Indicators of the number of surgeries and severity in pediatric patients with severe burns: A retrospective comparative study

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Surgical interventions are often indispensable for such pediatric patients. However, healthcare providers may encounter issues such as a high risk of perioperative complications and guardian’s refusal of surgery. This study aims to identify early predictive indicators associated with the number of surgeries, recognize high-risk patients, and provide data support for clinical decision-making. Methods : The clinical data of 102 pediatric patients with total burn surface area exceeding 30% from January 2014 to December 2024 were evaluated. Patients were stratified into three groups based on whether they underwent surgery and the number of surgeries received. The associations among age, gender, cause of injury, total burn surface area, burn index (BI), length of hospital stay, and various laboratory indicators were assessed across the groups. Results : Total burn surface area (OR: 1.071, 95% CI: 1.015–1.130, P=0.012), BI (OR: 1.398, 95% CI: 1.196–1.635, P=0.000) and white blood cell (WBC) counts (OR: 1.043, 95% CI: 1.004–1.083, P=0.031) were significantly correlated with the number of surgeries. Total burn surface area (OR: 1.074, 95% CI: 1.016–1.135, P=0.012), BI (OR: 1.376, 95% CI: 1.174–1.612, P=0.000) and WBC counts (OR: 1.045, 95% CI: 1.004–1.087, P=0.031) also emerged as independent risk factors for the number of surgeries for children with severe burns. Conclusion : The total burn surface area, BI, and WBC counts are associated with the number of surgeries and severity of illness in pediatric patients with severe burns. These findings facilitate the rapid identification of high-risk patients who may require transfer to hospital with specialized resources and the development of tailored treatments. pediatrics white blood cell surgery total burn surface area burn index 1 Introduction Burn injuries in children are characterized by high morbidity and mortality rates, particularly in developing countries where burn ranks the third most prevalent cause of pediatric mortality, surpassed only by traffic accidents and drowning [ 1 ]. Children with severe burns accounts for a considerable proportion of emergency department admissions. These patients suffer from both immediate physical pain and long-term physiological consequences, including hypertrophic or contracted scars, increased risk of comorbidities, as well as psychological sequelae and mental health issues [ 2 ]. Compared with adults, hypertrophic scars exert a more pronounced impact on children because of their ongoing development, leading to a more substantial decrement in their life quality. Wound management is pivotal in the clinical treatment of burn patients. Routine therapeutic measures include the application of appropriate wound dressings and healing agents [ 3 ]. In pediatric patients presenting with extensive deep partial-thickness or full-thickness burns, early surgical intervention is the preferred approach, with necrosis tissue excision and skin grafting serving as indispensable steps of treatment [ 4 ]. However, pediatric patients exhibit notable anatomical, physiological, pathological, and immunologic differences compared with adults, which markedly elevate their risk of perioperative complications [ 5 ]. Knowing the possible number of surgical procedures required for pediatric burn patients can offer decision-making support to doctors, facilitating the development of tailored treatments. This includes preoperative preparations, surgical timing, surgical methods, anesthesia options, and postoperative care, all of which contribute to the efficacy and safety of the treatment. Furthermore, guardians of pediatric burn patients tend to decline surgeries due to insufficient medical knowledge, which may potentially delay treatment and exacerbating the patient's condition. Additionally, the uneven distribution of specialized burn care resources often necessitates transferring patients to more specialized hospitals. Except for special circumstances, newborns are usually treated conservatively due to their good wound healing ability. The healing characteristics and wound management for school-age children and adolescents mirror those employed for adults [ 6 ]. Therefore, this study primarily focuses on infants and preschool children aged between 6 months and 6 years. In this study, we aim to contribute data-driven support for clinical decision-making by retrospectively analyzing early indicators associated with the number of surgeries, which reflects the severity of the condition, in pediatric burn patients. This will also facilitate communication with caregivers, aid in decision-making, optimize resources allocation, and predict the prognosis. 2 Materials and methods 2.1 Patient selection This retrospective observational study was approved by the Ethics Committee of the 990th Hospital of the Joint Logistics Support Force and adhered strictly to the principles outlined in the Declaration of Helsinki. The study enrolled 102 paediatric patients with severe burns who were admitted to our hospital from January 1, 2014, to December 31, 2024. All patients met the following inclusion criteria: aged between 6 months and 6 years, burns affected more than 30% total body surface area (TBSA), and primary admission following burn injury. Children with psychiatric disorders, multiple traumatic complications, treatment termination, refusal of formal surgery, or death were excluded. Upon admission, all patients underwent clinical assessment and received standard treatments, including immediate laboratory tests, wound care, dressing changes, intravenous antibiotics administration, and surgical intervention if necessary. Dressings were changed timely based on the wound condition, with the application of topical antimicrobial agents during each change. The decision to perform surgical excision or skin grafting was made by two senior surgeons after assessing the patient's condition. 2.2 Data collection The demographic and clinical information of all enrolled patients was collected, including age, gender, cause of injury, total burn surface area, area of deep partial-thickness burn, area of full-thickness burn, length of stay, and number of surgeries. The laboratory data collected included white blood cell (WBC) count, lymphocyte (Lym) count, neutrophil (Neu) count, red blood cell (RBC) count, platelet (PLT) count, haemoglobin (HGB) level, serum albumin (ALB) concentration, prothrombin time (PT), activated partial thromboplastin time (APPT), and fibrinogen (FIB) level. The burn index (BI) = area of full-thickness burn + area of deep partial-thickness burn/2, the neutrophil-to-lymphocyte ratio (NLR) = Neu count/Lym count, the platelet-to-lymphocyte ratio (PLR) = PLT count/Lym count. 2.3 Statistical analyses All the statistical analyses were conducted using the SPSS 25.0 software (IBM SPSS, USA). P < 0.05 indicates statistical significance. The normal distribution and homogeneity of variances of the data were assessed. Continuous variables that were normally distributed are expressed as medians (ranges) and compared using independent t tests or Mann–Whitney U tests. Categorical variables were presented as frequencies and percentages, and compared using chi-square tests and. Univariate and multivariate logistic regression were conducted to identify risk factors for multiple surgery. 