Pediatric Thermal Burns

This evidence repository is a collection of best available resources and evidence collated by a knowledge synthesis team at Alberta Research for Health Evidence (ARCHE) and the clinical content team.

The knowledge synthesis team utilizes a pyramid-shaped framework, built upon the “4S” hierarchy of evidence model, to provide detailed evidence appropriate to meet stakeholders’ needs. They search a combination of databases (Cochrane Library, PubMed, TRIP Database) and web-based search engines (Google, Google Scholar) to locate evidence for the knowledge pyramids. Publication types sought in the initial topic searches are organized into five levels that determine the order in which resources are presented:

1. Bottom Line Recommendations
2. Clinical Practice Guidelines and Pathways
3. Overviews and Summaries of Systematic Reviews
4. Systematic Reviews
5. Key Studies

Where applicable resources for families and parents are also listed.

The knowledge synthesis team collaborates with the clinical content team to select the most relevant guidelines, reviews, and key studies, which can be found below. This evidence repository is not intended to be an exhaustive list of resources for a topic, but rather a curated list of current, evidence-based resources, based on expert consensus of relevance and usability for a general emergency department setting. Every effort is made to identify resources that are open access (i.e. publicly available, free of charge, not requiring a subscription).

More information about the creation of our evidence repositories can be found here.

Thank you to the following clinical content experts and Knowledge Synthesis team who led the development of this evidence repository.

Tighe Crombie, MB BCh, FRCPC; Pediatric Emergentologist & Trauma Team Leader; Assistant Professor, Department of Pediatrics, Director, CHEO ED Outreach Program

Claudia Malic, MD, MRCS(Eng), FRCS(Plast); Paediatric Plastic Surgeon, CHEO; Director of Research, Division of Plastic and Reconstructive Surgery, Assistant Professor, University of Ottawa

Liza Bialy, BSc, MPH, Knowledge Synthesis Project Coordinator, Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta

Sarah Elliott, PhD, Assistant Director, Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta

TREKK developed resources for healthcare providers and parents & families can be found here.

1. Government of South Australia. Paediatric burns service guidelines. Women’s & Children’s Hospital. 2023.
2. The Royal Children’s Hospital Melbourne. Burns – acute management. 2020.
3. Legrand M, Barraud D, Constant I, et al. Management of severe thermal burns in the acute phase in adults and children. Anaesth Crit Care Pain Med. 2020;39(2):253-67.
4. Western Region Burn Disaster Consortium. Burn injury: Guidelines for care. 2020.
5. ISBI Practice Guidelines Committee; Steering Subcommittee; Advisory Subcommittee. ISBI practice guidelines for burn care. Burns. 2016;42(5):953-1021.

1. CritiCall Ontario. Burns centre consultation guidelines. Critical Care Services Ontario. 2019.
2. UBC Division of Plastic Surgery. Pediatric burn referrals. 2017.

1. Griffin B, Cabilan CJ, Ayoub B, et al. The effect of 20 minutes of cool running water first aid within three hours of thermal burn injury on patient outcomes: A systematic review and meta-analysis. Australas Emerg Care. 2022;25(4):367-76.
2. Djärv T, Douma M, Palmieri T, et al. Duration of cooling with water for thermal burns as a first aid intervention: A systematic review. Burns. 2022;48(2):251-62.
3. Pisano C, Fabia R, Shi J, et al. Variation in acute fluid resuscitation among pediatric burn centers. Burns. 2021;47(3):545-50.
4. Suman A, Owen J. Update on the management of burns in paediatrics. BJA Educ. 2020;20(3):103-10.
5. Jeschke MG, van Baar ME, Choudhry MA, et al. Burn injury. Nat Rev Dis Primers. 2020;6(1):11.
6. Nímia HH, Carvalho VF, Isaac C, et al. Comparative study of silver sulfadiazine with other materials for healing and infection prevention in burns: A systematic review and meta-analysis. Burns. 2019;45(2):282-92.
7. Harshman J, Roy M, Cartotto R. Emergency care of the burn patient before the burn center: A systematic review and meta-analysis. J Burn Care Res. 2019;40(2):166-88.
8. Antequera Martín AM, Barea Mendoza JA, Muriel A, et al. Buffered solutions versus 0.9% saline for resuscitation in critically ill adults and children. Cochrane Database Syst Rev. 2019;7(7):Cd012247.
9. Strobel AM, Fey R. Emergency care of pediatric burns. Emerg Med Clin North Am. 2018;36(2):441-58.
10. Stiles K. Emergency management of burns: Part 2. Emerg Nurse. 2018;26(2):36-41.
11. Stiles K. Emergency management of burns: Part 1. Emerg Nurse. 2018;26(1):36-42.
12. Sheridan RL. Burn care for children. Pediatr Rev. 2018;39(6):273-86.
13. Shah AR, Liao LF. Pediatric burn care: Unique considerations in management. Clin Plast Surg. 2017;44(3):603-10.
14. Romanowski KS, Palmieri TL. Pediatric burn resuscitation: Past, present, and future. Burns Trauma. 2017;5:26.
15. Norman G, Christie J, Liu Z, et al. Antiseptics for burns. Cochrane Database of Systematic Reviews. 2017(7).
16. 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.
17. Nherera L, Trueman P, Roberts C, Berg L. Silver delivery approaches in the management of partial thickness burns: A systematic review and indirect treatment comparison. Wound Repair Regen. 2017;25(4):707-21.
18. Palmieri TL. Pediatric burn resuscitation. Crit Care Clin. 2016;32(4):547-59.
19. Haines E, Fairbrother H. Optimizing emergency management to reduce morbidity and mortality in pediatric burn patients. Pediatr Emerg Med Pract. 2015;12(5):1-23; quiz 4-5.
20. Rashaan ZM, Krijnen P, Klamer RR, et al. Nonsilver treatment vs. Silver sulfadiazine in treatment of partial-thickness burn wounds in children: A systematic review and meta-analysis. Wound Repair Regen. 2014;22(4):473-82.
21. Wasiak J, Cleland H, Campbell F, Spinks A. Dressings for superficial and partial thickness burns. Cochrane Database of Systematic Reviews. 2013(3).
22. Barajas‐Nava LA, López‐Alcalde J, Roqué i Figuls M, et al. Antibiotic prophylaxis for preventing burn wound infection. Cochrane Database of Systematic Reviews. 2013(6).
23. Khundkar R, Malic C, Burge T. Use of acticoat dressings in burns: What is the evidence? Burns. 2010;36(6):751-8.
24. Latenser BA. Critical care of the burn patient: The first 48 hours. Crit Care Med. 2009;37(10):2819- 26.

