsp;10% (9.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1 vs 5.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5 days; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAmong modern wound care modalities, silver-based dressings were used in 22%, hyaluronic acid preparations in 18%, enzymatic alginogel in 16%, antiseptic Tulle Gras dressings in 16%, hydrogel in 15%, and hemoglobin spray in 13% of cases (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eWith these combinations, 98% of patients achieved complete healing without grafting, while only 10 patients (2%) required split-thickness skin grafts.\u003c/p\u003e\u003cp\u003eAll grafted patients had TBSA\u0026thinsp;\u0026gt;\u0026thinsp;15% or flame/electrical burns.\u003c/p\u003e\u003cp\u003eThe need for grafting was significantly higher among patients with TBSA\u0026thinsp;\u0026gt;\u0026thinsp;15% (RR\u0026thinsp;=\u0026thinsp;8.5; 95% CI: 3.2\u0026ndash;22.3; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eComplications and Mortality\u003c/h2\u003e\u003cp\u003eKeloid formation was observed in 26 patients (5.0%), more frequently in those with TBSA\u0026thinsp;\u0026gt;\u0026thinsp;10% (p\u0026thinsp;=\u0026thinsp;0.04).\u003c/p\u003e\u003cp\u003eOnly two patients (0.4%) developed contractures, successfully managed with physical therapy.\u003c/p\u003e\u003cp\u003eNo mortality occurred during the study period (0%; 95% CI: 0\u0026ndash;0.7) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\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\u003eTreatment Outcomes and Distribution of Complications in Pediatric Burn Cases\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTreatment Success\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealing with conservative treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e510\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e98.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSurgical Intervention\u003c/b\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSplit-thickness skin graft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eComplications\u003c/b\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\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLocal keloid formation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eContracture\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMortality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, the predominance of the 0\u0026ndash;6-year age group (65%) among pediatric burn patients aligns with previous reports emphasizing that younger children are at a higher risk of burn injuries. Consistent with earlier studies from developing countries, domestic scald injuries were the most common cause of burns, highlighting the household as the primary setting for pediatric burn accidents (\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). In our series, scald burns accounted for 76.2% of all etiologies, a rate comparable to that reported by Dissanaike and Rahimi (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eA major component of our treatment approach was the use of modern conservative wound care modalities, often in combination. Silver-based dressings (22%), hyaluronic acid preparations (18%), enzymatic alginogel (16%), antiseptic Tulle Gras dressings (16%), hydrogel sheets (15%), and hemoglobin spray (13%) were the most frequently applied. This multimodal strategy achieved complete healing without grafting in 98% of patients, closely corresponding to the 2\u0026ndash;4% graft requirement reported by Ball et al. in partial-thickness burns involving\u0026thinsp;\u0026lt;\u0026thinsp;10% TBSA (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Likewise, Mistry et al. found that long-term scar outcomes were comparable between conservative and surgical approaches, reinforcing that appropriate wound management can minimize the need for operative intervention (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe low grafting rate (2%) observed in our cohort underscores the efficacy of the implemented conservative protocol and supports the feasibility of non-surgical healing in pediatric burns. Similar findings were shown in meta-analyses of advanced dressings\u0026mdash;for example, Nherera et al. demonstrated that nanocrystalline silver dressings accelerate healing time in burns (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). The significantly higher graft requirement among patients with TBSA\u0026thinsp;\u0026gt;\u0026thinsp;15% or flame/electrical burns (RR\u0026thinsp;\u0026asymp;\u0026thinsp;8.5; 95% CI: 3.2\u0026ndash;22.3; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) is consistent with the Chinese Burn Association\u0026rsquo;s 2023 consensus, which recommends early surgery for deep partial-thickness injuries (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). As expected, grafting is more likely in deep and extensive burns, emphasizing the need for careful monitoring during conservative management in such cases.\u003c/p\u003e\u003cp\u003eAn additional advantage of modern conservative methods was the reduction in dressing frequency\u0026mdash;patients were often treated every 2\u0026ndash;3 days, and in some cases up to a week, without requiring daily changes. This significantly decreased pain during dressing procedures, reduced sedation and anesthetic use, and minimized fasting episodes associated with anesthesia. Thus, conservative management not only proved effective but also child-friendly, an observation consistent with Greenhalgh\u0026rsquo;s statement that \u0026ldquo;pain-free, minimally invasive wound care improves recovery in pediatric partial-thickness burns\u0026rdquo; (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe low incidence of keloid and contracture formation (5% and 0.4%, respectively) in our study may reflect the benefits of early wound management, appropriate dressing selection, and systematic follow-up. Previous studies have reported higher rates of hypertrophic scarring (17\u0026ndash;30%), particularly in children with healing times exceeding 21 days (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The relatively low TBSA involvement (\u0026le;\u0026thinsp;20%) and shorter healing duration in our cohort likely explain the lower complication rates observed.\u003c/p\u003e\u003cp\u003eThis study has several limitations, including its retrospective design, which may have led to missing data, and the lack of long-term cosmetic, functional, and psychosocial assessments. Nevertheless, previous research has established that early wound closure time, TBSA, and burn depth are the most critical determinants of scar quality and long-term outcomes. Future prospective, multicenter studies should therefore focus on objective evaluation of long-term results of conservative treatment protocols.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur findings demonstrate that in pediatric patients with TBSA\u0026thinsp;\u0026le;\u0026thinsp;20%, modern conservative wound management can achieve excellent healing outcomes without surgical intervention, with minimal complications and no mortality. This underscores the cost-effectiveness and clinical utility of conservative burn care, particularly in resource-limited settings, while also highlighting its humane and child-centered nature. Furthermore, community education, early presentation, and improved healthcare personnel training are essential to further enhance pediatric burn care quality.