3 Results 3.1 Baseline characteristics The baseline characteristics of the enrolled children were presented in Table 1 . A total of 102 severely burned children admitted to the hospital within 24 hours after the injury were included. Hydrothermal scalding (77.45%) was the most common cause of injury, followed by flame burns (22.55%). Among the patients, there were 57 males and 45 females, with the average age of 2.71 years old (0.50–5.92 years), average burn area of 38.72% TBSA (30–90% TBSA), average BI of 24.49 (15-67.5), and average length of stay of 41.22 days. Table 1 Distribution of 102 paediatric patients with severe burns All cases (n = 102) Male/Female 57/45 Age, years 2.71 (0.50–5.92) Cause of injury Hydrothermal scald 79 (77.45%) Flame 23 (22.55%) Burn wound area, %TBSA 38.72% (30%-90%) Burn index (BI) 24.49 (15-67.5) Length of stay, days 41.22 3.2 Data analysis All patients were discharged after wound healing and were stratified into three groups according to the number of surgeries they underwent. Group 1 included patients whose wounds healed through dressing changes without surgery. Patients whose wounds healed after one surgery were classified as the group 2. Group 3 included patients who underwent two or more surgeries and achieved wound healing through repeated skin grafting. The basic demographic information, injury details, and laboratory results for the three groups were presented in Table 2 . Table 2 Distribution of 102 paediatric patients with severe burns according to the number of surgeries Group 1 (n = 46) Group 2 (n = 29) Group 3 (n = 27) p a p b Male/Female 25/21 16/13 16/11 0.944 0.683 Age, years 2.64 (0.50–5.92) 2.52 (0.50–5.83) 3.21 (0.75–5.50) 0.460 0.112 Cause of injury < 0.05 < 0.01 Hydrothermal scald 44 (95.65%) 23 (79.31%) 12 (44.44%) Flame 2 (4.35%) 6 (20.69%) 15 (55.56%) Total burn surface area, %TBSA 35.5% (30–65%) 40.3% (30–90%) 42.5% (30–75%) 0.070 < 0.01 Burn index (BI) 18.51 (15-32.5) 24.79 (16–47) 34.33 (18.5–67.5) < 0.01 < 0.01 Length of stay, days 25.41 (10–56) 44.07 (17–68) 65.07 (33–142) < 0.01 < 0.01 Laboratory tests WBC, 10 9 /L 26.56 (5.28–66.72) 26.83 (5.37–56.82) 33.87 (6.17-61.00) 0.925 < 0.05 Lym, 10 9 /L 5.02 (1.07–14.02) 5.88 (1.27–20.25) 6.41 (1.42–17.04) 0.332 0.109 Neu, 10 9 /L 19.97 (2.70-57.45) 17.61 (1.75–49.41) 24.60 (4.06–42.42) 0.344 0.069 NLR 5.20 (0.63–27.81) 4.29 (0.66–18.02) 4.66 (1.75–10.94) 0.375 0.525 RBC, 10 12 /L 5.07 (3.04–6.86) 5.27 (2.87–7.55) 5.34 (2.97–6.59) 0.390 0.172 HGB, g/L 133.52 (72.00-186.00) 136.82 (70.00-186.00) 144.00 (86.00-172.00) 0.594 < 0.05 PLT, 10 9 /L 448.35 (172.00-787.00) 399.14 (62.00-748.00) 456.04 (84.00-808.00) 0.173 0.851 PLR 119.81 (42.40-414.12) 97.75 (14.55-388.19) 85.33 (9.06-170.03) 0.247 < 0.05 ALB, g/L 34.10 (19.00-41.70) 33.38 (23.00-44.20) 32.37 (23.50–40.80) 0.583 0.156 PT, sec 14.35 (12.10–18.90) 14.59 (11.70–18.90) 15.01 (12.10–20.20) 0.571 0.148 APPT, sec 35.40 (20.20-124.40) 35.69 (20.30–50.60) 40.69 (27.70–124.00) 0.918 0.217 FIB, g/L 2.63 (1.34–5.91) 2.77 (0.98–4.83) 2.59 (1.24–4.81) 0.610 0.869 a Comparisons were conducted between Group 1 and Group 2. b Comparisons were conducted between Group 1 and Group 3. Abbreviations: NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio. No significant differences in variables except for length of stay were found between Group 1 and Group 2. Compared with Group 1, patients in Group 3 exhibited significantly increased total burn surface area, BI, length of stay, WBC count, and HGB level, as well as significantly decreased PLR (P 0.05). 3.3 Indictors associated with the number of surgeries Univariate analysis revealed that total burn surface area (OR: 1.071, 95% CI: 1.015–1.130, P = 0.012), BI (OR: 1.398, 95% CI: 1.196–1.635, P = 0.000), and WBC count (OR: 1.043, 95% CI: 1.004–1.083, P = 0.031) were significantly correlated with the number of surgeries. In the multivariate analysis, total burn surface area (OR: 1.074, 95% CI: 1.016–1.135, P = 0.012), BI (OR: 1.376, 95% CI: 1.174–1.612, P = 0.000), and WBC count (OR: 1.045, 95% CI: 1.004–1.087, P = 0.031) also emerged as independent risk factors for the number of surgeries in paediatric patients with severe burns (Table 3 ). Table 3 Univariate and multivariate analyses of indicators associated with the number of surgeries Univariate Multivariate OR 95%CI P OR 95%CI P Burn wound area, %TBSA 1.071 1.015–1.130 0.012 1.074 1.016–1.135 0.012 Burn index (BI) 1.398 1.196–1.635 0.000 1.376 1.174–1.612 0.000 WBC, 10 9 /L 1.043 1.004–1.083 0.031 1.045 1.004–1.087 0.031 HGB, g/L 1.024 0.999–1.049 0.059 PLR 0.989 0.978–1.001 0.066 4 Discussion Burn injuries are the main type of accidental injury in children worldwide, imposing substantial economic and psychological burdens on families and society. Children aged 6 months to 6 years have increased activity area, coupled with curiosity and active exploration of their surroundings. Due to incompletely developed coordination and motor abilities, as well as lack of self-protection awareness, they are more susceptible to accidental burn from hot liquids or flames during bathing, eating, or playing [ 7 , 8 ]. Notably, Asia accounts for over half of pediatric burn cases worldwide, with a significant proportion requiring hospitalization [ 9 ]. However, the distribution of specialized burn care resources varies considerably across countries and regions, with underdeveloped areas lacking specialized burn doctors. Meanwhile, severely burned children often face life-threatening conditions, necessitating special attention. Although children with burn areas exceeding 30% TBSA are classified as severe burn, there are notable variations in burn depth and the body's regulatory abilities among different ages, especially in pediatric patients. This results in considerable heterogeneity in the severity of pediatric burn patients' conditions. However, the number of skin grafting surgeries is positively correlated with the severity of burns, as more surgeries indicates larger full-thickness burns wounds. Through retrospective analysis, we found that the total burn surface area, BI, and WBC are independent risk factors for multiple surgeries. Firstly, our research enables doctors and guardians to quickly identify high-risk pediatric patients who require multiple surgeries upon admission. This allows for the development of a more precise treatment plan, as well as the rational arrangement of the timing, frequency, sequence, of surgeries. For instance, it facilitates advance planning of the regions, areas, and dates for every skin grafting surgery. Secondly, children with severe burns are prone to complications such as infection, shock, and multiple organ dysfunction. Early identification of critically ill children aids doctors in taking intervention measures in advance, such as using higher-level antibiotics, thereby reducing the incidence and severity of complications. Last but not least, the distribution of burn care resources in a region is highly uneven. In underdeveloped or developing areas, burn specialists are often in short supply, leading to situations where emergency doctors or other surgeons may treat patients in the absence of burn surgeons. In regions lacking adequate burn care resources, it is imperative to identify high-risk patients who require multiple surgeries and, when medically feasible, to promptly transfer them to hospitals equipped with more specialized burn care expertise. In addition to experienced burn surgeons and nurses, early intervention by specialized plastic surgeons, rehabilitation doctors, and psychologists is also required. These severely burned patients often suffer from multiple complications, notable scar hyperplasia, poor prognosis, and possibly accompanying psychological issues. Providing them with comprehensive, specialized, and holistic treatment as early as possible can effectively reduce the risk of severe complications such as infection, septic shock, and multi-organ failure. This, in turn, improves the survival rate, improves rehabilitation quality, and optimizes prognosis. Most of children with burn areas exceeding 30% TBSA have extensive deep partial-thickness or full-thickness burns. Removing necrotic tissues and achieving wound closure constitutes the fundamental principle in the treatment of deep burn wounds. However, clinicians, anesthesiologists, and guardians are cautious when deciding on treatment plans for preschool children. This caution stems from the incomplete physiological development of these patients. Surgery and anesthesia may lead to complications such as hypothermia, bronchospasm, airway obstruction, pulmonary infection, massive blood loss, and hemodynamic fluctuations [ 10 ]. Coupled with the strong repair ability of children's skin, there has been considerable controversy regarding the treatment approach to achieve optimal outcomes for them. For the 14 patients in Group 2, the wounds were covered with acellular dermal matrix or negative pressure wound therapy devices. The remaining 15 patients underwent autologous skin grafting for unhealed wounds after 3–4 weeks of routine dressing changes. Early removal of eschars and the application of appropriate dressings such as negative pressure wound therapy can effectively improve blood supply, protect the stasis zone, and mitigate the progressive deepening of burn wounds, thereby creating a favorable microenvironment for re-epithelialization [ 11 , 12 ]. However, in the immediate aftermath of burn injury, various factors can affect the timing of surgery, including inaccurate assessment of burn depth, disturbances in acid-base balance, shock, and delayed hospital admission [ 13 ]. Therefore, upon admission, patients should first receive necessary systemic treatment and wound dressing changes, especially for those with large burn areas. Once their condition stabilizes, debridement to remove necrotic tissue [ 14 ] and selective skin grafting as needed can effectively reduce infectious complications, decrease the frequency of