Cool Running Water Reduces Odds of Grafting and Decreases Depth of Burns in Children

Second-degree burns (shown here) form blisters and have associated skin sloughing.
Second-degree burns (shown here) form blisters and have associated skin sloughing.
This study showed significant improvements with cool running water first aid in injury severity and clinical outcomes such as odds of skin grafting and depth of burns in children post-burn.

Consistent with first-aid guidelines, the action of applying cool running water to a thermal injury is associated with improvements in burn severity and reduced odds of skin grafting in children, study results published in the Annals of Emergency Medicine reports.

Patient data were prospectively collected from a registry comprising pediatric patients who were managed at a tertiary care children’s hospital (n=2,495; median age, 2 years). In a multivariate logistic regression analysis, researchers evaluated the association between adequate first aid (ie, applying cool running water for 20 minutes on a thermal burn within 3 hours of injury) and skin grafting. Other outcomes included in the study were time to re-epithelialization, wound depth, hospital admission, length of stay, and operating room interventions.

Approximately 71.3% of the children (n=1780) who received first aid with running water were given the adequate duration of 20 minutes. Only 9.5% of children (n=236) required grafting, with patients in the adequate first aid group having reduced odds of grafting (odds ratio [OR], 0.6; 95% CI, 0.4-0.8). The adequate duration of water exposure to the burn was associated with a decrease in full-thickness depth of the burn (OR, 0.4; 95% CI, 0.2-0.6), as well as reduced hospital admissions (OR, 0.7; 95% CI, 0.3-0.9) and operating room interventions (OR, 0.7; 95% CI, 0.5-0.9). No changes were observed with hospital length of stay (hazard ratio, 0.9; 95% CI, 0.7-1.2; P =.48).

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The single-center design and the reliance on structured interviews to identify which type of first aid (adequate vs inadequate) was given to patients may represent study limitations.

Since the study suggests that cool running water can be of benefit up to 3 hours after a burn, the researchers suggest “out-of-hospital and emergency services should therefore prioritize first aid in the management of all patients who present within this timeframe.”

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Griffin BR, Frear CC, Babl F, Oakley E, Kimble RM. Cool running water first aid decreases skin grafting requirements in pediatric burns: a cohort study of two thousand four hundred ninety-five children [published online August 29, 2019]. Ann Emerg Med. doi:10.1016/j.annemergmed.2019.06.028