Concomitant Pediatric Burns and Craniomaxillofacial Trauma

Abstract

This study is the first to investigate pediatric craniomaxillofacial (CMF) trauma patients that present with concomitant burns. The authors aim to identify differing etiologies, presentations, facial fracture patterns, interventions, and outcomes between pediatric CMF trauma patients with versus without concomitant burns. In this retrospective cohort study of a tertiary care center between the years 1990 and 2010, concomitant burns were identified among pediatric patients presenting with CMF fractures. Patient charts were reviewed for demographics, presentation, burn characteristics (total body surface area %, location, and degree), imaging, interventions, involvement of child protective services, and long-term outcomes. Data were analyzed using two-tailed Student t tests and chi-square analysis. Of the identified 2966 pediatric CMF trauma patients (64.0% boys; age 7 ± 4.7 years), 10 (0.34%) patients presented with concomitant burns. Concomitant burn and CMF traumas were more likely to be due to penetrating injuries (P < 0.0001) and had longer hospital lengths of stay (13 ± 18.6 versus 4 ± 6.2 days, P < 0.0001). 40% were due to child abuse, 40% due to motor vehicle collisions, and 20% due to house fires. All four child abuse patients presented in a delayed fashion; operative burn care was prioritized and 70% of the CMF fractures were managed nonoperatively. Concomitant burn and CMF trauma is a rare injury pattern in pediatrics and warrants skeletal surveys with suspicious injury patterns. Future research is necessary to develop practice guidelines.