surgeries/dressing changes, shorten wound healing time, alleviate scar formation, and improve the prognosis. Compared with group 1, although group 2, which underwent one surgery, exhibited no statistically significant differences in burn area, WBC count, HGB level, or PLR. However, their BI was notably elevated, suggesting deeper burn wounds. Group 3, which had the highest BI, underwent multiple skin grafting surgeries. This underscores the utility of the BI early after injury in identifying critically ill children. Clinically, the intermingling of deep partial-thickness and full-thickness burns is common. Over time post-injury, some wounds may deepen, causing dynamic changes in the BI. Therefore, the BI assessed during the initial stages after burn is generally considered inaccurate. However, we found that the BI upon admission remained an independent risk factor for the number of surgeries. Therefore, although the early BI cannot yet accurately reflect the severity of burns, it still serves as a valuable indicator for identifying critically ill children and guiding treatment plans. This study was conducted in a tertiary hospital renowned nationwide for its burn treatment resources, guaranteeing precision in evaluating wound depth, area, and surgical criteria. When the BI exceeds 25, hospitals without specialized burn care resources should consider transferring the patient to a more appropriate facility as soon as their condition allows. WBC count is also an independent risk factor for multiple surgeries in children with severe burns. WBC, which are commonly found in peripheral blood as nucleated cells, constitute the primary defense against the invasion of pathogenic microorganisms. It engages in complex interactions within the immune system framework, fulfilling roles such as phagocytosis, activation and regulation of other immune cells, removal of necrotic tissue, and elimination of pathogens [ 15 ]. Therefore, peripheral WBC counts serve as essential indicators for evaluating inflammatory, immune, and hematological states [ 16 ], and its changes play a significant role in disease risk, severity, progression, and mortality [ 17 ]. It has been reported that the initial WBC count in the emergency department is a good and cost-effective biomarker for predicting subsequent bloodstream infections in burn patients [ 18 ]. This study found that a high WBC count was an independent risk factor for the number of surgeries in children with severe burns. This may be related to large burn areas, deep burn depths, and high risk of infection, which result in slower wound healing and lower skin graft survival rates, increased number of surgeries, and prolonged hospital stays. In addition, our patients were admitted to the hospital within 24 hours after injury, during which they were still in the shock stage. The significant elevation of WBC counts may be related to hemodilution. However, this does not negate the fact that WBC count is an independent risk factor for the number of surgeries, as the severity of burns positively correlates with the degree of hemodilution. It is therefore reasonable that more surgeries are required to repair burn wounds. This study also found that there were significant differences in the causes of injury between group 3, who had the most severe condition, and group 1 and 2. The majority of injuries in group 1 were caused by hot water, accounting for 95.65%, while flame burns predominated in the group 3 ( P < 0.05). This may be related to higher temperatures during flame burns, ignition of clothing, longer duration of exposure, and a higher likelihood of inhalation injuries. The study also had several limitations. The sample size is relatively small, including data from only 102 patients, which may lead to unintentional bias. Additionally, the study was conducted in a single data center in China, which may limit the generalizability of its findings. Larger-scale, multicenter, randomized studies are needed to confirm our findings. Despite these limitations, the results of this study still provide guidance for clinicians and may offer new directions for future research. 5 Conclusion In conclusion, the total burn surface area, BI, and WBC counts are independent risk factors for the number of surgeries and the severity of illness in pediatric patients with severe burns. These findings aid healthcare providers in quickly identifying high-risk pediatric patients and formulating appropriate treatment plans. Additionally, the results also assist hospitals without specialized burn care resources in identifying patients who require transfer to another hospital. Abbreviations The following abbreviations are used in this manuscript: BI Burn Index WBC White Blood Cell TBSA Total Body Surface Area RBC Red Blood Cell PLT Platelet HGB Haemoglobin ALB Albumin PT Prothrombin Time APTT Activated Partial Thromboplastin Time FIB Fibrinogen NLR Neutrophil-to-Lymphocyte Ratio PLR Platelet-to-Lymphocyte Ratio Declarations conflict of interest The authors declare that they have no financial conflict of interest with regard to the content of this report. Ethics statement This study was approved by the Ethics Committee of the 990th Hospital of the Joint Logistics Support Force. This study is a retrospective cohort study. Informed consent was waived by the ethics committee because retrospective studies have no adverse effect on the health and rights of patients. Funding This study was funded by Henan Provincial Medical Science and Technology Tackling Program Project (LHGJ20210830); Key Project of the 990th Hospital of the Joint Logistic Support Force (21ZDXM01); Zhumadian Youth Special Project for Scientific and Technological Innovation (QNZX202411). Author Contribution Conceptualization, T.H. and T.Y.; methodology, R.X.; software, R.L.; validation, T.H., T.Y. and G.L.; formal analysis, S.L.; investigation, Z.L.; resources, N.W.; data curation, D.H. and C.W.; writing—original draft preparation, T.H.; writing—review and editing, J.M.; visualization, S.L.; supervision, R.X. and T.Y.; project administration, T.Y.; funding acquisition, T.Y. All authors have read and agreed to the published version of the manuscript. Data availability The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. 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Cite Share Download PDF Status: Published Journal Publication published 18 Aug, 2025 Read the published version in Pediatric Surgery International → Version 1 posted Editorial decision: Revision requested 27 May, 2025 Reviews received at journal 16 May, 2025 Reviewers agreed at journal 07 May, 2025 Reviewers invited by journal 02 May, 2025 Editor assigned by journal 22 Apr, 2025 Submission checks completed at journal 22 Apr, 2025 First submitted to journal 15 Apr, 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. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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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-6459056","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":451219764,"identity":"08f1e05d-79ea-47e1-9080-274b5512e220","order_by":0,"name":"Ting He","email":"","orcid":"","institution":"Department of Burns and Plastic Surgery, the Fourth Medical Center of Chinese PLA General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ting","middleName":"","lastName":"He","suffix":""},{"id":451219765,"identity":"fb71bbe8-a24d-42c5-9da6-b1a3021fed76","order_by":1,"name":"Ran Liu","email":"","orcid":"","institution":"Ultrasound Diagnostic Department, 82nd Army Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ran","middleName":"","lastName":"Liu","suffix":""},{"id":451219766,"identity":"f7b310db-7a19-40ea-b739-3e4592079629","order_by":2,"name":"Nannan Wang","email":"","orcid":"","institution":"Military Burn Center, the 990th Hospital of the Joint Logistic Support Force","correspondingAuthor":false,"prefix":"","firstName":"Nannan","middleName":"","lastName":"Wang","suffix":""},{"id":451219767,"identity":"054d0071-f842-4382-8bd5-85d4dfd8f5b3","order_by":3,"name":"Dongsheng Hu","email":"","orcid":"","institution":"Military Burn Center, the 990th Hospital of the Joint Logistic Support Force","correspondingAuthor":false,"prefix":"","firstName":"Dongsheng","middleName":"","lastName":"Hu","suffix":""},{"id":451219768,"identity":"be08cfb0-8b99-4e7e-a119-49c4522e27d5","order_by":4,"name":"Zhichen Lin","email":"","orcid":"","institution":"Military Burn Center, the 990th Hospital of the Joint Logistic Support Force","correspondingAuthor":false,"prefix":"","firstName":"Zhichen","middleName":"","lastName":"Lin","suffix":""},{"id":451219774,"identity":"f363ada1-6863-47d4-8864-2f63d9ff7a31","order_by":5,"name":"Chao Wang","email":"","orcid":"","institution":"Military