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Numerous experimental studies have shown several benefits of treating burns by the immediate application of cool water. In this study of 695 children with burns, treated in the National Burn Institute (NBI), Hanoi, Vietnam, patients were assessed on admission according to first aid measures at the time of injury, i.e. the removal of the cause and immediate cooling with cold water. A total of 33% of the children who had had immediate cooling of the burn with water had deep burns, compared with 49% of the children who had not had immediate cooling. The prevalence ratio of deep burns was thus 0.68 (95% confidence interval (CI) 0.55-0.85); that is, there was an estimated reduction of 32% in the need for skin grafting, a reduction which was statistically significant. After adjusting for the effect of cooling the burn, removal of the causal agent reduced the odds of requiring skin grafting, but the reduction was not statistically significant. It is concluded that early cooling will prevent a significant percentage of superficial burns from progressing to deep burns. This will not only reduce the probability that skin grafting and expensive treatment will be required, but will reduce the risk of other consequences of deep burns, which may be fatal. Public health programs to promote immediate cooling of burns with cool water are at least as important as subsequent medical and surgical treatment in determining the outcome of burns in children. [ABSTRACT FROM AUTHOR]

The success of treatment of childhood burns is critically dependent on how well the initial management is performed. In this case series of 695 children with burns transferred to the National Burn Institute (NBI) in Hanoi from peripheral hospitals, the initial management of each patient was assessed for the following initial management measures: removal of the cause and immediate cooling with water at the accident site; and pain relief, dry dressing, administration of oxygen, and adequate fluid replacement at the peripheral hospital. Overall, 61 of the 695 children died, but of the 95 patients who received all of these initial management measures, all survived. There were no cases of irreversible shock, acute renal failure, or multiple organ failure in the patients who received adequate initial management. Provision of adequate initial management was also significantly protective against septicaemia. Thus in this group of subjects who survived until admission, effective initial management significantly reduced the risk of death and other complications such as irreversible shock, septicaemia and multiple organ failure. [ABSTRACT FROM AUTHOR]