Facial burns in children: A series analysis with implications for resuscitation and forensic odontology

This study comprises a continuous (1981-1995) unselected series of all chil dren who died from thermal injuries in the State of Queensland, Australia. One hundred and six children, so identified, died from incineration (35 per cent), respiratory burns with smoke or carbon monoxide inhalation (33 per cent), body surface area burns comprising greater than 60 per cent (9 per c ent) and electrocution (20 per cent). The burn fatality rate was 0.98 per h undred thousand children (0-14 years) per year, with no secular trend and, specifically, no reduction in the annual rate of such fatalities. Eighty-tw o children (49 males) had concomitant facial injuries, both thermal and non thermal; of whom 55 per cent were under the age of five years. Sixty (73 pe r cent) child burn victims died in house fires. Forensic odontology is impo rtant in confirming the age of such victims in single incinerations but is of limited value when larger numbers of children are incinerated, because o f the relative lack of dental restorations in the infant and pre-school age group. Of the 82 children with facial and airway injuries, 12 per cent had only mild or superficial facial damage and only seven (8 per cent) were al ive or resuscitatable at the time of rescue from the conflagration or burni ng injury. Child deaths from burns contributed an annual loss rate of 506 y ears of potential life lost (YPLL) in a population of 3 million of whom 21. 5 per cent were children under the age of 15 years. Airway management and r esuscitation, in the context of managing surviving burn victims of any age with facial injuries, pose special difficulties. Inhalational burns (smoke and the gases of conflagration) result in a mortality greater than 60 per c ent. Although 81 per cent of children showed evidence of airway obstruction , analysis of current data indicates that a maximum of 8 per cent could hav e survived with airway maintenance and protection. Inhalational burns (to b oth upper and lower airways) grossly reduce survivability. Primary preventi on would seem vital and thus remains a major challenge to reduce the incide nce of such deaths. Some strategies include advocacy to promote the compuls ory installation of smoke alarms, family drills to practise escape and the teaching of 'first aid for all'.