Burn Center, the 990th Hospital of the Joint Logistic Support Force","correspondingAuthor":false,"prefix":"","firstName":"Chao","middleName":"","lastName":"Wang","suffix":""},{"id":451219775,"identity":"d32c7669-0975-4e9f-b992-12096d744490","order_by":6,"name":"Jinsong Meng","email":"","orcid":"","institution":"Military Burn Center, the 990th Hospital of the Joint Logistic Support Force","correspondingAuthor":false,"prefix":"","firstName":"Jinsong","middleName":"","lastName":"Meng","suffix":""},{"id":451219776,"identity":"c5b19f82-a554-4fcb-812b-0e77c55e6a8f","order_by":7,"name":"Song Li","email":"","orcid":"","institution":"Military Burn Center, the 990th Hospital of the Joint Logistic Support Force","correspondingAuthor":false,"prefix":"","firstName":"Song","middleName":"","lastName":"Li","suffix":""},{"id":451219777,"identity":"c2f3a15e-3690-4af2-b0d7-7b1cde6666d5","order_by":8,"name":"Guoan Lin","email":"","orcid":"","institution":"Military Burn Center, the 990th Hospital of the Joint Logistic Support Force","correspondingAuthor":false,"prefix":"","firstName":"Guoan","middleName":"","lastName":"Lin","suffix":""},{"id":451219778,"identity":"14e4f813-57fd-40b7-847d-551040c9da4d","order_by":9,"name":"Rong Xiao","email":"","orcid":"","institution":"Military Burn Center, the 990th Hospital of the Joint Logistic Support Force","correspondingAuthor":false,"prefix":"","firstName":"Rong","middleName":"","lastName":"Xiao","suffix":""},{"id":451219779,"identity":"284e37c0-9360-442f-a408-7b96b4e4a0dc","order_by":10,"name":"Tiantian Yan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEElEQVRIie2QP0vDQBTAUx4ky9OuVyjYj/BKIF2C/SAudwidYhEECRgwIsTNzn6LTM4nB8kSydoxUHDq0MnFDs1ZEJdcVsH7DY938H7vzzmOxfIXAR3oOx1s9pTgEEA1JgO1Io8KEMbFePTkLsio6CCPucuwgpBqnDCTMvfgY7O7Pl9S+S7ZKHPRV9gumoQX3Yu5M5J0eUPVktM0G2OgTmTjFIurtPuWgEkCkcuIuGinBOqU0yBVBsX7bJV7kddbkm8ZoP+IxMwK6ilK5Oto+pBWgAR9isJbVlEpXtZbH5y4QKbaT+aGW7xV+cri/Z14rqPZl0PJfLhSqtklYafyw0T+fvG+cs1Zb1OLxWL5txwA0FNXTXdPTrwAAAAASUVORK5CYII=","orcid":"","institution":"Military Burn Center, the 990th Hospital of the Joint Logistic Support Force","correspondingAuthor":true,"prefix":"","firstName":"Tiantian","middleName":"","lastName":"Yan","suffix":""}],"badges":[],"createdAt":"2025-04-16 03:23:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6459056/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6459056/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00383-025-06148-x","type":"published","date":"2025-08-18T16:29:39+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":89847393,"identity":"4e509ab7-cc44-4495-9bdc-95003edc5d3e","added_by":"auto","created_at":"2025-08-25 16:43:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":682817,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6459056/v1/608cbed6-482a-4f7c-9c21-16faba292e44.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Indicators of the number of surgeries and severity in pediatric patients with severe burns: A retrospective comparative study","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eBurn injuries in children are characterized by high morbidity and mortality rates, particularly in developing countries where burn ranks the third most prevalent cause of pediatric mortality, surpassed only by traffic accidents and drowning [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Children with severe burns accounts for a considerable proportion of emergency department admissions. These patients suffer from both immediate physical pain and long-term physiological consequences, including hypertrophic or contracted scars, increased risk of comorbidities, as well as psychological sequelae and mental health issues [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Compared with adults, hypertrophic scars exert a more pronounced impact on children because of their ongoing development, leading to a more substantial decrement in their life quality.\u003c/p\u003e \u003cp\u003eWound management is pivotal in the clinical treatment of burn patients. Routine therapeutic measures include the application of appropriate wound dressings and healing agents [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In pediatric patients presenting with extensive deep partial-thickness or full-thickness burns, early surgical intervention is the preferred approach, with necrosis tissue excision and skin grafting serving as indispensable steps of treatment [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, pediatric patients exhibit notable anatomical, physiological, pathological, and immunologic differences compared with adults, which markedly elevate their risk of perioperative complications [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eKnowing the possible number of surgical procedures required for pediatric burn patients can offer decision-making support to doctors, facilitating the development of tailored treatments. This includes preoperative preparations, surgical timing, surgical methods, anesthesia options, and postoperative care, all of which contribute to the efficacy and safety of the treatment. Furthermore, guardians of pediatric burn patients tend to decline surgeries due to insufficient medical knowledge, which may potentially delay treatment and exacerbating the patient's condition. Additionally, the uneven distribution of specialized burn care resources often necessitates transferring patients to more specialized hospitals.\u003c/p\u003e \u003cp\u003eExcept for special circumstances, newborns are usually treated conservatively due to their good wound healing ability. The healing characteristics and wound management for school-age children and adolescents mirror those employed for adults [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Therefore, this study primarily focuses on infants and preschool children aged between 6 months and 6 years. In this study, we aim to contribute data-driven support for clinical decision-making by retrospectively analyzing early indicators associated with the number of surgeries, which reflects the severity of the condition, in pediatric burn patients. This will also facilitate communication with caregivers, aid in decision-making, optimize resources allocation, and predict the prognosis.\u003c/p\u003e"},{"header":"2 Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Patient selection\u003c/h2\u003e \u003cp\u003e This retrospective observational study was approved by the Ethics Committee of the 990th Hospital of the Joint Logistics Support Force and adhered strictly to the principles outlined in the Declaration of Helsinki. The study enrolled 102 paediatric patients with severe burns who were admitted to our hospital from January 1, 2014, to December 31, 2024. All patients met the following inclusion criteria: aged between 6 months and 6 years, burns affected more than 30% total body surface area (TBSA), and primary admission following burn injury. Children with psychiatric disorders, multiple traumatic complications, treatment termination, refusal of formal surgery, or death were excluded. Upon admission, all patients underwent clinical assessment and received standard treatments, including immediate laboratory tests, wound care, dressing changes, intravenous antibiotics administration, and surgical intervention if necessary. Dressings were changed timely based on the wound condition, with the application of topical antimicrobial agents during each change. The decision to perform surgical excision or skin grafting was made by two senior surgeons after assessing the patient's condition.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Data collection\u003c/h2\u003e \u003cp\u003eThe demographic and clinical information of all enrolled patients was collected, including age, gender, cause of injury, total burn surface area, area of deep partial-thickness burn, area of full-thickness burn, length of stay, and number of surgeries. The laboratory data collected included white blood cell (WBC) count, lymphocyte (Lym) count, neutrophil (Neu) count, red blood cell (RBC) count, platelet (PLT) count, haemoglobin (HGB) level, serum albumin (ALB) concentration, prothrombin time (PT), activated partial thromboplastin time (APPT), and fibrinogen (FIB) level. The burn index (BI)\u0026thinsp;=\u0026thinsp;area of full-thickness burn\u0026thinsp;+\u0026thinsp;area of deep partial-thickness burn/2, the neutrophil-to-lymphocyte ratio (NLR)\u0026thinsp;=\u0026thinsp;Neu count/Lym count, the platelet-to-lymphocyte ratio (PLR)\u0026thinsp;=\u0026thinsp;PLT count/Lym count.