Outcomes of modern conservative burn care in children treated outside a burn center: a four-year retrospective analysis of 520 patients

Burn injuries are a major cause of morbidity and mortality in children, particularly in low- and middle-income countries where access to specialized burn centers is limited. Advances in modern dressings have facilitated conservative management, but evidence from non-burn centers remains scarce. We retrospectively analyzed 520 pediatric patients with burn injuries involving ≤ 20% total body surface area (TBSA) treated between January 2021 and February 2025 in a tertiary hospital without a dedicated burn unit. All children were managed using a standardized conservative protocol incorporating silver-based, hyaluronic acid–based, alginogel, hydrogel, Tulle Gras, and hemoglobin spray dressings. Demographic features, etiology, TBSA, hospitalization, graft requirement, early complications, microbiologically confirmed infections, and mortality were evaluated. Long-term cosmetic and functional outcomes could not be systematically assessed and were therefore not primary endpoints of this study. The median age was 4.2 years, and 65% of patients were aged 0–6 years. Scald burns accounted for 76.2% of injuries, and 65.0% of children had TBSA 1–10%. Overall, 98% of patients achieved acute wound closure without grafting, while 2% required split-thickness skin grafts, predominantly in burns > 15% TBSA or flame/electrical injuries. Keloid formation was documented in 5.0% and contractures in 0.4% of patients during early follow-up, but these rates likely underestimate true long-term scar prevalence due to incomplete late follow-up. Microbiologically confirmed infection occurred in 12.8% of hospitalized children, and no sepsis, invasive infections or mortality was observed. In pediatric patients with burns involving ≤20% TBSA, a structured conservative wound-care protocol can achieve high rates of acute wound closure with a very low need for grafting and no observed in-hospital mortality, even in a hospital without a dedicated burn center. These findings relate to acute outcomes; definitive long-term cosmetic and functional results could not be determined and warrant prospective studies with standardized long-term follow-up. Not applicable. This was a retrospective observational study that did not involve any prospective intervention or randomization.