Burn Injury, Characteristics, and Epidemiology in African American Children in North Carolina 
Creators: name: Anthony Charles, MD, MPH
name: Jared Gallaher, MD, MPH
name: Alexa Holloway
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2021

description: Unintentional injuries, including burns, represent the leading cause of morbidity and mortality for children in the United States. This study seeks to identify trends among African American pediatric burn patients compared to other races with regards to burn characteristics, hospital stay, and type of surgical intervention utilized. 

This is a retrospective review of all admitted pediatric burn patients (< 18 years old) to a busy, tertiary burn center in North Carolina from 2009 through 2019. We used bivariate analysis to compare patients based on reported race, comparing African Americans to all other races. Modified Poisson regression was used to model the probability of undergoing autologous skin grafting based on African American race, adjusted for potential confounders. To estimate socioeconomic disadvantage, we used the Area Deprivation Index (ADI), which uses factors for the theoretical domains of income, education, employment, and housing quality to rank groups of geographical blocks from lowest level of disadvantage (1) to the highest (100).

4,227 children were admitted to UNC between 2009-2019. The median age was 3 years (IQR 1-8) with a male preponderance at 59.8% (n=2,529). The median TBSA was 2% (IQR 1-5). African American (AA) children were disproportionally represented among pediatric burn patients, comprising 33.7% of all patients, compared to an African American state population of 22.2%.  AA patients were more likely to have scald burn injuries compared to other races at 68.5% (n=976) compared to 49.3% (1,382, p<0.001) with both fire and contact injuries less common in AA children. AA patients had a slightly larger TBSA with a median of 3% (IQR 1-6) compared to 2% (IQR 1-5, p<0.001). In the hospital, AA patients had a longer mean length of stay at 5.8 days (SD 13.6) versus 4.9 days (SD 13.8) but were not more likely to be admitted to the ICU with an admission prevalence of 17.1% (n=244) compared to 15.4% (n=430, p=0.13). Compared to other races, African American patients were more likely to have autologous skin grafting at their initial operation, with an adjusted RR of 1.49 (95% CI 1.22-1.82) when controlling for age, Area Deprivation Index (ADI) national rank, TBSA, and burn type.

African American children were disproportionately represented among pediatric burn patients, more likely to have scald burn injuries that were slightly bigger compared to patients of other races, had longer hospital stays, and were more likely to have autologous skin grafting upon initial surgical intervention.

This research provides important insight into the demographics of pediatric burn patients in North Carolina, as well as data on burn characteristics and medical interventions used for African American patients compared to other races. This information is necessary in order to guide treatment decisions, inform prevention strategies, and accurately assess mortality risk in a vulnerable patient population.