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Statistical analyses\u003c/h2\u003e \u003cp\u003eAll the statistical analyses were conducted using the SPSS 25.0 software (IBM SPSS, USA). \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicates statistical significance. The normal distribution and homogeneity of variances of the data were assessed. Continuous variables that were normally distributed are expressed as medians (ranges) and compared using independent \u003cem\u003et\u003c/em\u003e tests or Mann\u0026ndash;Whitney U tests. Categorical variables were presented as frequencies and percentages, and compared using chi-square tests and. Univariate and multivariate logistic regression were conducted to identify risk factors for multiple surgery.\u003c/p\u003e \u003c/div\u003e"},{"header":"3 Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Baseline characteristics\u003c/h2\u003e \u003cp\u003eThe baseline characteristics of the enrolled children were presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. A total of 102 severely burned children admitted to the hospital within 24 hours after the injury were included. Hydrothermal scalding (77.45%) was the most common cause of injury, followed by flame burns (22.55%). Among the patients, there were 57 males and 45 females, with the average age of 2.71 years old (0.50\u0026ndash;5.92 years), average burn area of 38.72% TBSA (30\u0026ndash;90% TBSA), average BI of 24.49 (15-67.5), and average length of stay of 41.22 days.\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\u003eDistribution of 102 paediatric patients with severe burns\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll cases (n\u0026thinsp;=\u0026thinsp;102)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale/Female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57/45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.71 (0.50\u0026ndash;5.92)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCause of injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHydrothermal scald\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79 (77.45%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFlame\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (22.55%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBurn wound area, %TBSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38.72% (30%-90%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBurn index (BI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.49 (15-67.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of stay, days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41.22\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 \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Data analysis\u003c/h2\u003e \u003cp\u003eAll patients were discharged after wound healing and were stratified into three groups according to the number of surgeries they underwent. Group 1 included patients whose wounds healed through dressing changes without surgery. Patients whose wounds healed after one surgery were classified as the group 2. Group 3 included patients who underwent two or more surgeries and achieved wound healing through repeated skin grafting. The basic demographic information, injury details, and laboratory results for the three groups were presented in 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\u003eDistribution of 102 paediatric patients with severe burns according to the number of surgeries\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup 1 (n\u0026thinsp;=\u0026thinsp;46)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup 2 (n\u0026thinsp;=\u0026thinsp;29)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGroup 3 (n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale/Female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25/21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16/13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16/11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.944\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.683\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.64 (0.50\u0026ndash;5.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.52 (0.50\u0026ndash;5.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.21 (0.75\u0026ndash;5.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.460\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.112\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCause of injury\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=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHydrothermal scald\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (95.65%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (79.31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (44.44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFlame\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (4.35%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (20.69%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (55.56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal burn surface area, %TBSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.5% (30\u0026ndash;65%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.3% (30\u0026ndash;90%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.5% (30\u0026ndash;75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.070\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBurn index (BI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.51 (15-32.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.79 (16\u0026ndash;47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.33 (18.5\u0026ndash;67.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of stay, days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.41 (10\u0026ndash;56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.07 (17\u0026ndash;68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65.07 (33\u0026ndash;142)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaboratory tests\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 \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWBC, 10\u003c/b\u003e\u003csup\u003e\u003cb\u003e9\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e/L\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.56 (5.28\u0026ndash;66.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.83 (5.37\u0026ndash;56.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.87 (6.17-61.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.925\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLym, 10\u003c/b\u003e\u003csup\u003e\u003cb\u003e9\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e/L\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.02 (1.07\u0026ndash;14.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.88 (1.27\u0026ndash;20.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.41 (1.42\u0026ndash;17.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.332\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.109\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNeu, 10\u003c/b\u003e\u003csup\u003e\u003cb\u003e9\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e/L\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19.97 (2.70-57.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.61 (1.75\u0026ndash;49.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.60 (4.06\u0026ndash;42.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.344\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.069\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.20 (0.63\u0026ndash;27.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.29 (0.66\u0026ndash;18.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.66 (1.75\u0026ndash;10.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.375\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.525\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRBC, 10\u003c/b\u003e\u003csup\u003e\u003cb\u003e12\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e/L\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.07 (3.04\u0026ndash;6.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.27 (2.87\u0026ndash;7.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.34 (2.97\u0026ndash;6.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.390\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.172\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHGB, g/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e133.52 (72.00-186.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e136.82 (70.00-186.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e144.00 (86.00-172.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.594\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePLT, 10\u003c/b\u003e\u003csup\u003e\u003cb\u003e9\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e/L\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e448.35 (172.00-787.