P53: Toxic shock syndrome in paediatric burn patients and the implication of silver-based dressings

A. Granahan

Our Lady’s Children's Hospital Crumlin, Dublin, Ireland

Toxic shock syndrome (TSS) is a rare, but potentially fatal, complication following burn injuries in children. The risk of burn wound infection corresponds with the age and health of the patient, the mechanism of injury and the extent and depth of the burn. The gold standard of care in burn wound management following timely prehospital first aid is centred on topical antibiotics and silver-based dressings. The true incidence of TSS in patients with burns, particularly paediatric patients, is undetermined, and the quantity of presumptive cases are infrequently reported. The purpose of this study is to outline the incidence of TSS in this high-risk patient cohort and to determine the significant risk of using silver-based burn dressings in TSS development. A retrospective clinical analysis was conducted evaluating TSS in paediatric patients admitted to our National Burns Unit over a 2-year period (1 January 2014–31December 2016). The overall incidence of TSS was analysed, with emphasis on its association with silver-based dressings [Silvercel^TM, Acticoat^TM and silver sulfadiazine (Flamazine^TM and Silvazine^TM)]. Current performance practices were compared with internationally accepted guidelines laid out by the Centre of Disease Control and Prevention (CDC) for TSS diagnosis and management. In total, 268 paediatric burn cases were identified [59·4% male; median age 1·9 years (range 0·2–15·9)]. Silver-based dressings were used in 98·1% of cases, most notably Silvercel (42·5%). Overall incidence of TSS was 14%. Statistical analysis was used to determine the consequential risk factors associated with developing TSS in this paediatric population. A χ² test revealed that the proportion of patients developing TSS with a Silvercel dressing was statistically significant compared with Acticoat (P = 0·023) and all silver-based dressings used (P = 0·003). A logistic regression test indicated that the probability of developing TSS with an Acticoat dressing is about one-third (exp(B) = 0·393) the probability of that with Silvercel. The presence of symptoms (meeting the CDC TSS guidelines), the application of first aid and patient’s age were also significantly associated with the development of TSS in paediatric patients with burns. Prehospital first aid was only performed in 67·4% of burn cases. There was statistically significant positive correlation between first aid, time to healing and the requirement of operative intervention. Burns are a global public health issue and their association with TSS, particularly in paediatric patients, is concerning. This study helps to determine the overall incidence of TSS in this high-risk population. The potential correlation with silver-based dressings, notably Silvercel dressings, is outlined and attention should be focused on raising a high index of suspicion with its use and the subsequent development of TSS.