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eTBSA\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eTotal Body Surface Area\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eWHO\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eWorld Health Organization\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eHA\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHyaluronic Acid\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eRR\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eRelative Risk\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eCI\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eConfidence Interval\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eIQR\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInterquartile Range\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eSD\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eStandard Deviation\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eSPSS\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eStatistical Package for the Social Sciences\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eAg\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eSilver (from silver-based dressings)\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ordu University Clinical Research Ethics Committee (Approval No: 172, Date: 09.05.2025).\u003cbr\u003e\u0026nbsp;Written informed consent was waived due to the retrospective design of the study. All procedures were conducted in accordance with the ethical standards of the institutional and national research committees and with the 1964 Helsinki Declaration and its later amendments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. This manuscript does not contain any individual person’s data in any form (including individual details, images, or videos).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to institutional privacy restrictions but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no external funding for this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVA and OY conceptualized the study and supervised patient management.\u003cbr\u003e\u0026nbsp;AKA and EA collected and analyzed clinical data.\u003cbr\u003e\u0026nbsp;EA performed the statistical analyses and drafted the manuscript.\u003cbr\u003e\u0026nbsp;All authors contributed to the interpretation of results, critically revised the manuscript for important intellectual content, and approved the final version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the staff of the Pediatric Surgery Clinic at Ordu University Training and Research Hospital for their contribution to patient care and data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ information (optional)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEcem İpek Altınok (EA) is an Assistant Professor at the Department of Pediatrics, Faculty of Medicine, Ordu University, Türkiye.\u003cbr\u003e\u0026nbsp;Volkan Altınok (VA), Onur Yalçın (OY), and Aybegüm Kalyoncu Ayçenk (AKA) are Assistant Professors at the Department of Pediatric Surgery, Faculty of Medicine, Ordu University, Türkiye.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. 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Burns Trauma. 2017;5:1\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s41038-016-0068-2\u003c/span\u003e\u003cspan address=\"10.1186/s41038-016-0068-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"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":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Pediatric burns, Conservative treatment, Clinical outcomes","lastPublishedDoi":"10.21203/rs.3.rs-7931564/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7931564/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003ePediatric burn injuries remain a major global health concern, particularly in low- and middle-income countries. Recent advances in wound care technologies have allowed non-surgical (conservative) management to become an increasingly effective option for partial-thickness burns, even in hospitals without specialized burn centers.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis retrospective clinical study included 520 pediatric patients (aged 0\u0026ndash;18 years) treated between January 2021 and February 2025 at Ordu University Training and Research Hospital, T\u0026uuml;rkiye. Patients were categorized according to age, burn etiology, and total body surface area (TBSA). Standardized conservative wound care protocols were applied using advanced dressings such as silver-based materials, hyaluronic acid preparations, enzymatic alginogel, antiseptic Tulle Gras, hydrogel sheets, and hemoglobin spray. Clinical outcomes\u0026mdash;including healing rate, graft requirement, hospitalization duration, and complication rates\u0026mdash;were analyzed statistically.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe median age was 4.2 years (IQR 2.0\u0026ndash;8.1), with 65% of patients aged 0\u0026ndash;6 years. Scald burns were the predominant cause (76.2%). TBSA was \u0026le;\u0026thinsp;10% in 65% and 11\u0026ndash;20% in 35% of cases. The mean hospital stay was 8.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5 days, which was significantly longer in patients with TBSA\u0026thinsp;\u0026gt;\u0026thinsp;10% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Conservative management achieved complete healing in 98% of patients, with only 2% requiring grafting. The rates of keloid and contracture formation were 5% and 0.4%, respectively. No mortality was observed.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eModern conservative burn care yielded excellent outcomes for pediatric patients with TBSA\u0026thinsp;\u0026le;\u0026thinsp;20%, with minimal complications and no mortality. These findings highlight the efficacy, safety, and cost-effectiveness of non-surgical burn management and support its wider use in resource-limited settings through standardized care protocols and improved prevention strategies.\u003c/p\u003e\u003ch2\u003eTrial registration\u003c/h2\u003e\u003cp\u003eNot applicable. This was a retrospective observational study that did not involve any prospective intervention or randomization.\u003c/p\u003e","manuscriptTitle":"Data-Driven Decision Making in Pediatric Burn Management Without a Burn Center: A Four-Year Retrospective Analysis of 520 Patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-29 06:26:47","doi":"10.21203/rs.3.rs-7931564/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-18T04:29:43+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-03T02:29:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"166112136810365409747448712720567885540","date":"2025-11-03T01:33:57+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-31T16:17:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"195925938068802150283894078727055744093","date":"2025-10-31T02:06:59+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-29T13:58:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"309569507850499107449372743671837896813","date":"2025-10-29T08:24:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"51536190198860301297748135185754520999","date":"2025-10-29T05:06:37+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-29T01:23:27+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-28T14:24:46+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-28T12:12:31+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-28T12:11:01+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2025-10-23T10:58:30+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5e3ef54b-b402-4dcd-afdc-03f7674c2d02","owner":[],"postedDate":"October 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-02T16:01:02+00:00","versionOfRecord":{"articleIdentity":"rs-7931564","link":"https://doi.org/10.1186/s12887-026-06522-1","journal":{"identity":"bmc-pediatrics","isVorOnly":false,"title":"BMC Pediatrics"},"publishedOn":"2026-01-28 15:58:33","publishedOnDateReadable":"January 28th, 2026"},"versionCreatedAt":"2025-10-29 06:26:47","video":"","vorDoi":"10.1186/s12887-026-06522-1","vorDoiUrl":"https://doi.org/10.1186/s12887-026-06522-1","workflowStages":[]},"version":"v1","identity":"rs-7931564","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7931564","identity":"rs-7931564","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}