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e399.14 (62.00-748.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e456.04 (84.00-808.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.851\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e119.81 (42.40-414.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97.75 (14.55-388.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85.33 (9.06-170.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.247\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALB, g/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34.10 (19.00-41.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.38 (23.00-44.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.37 (23.50\u0026ndash;40.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.583\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.156\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePT, sec\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.35 (12.10\u0026ndash;18.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.59 (11.70\u0026ndash;18.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.01 (12.10\u0026ndash;20.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.571\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.148\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAPPT, sec\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.40 (20.20-124.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.69 (20.30\u0026ndash;50.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40.69 (27.70\u0026ndash;124.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.918\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.217\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFIB, g/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.63 (1.34\u0026ndash;5.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.77 (0.98\u0026ndash;4.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.59 (1.24\u0026ndash;4.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.610\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.869\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003ea Comparisons were conducted between Group 1 and Group 2.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eb Comparisons were conducted between Group 1 and Group 3.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eAbbreviations: NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eNo significant differences in variables except for length of stay were found between Group 1 and Group 2. Compared with Group 1, patients in Group 3 exhibited significantly increased total burn surface area, BI, length of stay, WBC count, and HGB level, as well as significantly decreased PLR (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Although the RBC count, PLT count, and APTT in Group 3 showed a slight increase compared with Group 1, no statistical differences were found (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Indictors associated with the number of surgeries\u003c/h2\u003e \u003cp\u003eUnivariate analysis revealed that total burn surface area (OR: 1.071, 95% CI: 1.015\u0026ndash;1.130, P\u0026thinsp;=\u0026thinsp;0.012), BI (OR: 1.398, 95% CI: 1.196\u0026ndash;1.635, P\u0026thinsp;=\u0026thinsp;0.000), and WBC count (OR: 1.043, 95% CI: 1.004\u0026ndash;1.083, P\u0026thinsp;=\u0026thinsp;0.031) were significantly correlated with the number of surgeries. In the multivariate analysis, total burn surface area (OR: 1.074, 95% CI: 1.016\u0026ndash;1.135, P\u0026thinsp;=\u0026thinsp;0.012), BI (OR: 1.376, 95% CI: 1.174\u0026ndash;1.612, P\u0026thinsp;=\u0026thinsp;0.000), and WBC count (OR: 1.045, 95% CI: 1.004\u0026ndash;1.087, P\u0026thinsp;=\u0026thinsp;0.031) also emerged as independent risk factors for the number of surgeries in paediatric patients with severe burns (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate and multivariate analyses of indicators associated with the number of surgeries\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\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnivariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMultivariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\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\u003eOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBurn wound area, %TBSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.015\u0026ndash;1.130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.074\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.016\u0026ndash;1.135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBurn index (BI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.398\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.196\u0026ndash;1.635\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.376\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.174\u0026ndash;1.612\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWBC, 10\u003csup\u003e9\u003c/sup\u003e/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.004\u0026ndash;1.083\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.004\u0026ndash;1.087\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHGB, g/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.999\u0026ndash;1.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.059\u003c/p\u003e \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\u003ePLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.989\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.978\u0026ndash;1.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.066\u003c/p\u003e \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 \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eBurn injuries are the main type of accidental injury in children worldwide, imposing substantial economic and psychological burdens on families and society. Children aged 6 months to 6 years have increased activity area, coupled with curiosity and active exploration of their surroundings. Due to incompletely developed coordination and motor abilities, as well as lack of self-protection awareness, they are more susceptible to accidental burn from hot liquids or flames during bathing, eating, or playing [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNotably, Asia accounts for over half of pediatric burn cases worldwide, with a significant proportion requiring hospitalization [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, the distribution of specialized burn care resources varies considerably across countries and regions, with underdeveloped areas lacking specialized burn doctors. Meanwhile, severely burned children often face life-threatening conditions, necessitating special attention.\u003c/p\u003e \u003cp\u003eAlthough children with burn areas exceeding 30% TBSA are classified as severe burn, there are notable variations in burn depth and the body's regulatory abilities among different ages, especially in pediatric patients. This results in considerable heterogeneity in the severity of pediatric burn patients' conditions. However, the number of skin grafting surgeries is positively correlated with the severity of burns, as more surgeries indicates larger full-thickness burns wounds. Through retrospective analysis, we found that the total burn surface area, BI, and WBC are independent risk factors for multiple surgeries. Firstly, our research enables doctors and guardians to quickly identify high-risk pediatric patients who require multiple surgeries upon admission. This allows for the development of a more precise treatment plan, as well as the rational arrangement of the timing, frequency, sequence, of surgeries. For instance, it facilitates advance planning of the regions, areas, and dates for every skin grafting surgery. Secondly, children with severe burns are prone to complications such as infection, shock, and multiple organ dysfunction. Early identification of critically ill children aids doctors in taking intervention measures in advance, such as using higher-level antibiotics, thereby reducing the incidence and severity of complications. Last but not least, the distribution of burn care resources in a region is highly uneven. In underdeveloped or developing areas, burn specialists are often in short supply, leading to situations where emergency doctors or other surgeons may treat patients in the absence of burn surgeons. In regions lacking adequate burn care resources, it is imperative to identify high-risk patients who require multiple surgeries and, when medically feasible, to promptly transfer them to hospitals equipped with more specialized burn care expertise. In addition to experienced burn surgeons and nurses, early intervention by specialized plastic surgeons, rehabilitation doctors, and psychologists is also required. These severely burned patients often suffer from multiple complications, notable scar hyperplasia, poor prognosis, and possibly accompanying psychological issues. Providing them with comprehensive, specialized, and holistic treatment as early as possible can effectively reduce the risk of severe complications such as infection, septic shock, and multi-organ failure. This, in turn, improves the survival rate, improves rehabilitation quality, and optimizes prognosis.