Paediatric Burns – A Single Institution Experience and Suggested Algorithm for School Return

Introduction. Paediatric burns account for almost 40,000 visits to UK emergency departments annually. Following a burn, patients often remain off school – this has educational and social impacts on children, plus financial implications for caregivers. The risk of infection, the commonest cause of morbidity, is highest in the first week post-burn. Currently, there are no formal guidelines regarding school return following a burn, and the recent cost of living crisis in the UK prompted a review into how school return could be facilitated. This study aimed to propose criteria to guide school return if no clear difference in complications was seen between patients returning school before versus after complete wound healing, and to reassess complication rates after implementing a trial in which select patients would return to school early. Methods. A retrospective review of all referrals between January-June 2023 was performed. A set of criteria to guide school return was implemented, and following a 6-month trial period between February-July 2024, another retrospective review was done. Results. 241 children were referred between January-June 2023; after exclusion, 113 cases were reviewed. 8 (7.08%) developed complications; 2/19 (10.53%) of those remaining off school, 2/77 (2.60%) with unclear school return, and 4/17 (23.53%) of those attending school before complete wound healing, with infection developing in all 3 with delayed initial hospital presentation. During the 6-month trial with guided school return, 238 children were referred. 28 children attended school prior to wound healing as per the agreed criteria; patients were followed up until discharge, and none developed complications. Discussion and Conclusions. Delay in presentation, and return to school immediately post-burn, with an associated delay in specialist burn care, appeared to be biggest risk factor for infection in the cohort reviewed. Findings also supported that other risk factors for burn wound complications include burn depth and disturbance to NPWT. Risk of complications did not seem to increase when school return was guided by the proposed criteria, with predictors for uncomplicated early school return appearing to be small burn size (≤1% TBSA), burn location (hands, trunk or limbs), and superficial partial thickness depth. Children remaining off school following a burn can have psychosocial, educational and monetary impacts upon the patient and their caregivers; allowing them to return before complete wound healing may help to diminish these effects, and has been shown to be safe when guided by the proposed criteria.