Frequency and Predictors of Hypertrophic Scarring in Pediatric Burns Patients Managed Conservatively in a Burn and Trauma Centre, Peshawar
Main Article Content
Abstract
Objective: To find out the prevalence and predictors of hypertrophic scarring in children with burns who were treated conservatively at a specialized facility.
Methodology: This descriptive longitudinal study was conducted at the Department of Burns and Plastic Surgery, Peshawar. Total 217 pediatric patients with type 1 or type 2 burns in the age group of 2-16 years were recruited using non-probability consecutive sampling technique. The ethical clearance was obtained from Institutional Ethical Committee. All patients underwent conservative management of burns wounds, were assessed on Day 0, Day 7 and Day 14. Hypertrophic scarring (HTS) was defined as a scar with elevation ≥ 2 mm and mVSS ≥ 5. Statistical analysis was done using SPSS version 26.0.
Results: Out of 217 patients, 124 (57.1%) were males with mean age of 6.9 ± 3.8 years. Partial thickness burns were found in 135 (62.2%) patients and the mean TBSA was 9.8 ± 4.1 %. The frequency of hypertrophic scarring was 46 (21.2%). Burn depth (p=0.002) and duration of complete wound healing (p<0.001) were found to be significant predictors of HTS. Mean time of healing in patients with HTS was 19.4 ± 6.6 vs 14.7 ± 5.9 days in non-HTS patients. Age, gender and TBSA were not significant predictors (p>0.05).
Conclusion: The frequency of hypertrophic scarring in conservatively managed pediatric burn patients was 21.2%. Burn depth and prolonged time to wound healing were the primary significant predictors. Early optimization of wound healing is critical to reduce hypertrophic scar burden in the paediatric population.
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References
1. Asefa L, Abebe MW, Negussie AG. Patterns and outcomes of pediatric burn injuries in a tertiary hospital's burn unit. Burns Open. 2024;8(2):87-91.
2. Thomas R, Wicks S, Dale M, Pacey V. Outcomes of early and intensive use of a palm and digit extension orthosis in young children after burn injury. J Burn Care Res. 2021;42(2):245-57.
3. Agarwal S, Sorkin M, Levi B. Heterotopic Ossification and Hypertrophic Scars. Clin Plast Surg. 2017;44(4):749-755.
4. Zhu Z, Kong W, Wang H, Xiao Y, Shi Y, Gan L, et al. Prevalence and predictors of scar contracture-associated re-hospitalisation among burn inpatients in China. Sci Rep. 2021;11:14973.
5. Spronk I, Stortelers A, van der Vlies CH, van Zuijlen PPM, Pijpe A; Burden of Burn Injuries Study Group. Scar quality in children with burns 5-7 years after injury: A cross-sectional multicentre study. Wound Repair Regen. 2021;29(6):951-60.
6. Chipp E, Charles L, Thomas C, Whiting K, Moiemen N, Wilson Y. A prospective study of time to healing and hypertrophic scarring in paediatric burns: every day counts. Burns Trauma. 2017;5:3.
7. Willoughby J, Prelack K, Moslander D. Wound characteristics and other predictive factors of hypertrophic scarring in pediatric burns. J Burn Care Res. 2025;46(Suppl 1):S19.
8. Ball S, Wicks S, Thomas R, Toose C, Gray K, Pacey V. Scar outcomes for conservatively managed children post burn injury: A retrospective study. Int Wound J. 2024;21(7):e14959.
9. Mony MP, Harmon KA, Hess R, Dorafshar AH, Shafikhani SH. An updated review of hypertrophic scarring. Cells. 2023;12(5):678.
10. Liu Y; Chinese Burn Association. Chinese expert consensus on the management of pediatric deep partial-thickness burn wounds (2023 edition). Burns Trauma. 2023;11:tkad053.
11. Mistry R, Issa F. No statistically significant difference in long term scarring outcomes of pediatric burns patients treated surgically vs. those treated conservatively. Front Surg. 2022;9:727983.
12. Patel KF, Rodríguez-Mercedes SL, Grant GG, Rencken CA, Kinney EM, Austen A, et al. Physical, psychological, and social outcomes in pediatric burn survivors ages 5 to 18 years: a systematic review. J Burn Care Res. 2022;43(2):343-52.
13. Jordan KC, Di Gennaro JL, von Saint André-von Arnim A, Stewart BT. Global trends in pediatric burn injuries and care capacity from the World Health Organization Global Burn Registry. Front Pediatr. 2022;10:954995.
14. Enkhtuvshin S, Odkhuu E, Batchuluun K, Chimeddorj B, Yadamsuren E, Lkhagvasuren N. Children's post-burn scars in Mongolia. Int Wound J. 2023;20(6):2082-6.
15. Edger-Lacoursière Z, Nedelec B, Marois-Pagé E, de Oliveira A, Couture MA, Calva V, et al. Systematic quantification of hypertrophic scar in adult burn survivors. Eur Burn J. 2021;2(3):88-105.
16. Hendriks TCC, Botman M, de Haas LEM, Mtui GS, Nuwass EQ, Jaspers MEH, et al. Burn scar contracture release surgery effectively improves functional range of motion, disability and quality of life: a pre/post cohort study with long-term follow-up in a low- and middle-income country. Burns. 2021;47(6):1285-94.
17. Liu H, Li D, Yuan H, Sun T, Li P, Cai Z, et al. Improved short-term prognosis of pediatric partial-thickness burns: emergency conservative debridement under topical anesthesia. Pediatr Emerg Care. 2024;40(5):390-4.
18. Chinese Burn Association. Clinical practice guideline for pediatric scar prevention and treatment (2025 edition). Burns Trauma. 2025;13: tkaf065.