\u003c/p\u003e \u003cp\u003eMost of children with burn areas exceeding 30% TBSA have extensive deep partial-thickness or full-thickness burns. Removing necrotic tissues and achieving wound closure constitutes the fundamental principle in the treatment of deep burn wounds. However, clinicians, anesthesiologists, and guardians are cautious when deciding on treatment plans for preschool children. This caution stems from the incomplete physiological development of these patients. Surgery and anesthesia may lead to complications such as hypothermia, bronchospasm, airway obstruction, pulmonary infection, massive blood loss, and hemodynamic fluctuations [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Coupled with the strong repair ability of children's skin, there has been considerable controversy regarding the treatment approach to achieve optimal outcomes for them. For the 14 patients in Group 2, the wounds were covered with acellular dermal matrix or negative pressure wound therapy devices. The remaining 15 patients underwent autologous skin grafting for unhealed wounds after 3\u0026ndash;4 weeks of routine dressing changes. Early removal of eschars and the application of appropriate dressings such as negative pressure wound therapy can effectively improve blood supply, protect the stasis zone, and mitigate the progressive deepening of burn wounds, thereby creating a favorable microenvironment for re-epithelialization [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, in the immediate aftermath of burn injury, various factors can affect the timing of surgery, including inaccurate assessment of burn depth, disturbances in acid-base balance, shock, and delayed hospital admission [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Therefore, upon admission, patients should first receive necessary systemic treatment and wound dressing changes, especially for those with large burn areas. Once their condition stabilizes, debridement to remove necrotic tissue [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] and selective skin grafting as needed can effectively reduce infectious complications, decrease the frequency of surgeries/dressing changes, shorten wound healing time, alleviate scar formation, and improve the prognosis.\u003c/p\u003e \u003cp\u003eCompared with group 1, although group 2, which underwent one surgery, exhibited no statistically significant differences in burn area, WBC count, HGB level, or PLR. However, their BI was notably elevated, suggesting deeper burn wounds. Group 3, which had the highest BI, underwent multiple skin grafting surgeries. This underscores the utility of the BI early after injury in identifying critically ill children. Clinically, the intermingling of deep partial-thickness and full-thickness burns is common. Over time post-injury, some wounds may deepen, causing dynamic changes in the BI. Therefore, the BI assessed during the initial stages after burn is generally considered inaccurate. However, we found that the BI upon admission remained an independent risk factor for the number of surgeries. Therefore, although the early BI cannot yet accurately reflect the severity of burns, it still serves as a valuable indicator for identifying critically ill children and guiding treatment plans. This study was conducted in a tertiary hospital renowned nationwide for its burn treatment resources, guaranteeing precision in evaluating wound depth, area, and surgical criteria. When the BI exceeds 25, hospitals without specialized burn care resources should consider transferring the patient to a more appropriate facility as soon as their condition allows.\u003c/p\u003e \u003cp\u003eWBC count is also an independent risk factor for multiple surgeries in children with severe burns. WBC, which are commonly found in peripheral blood as nucleated cells, constitute the primary defense against the invasion of pathogenic microorganisms. It engages in complex interactions within the immune system framework, fulfilling roles such as phagocytosis, activation and regulation of other immune cells, removal of necrotic tissue, and elimination of pathogens [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Therefore, peripheral WBC counts serve as essential indicators for evaluating inflammatory, immune, and hematological states [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], and its changes play a significant role in disease risk, severity, progression, and mortality [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. It has been reported that the initial WBC count in the emergency department is a good and cost-effective biomarker for predicting subsequent bloodstream infections in burn patients [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. This study found that a high WBC count was an independent risk factor for the number of surgeries in children with severe burns. This may be related to large burn areas, deep burn depths, and high risk of infection, which result in slower wound healing and lower skin graft survival rates, increased number of surgeries, and prolonged hospital stays. In addition, our patients were admitted to the hospital within 24 hours after injury, during which they were still in the shock stage. The significant elevation of WBC counts may be related to hemodilution. However, this does not negate the fact that WBC count is an independent risk factor for the number of surgeries, as the severity of burns positively correlates with the degree of hemodilution. It is therefore reasonable that more surgeries are required to repair burn wounds.\u003c/p\u003e \u003cp\u003eThis study also found that there were significant differences in the causes of injury between group 3, who had the most severe condition, and group 1 and 2. The majority of injuries in group 1 were caused by hot water, accounting for 95.65%, while flame burns predominated in the group 3 (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This may be related to higher temperatures during flame burns, ignition of clothing, longer duration of exposure, and a higher likelihood of inhalation injuries.\u003c/p\u003e \u003cp\u003eThe study also had several limitations. The sample size is relatively small, including data from only 102 patients, which may lead to unintentional bias. Additionally, the study was conducted in a single data center in China, which may limit the generalizability of its findings. Larger-scale, multicenter, randomized studies are needed to confirm our findings. Despite these limitations, the results of this study still provide guidance for clinicians and may offer new directions for future research.\u003c/p\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003eIn conclusion, the total burn surface area, BI, and WBC counts are independent risk factors for the number of surgeries and the severity of illness in pediatric patients with severe burns. These findings aid healthcare providers in quickly identifying high-risk pediatric patients and formulating appropriate treatment plans. Additionally, the results also assist hospitals without specialized burn care resources in identifying patients who require transfer to another hospital.