1. Delgado-Miguel C, Miguel-Ferrero M, Ezquerra A, et al. Sedoanalgesia in the debridement of pediatric burns in the emergency department: Is it effective and safe? Children (Basel). 2023;10(7).
2. Suman A, Owen J. Update on the management of burns in paediatrics. BJA Educ. 2020 Mar;20(3):103-110.
3. Mitchell M, Kistamgari S, Chounthirath T, et al. Children younger than 18 years treated for nonfatal burns in us emergency departments. Clin Pediatr (Phila). 2020;59(1):34-44.
4. Griffin BR, Frear CC, Babl F, et al. Cool running water first aid decreases skin grafting requirements in pediatric burns: A cohort study of two thousand four hundred ninety-five children. Ann Emerg Med. 2020;75(1):75-85.
5. Auh E, Kistamgari S, Yang J, Smith GA. Children with facial burns treated in united states emergency departments, 2000 to 2018. Acad Pediatr. 2020;20(4):540-8.
6. Kirsner RS, Amaya R, Bass K, et al. Effects of a surfactant-based gel on acute and chronic paediatric wounds: A panel discussion and case series. J Wound Care. 2019;28(6):398-408.
7. Hansen JK, Voss J, Ganatra H, et al. Sedation and analgesia during pediatric burn dressing change: A survey of American burn association centers. J Burn Care Res. 2019;40(3):287-93.
8. Ro HS, Shin JY, Sabbagh MD, et al. Effectiveness of aspiration or deroofing for blister management in patients with burns: A prospective randomized controlled trial. Medicine (Baltimore). 2018;97(17):e0563.
9. Raymond SL, Zecevic A, Larson SD, et al. Delayed healing associated with silver sulfadiazine use for partial thickness scald burns in children. Am Surg. 2018;84(6):836-40.
10. Ojeda S, Blumenthal E, Stevens P, et al. The safety and efficacy of propranolol in reducing the hypermetabolic response in the pediatric burn population. J Burn Care Res. 2018;39(6):963-9.
11. Mehrotra S, Misir A. Special traumatized populations: Burns injuries. Curr Pediatr Rev. 2018;14(1):64-9.
12. Sadideen H, D’Asta F, Moiemen N, Wilson Y. Does overestimation of burn size in children requiring fluid resuscitation cause any harm? J Burn Care Res. 2017;38(2):e546-e51.
13. de Graaf E, van Baar ME, Baartmans MGA, et al. Partial-thickness scalds in children: A comparison of different treatment strategies. Burns. 2017;43(4):733-40.
14. Brown M, Dalziel SR, Herd E, et al. A randomized controlled study of silver-based burns dressing in a pediatric emergency department. J Burn Care Res. 2016;37(4):e340-7.
15. Goverman J, Bittner EA, Friedstat JS, et al. Discrepancy in initial pediatric burn estimates and its impact on fluid resuscitation. J Burn Care Res. 2015;36(5):574-9.
16. Gee Kee EL, Kimble RM, Cuttle L, et al. Randomized controlled trial of three burns dressings for partial thickness burns in children. Burns. 2015;41(5):946-55.
17. Liao AY, Andresen D, Martin HC, et al. The infection risk of plastic wrap as an acute burns dressing. Burns. 2014;40(3):443-5.
18. D’Souza AL, Nelson NG, McKenzie LB. Pediatric burn injuries treated in us emergency departments between 1990 and 2006. Pediatrics. 2009;124(5):1424-30.

1. Helman A, Fish J, Ivankovic M, Kovacs G. Emergency medicine cases podcast: Burn and inhalation injuries: Ed wound care, resuscitation and airway management. Emergency Medicine Cases. 2019.
2. Victoria Adult Burns Service at the Alfred. Paediatric burn assessment. The Royal Children’s Hospital Melbourne. 2012.