Pediatric Critical Care Medicine Fellow St. Christopher's Hospital for Children/Tower Health, United States
Introduction: Pediatric patients with burn injuries are at significantly increased risk for serious bacterial infection, and sepsis is a major cause of morbidity and mortality in this population. The diagnosis of infection and sepsis, however, is challenging. Investigators have attempted to use the well-known procalcitonin (PCT) to detect infection burn-injured patients. There have been mixed results reported, and additional pediatric studies are especially needed. The aim of this study was to investigate the ability of procalcitonin to specifically identify pediatric burn patients with serious bacterial infections.
Methods: This was a retrospective study in a tertiary care, regional pediatric Burn Center. Included patients had a primary admission diagnosis of burn injury and had at least one PCT drawn for purposes of infection workup during admission. Patients were sorted into infected and non-infected groups. Infected patients had positive bacterial culture, diagnosis of wound infection by a burn surgeon, or diagnosis of toxin-mediated disease. Patients also must have received an appropriate treatment course of targeted systemic antibiotics to be considered in the infected group. All age ranges (0-22 years), total body surface areas (TBSA), and burn mechanisms were included. Patients were excluded if there were factors that would potentially confound their procalcitonin value, such as concurrent traumatic injuries.
Results: A total of 89 patients met inclusion criteria. Average initial PCT was significantly higher in infected (8.13 ng/mL) vs non-infected (3.83 ng/mL) patients (one-sided t-test, p=0.18), as was average peak PCT (19.15 ng/mL vs 4.48 ng/mL, one-sided t-test, p=0.001). Receiver operating curve (ROC) demonstrated that the first PCT value drawn had a moderate ability to differentiate patients with bacterial infection with an AUC of 0.71 when all patients were analyzed together. When stratified by %TBSA, the procalcitonin was better predictive of bacterial infection in smaller burns ( < 10%, AUC 0.776, < 15% AUC 0.771). The peak measured procalcitonin was strongly predictive of bacterial infection with an AUC of 0.804.
Conclusions: The results of this study demonstrate that procalcitonin in pediatric burn patients is predictive of bacterial infection, especially for smaller %TBSA burns.