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eThe following abbreviations are used in this manuscript:\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"524\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003eBI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 461px;\"\u003e\n \u003cp\u003eBurn Index\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003eWBC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 461px;\"\u003e\n \u003cp\u003eWhite Blood Cell\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003eTBSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 461px;\"\u003e\n \u003cp\u003eTotal Body Surface Area\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003eRBC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 461px;\"\u003e\n \u003cp\u003eRed Blood Cell\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003ePLT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 461px;\"\u003e\n \u003cp\u003ePlatelet\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003eHGB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 461px;\"\u003e\n \u003cp\u003eHaemoglobin\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003eALB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 461px;\"\u003e\n \u003cp\u003eAlbumin\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003ePT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 461px;\"\u003e\n \u003cp\u003eProthrombin Time\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003eAPTT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 461px;\"\u003e\n \u003cp\u003eActivated Partial Thromboplastin Time\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003eFIB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 461px;\"\u003e\n \u003cp\u003eFibrinogen\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003eNLR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 461px;\"\u003e\n \u003cp\u003eNeutrophil-to-Lymphocyte Ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003ePLR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 461px;\"\u003e\n \u003cp\u003ePlatelet-to-Lymphocyte Ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003econflict of interest\u003c/strong\u003e \u003cp\u003eThe authors declare that they have no financial conflict of interest with regard to the content of this report.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eEthics statement\u003c/h2\u003e \u003cp\u003e This study was approved by the Ethics Committee of the 990th Hospital of the Joint Logistics Support Force. This study is a retrospective cohort study. Informed consent was waived by the ethics committee because retrospective studies have no adverse effect on the health and rights of patients.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study was funded by Henan Provincial Medical Science and Technology Tackling Program Project (LHGJ20210830); Key Project of the 990th Hospital of the Joint Logistic Support Force (21ZDXM01); Zhumadian Youth Special Project for Scientific and Technological Innovation (QNZX202411).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConceptualization, T.H. and T.Y.; methodology, R.X.; software, R.L.; validation, T.H., T.Y. and G.L.; formal analysis, S.L.; investigation, Z.L.; resources, N.W.; data curation, D.H. and C.W.; writing\u0026mdash;original draft preparation, T.H.; writing\u0026mdash;review and editing, J.M.; visualization, S.L.; supervision, R.X. and T.Y.; project administration, T.Y.; funding acquisition, T.Y. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\u003ch2\u003eData availability\u003c/h2\u003e \u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eNduagubam OC, Mba UC, Onumaegbu OO et al (2022) Paediatric burn injuries in Enugu, South-East Nigeria: A 7-year multi-centre retrospective review. Burns 48:432\u0026ndash;439. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.burns.2021.04.029\u003c/span\u003e\u003cspan address=\"10.1016/j.burns.2021.04.029\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAllahham A, Cooper MN, Fear MW et al (2023) Quality of life in paediatric burn patients with non-severe burns. 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Hum Mol Genet 26:1193\u0026ndash;1204. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/hmg/ddx024\u003c/span\u003e\u003cspan address=\"10.1093/hmg/ddx024\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eConstantinescu AE, Bull CJ, Jones N et al (2024) Circulating white blood cell traits and colorectal cancer risk: A Mendelian randomisation study. Int J Cancer 154:94\u0026ndash;103. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/ijc.34691\u003c/span\u003e\u003cspan address=\"10.1002/ijc.34691\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiao PH, Kao CC, How CK et al (2021) Initial white blood cell count and revised Baux score predict subsequent bloodstream infection in burn patients: A retrospective analysis of severe burn patients from the Formosa color dust explosion of 2015. J Formos Med Assoc 120:1719\u0026ndash;1728. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jfma.2020.12.004\u003c/span\u003e\u003cspan address=\"10.1016/j.jfma.2020.12.004\" 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":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":"pediatric-surgery-international","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pesi","sideBox":"Learn more about [Pediatric Surgery International](http://link.springer.com/journal/383)","snPcode":"383","submissionUrl":"https://submission.nature.com/new-submission/383/3","title":"Pediatric Surgery International","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"pediatrics, white blood cell, surgery, total burn surface area, burn index","lastPublishedDoi":"10.21203/rs.3.rs-6459056/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6459056/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e: Children with severe burns accounts for a considerable proportion of emergency department admissions. Surgical interventions are often indispensable for such pediatric patients. However, healthcare providers may encounter issues such as a high risk of perioperative complications and guardian’s refusal of surgery. This study aims to identify early predictive indicators associated with the number of surgeries, recognize high-risk patients, and provide data support for clinical decision-making.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: The clinical data of 102 pediatric patients with total burn surface area exceeding 30% from January 2014 to December 2024 were evaluated. Patients were stratified into three groups based on whether they underwent surgery and the number of surgeries received. The associations among age, gender, cause of injury, total burn surface area, burn index (BI), length of hospital stay, and various laboratory indicators were assessed across the groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Total burn surface area (OR: 1.071, 95% CI: 1.015–1.130, P=0.012), BI (OR: 1.398, 95% CI: 1.196–1.635, P=0.000) and white blood cell (WBC) counts (OR: 1.043, 95% CI: 1.004–1.083, P=0.031) were significantly correlated with the number of surgeries. Total burn surface area (OR: 1.074, 95% CI: 1.016–1.135, P=0.012), BI (OR: 1.376, 95% CI: 1.174–1.612, P=0.000) and WBC counts (OR: 1.045, 95% CI: 1.004–1.087, P=0.031) also emerged as independent risk factors for the number of surgeries for children with severe burns.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: The total burn surface area, BI, and WBC counts are associated with the number of surgeries and severity of illness in pediatric patients with severe burns. These findings facilitate the rapid identification of high-risk patients who may require transfer to hospital with specialized resources and the development of tailored treatments.\u003c/p\u003e","manuscriptTitle":"Indicators of the number of surgeries and severity in pediatric patients with severe burns: A retrospective comparative study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-07 07:15:57","doi":"10.21203/rs.3.rs-6459056/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-27T10:38:26+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-16T07:54:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"309569507850499107449372743671837896813","date":"2025-05-07T11:12:30+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-02T09:32:21+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-22T08:53:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-22T07:49:24+00:00","index":"","fulltext":""},{"type":"submitted","content":"Pediatric Surgery International","date":"2025-04-16T03:13:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"pediatric-surgery-international","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pesi","sideBox":"Learn more about [Pediatric Surgery International](http://link.springer.com/journal/383)","snPcode":"383","submissionUrl":"https://submission.nature.com/new-submission/383/3","title":"Pediatric Surgery International","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"db34186e-4b8e-4ecf-a4b6-dfa9bddfad2a","owner":[],"postedDate":"May 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-08-25T16:37:17+00:00","versionOfRecord":{"articleIdentity":"rs-6459056","link":"https://doi.org/10.1007/s00383-025-06148-x","journal":{"identity":"pediatric-surgery-international","isVorOnly":false,"title":"Pediatric Surgery International"},"publishedOn":"2025-08-18 16:29:39","publishedOnDateReadable":"August 18th, 2025"},"versionCreatedAt":"2025-05-07 07:15:57","video":"","vorDoi":"10.1007/s00383-025-06148-x","vorDoiUrl":"https://doi.org/10.1007/s00383-025-06148-x","workflowStages":[]},"version":"v1","identity":"rs-6459056","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6459056","identity":"rs-6459056","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}