What Changes Have Occurred in the Pattern of Paediatric Burns in the Last Years with Special Attention to the COVID-19 Pandemic?
Round 1
Reviewer 1 Report
Overall it is a very good manuscript that provides a comprehensive overview. Congratulations.
I'm a little confused about the title. I would rather use the COVID reference. The 10 years are of course the framework for the literature research, but there is no direct comparison between different time-defined cohorts. Perhaps the following title would be more direct: What changes have occurred in the pattern pediatric burns in the last years with special attention to the covid pandemic? Or something like this, but sounding more fancy... (I just don't have a better idea right now... :) )
But that's whining on a high level...
Otherwise I would suggest some minor corrections:
line 60: a dot is missing at the end of the sentence.
line 93/94: I wouldn't put it that way! In particular, deep burns on the palm of the hand (hopefully) lead to different treatment strategies than, for example, more superficial scalding. this clause can therefore be misinterpreted.
line 160: I am not Australian so you most-likely know better, but I would write region or area and not city talking about Victoria.
line 339-341: you talk very broadly about the need for cooling. I think that's dangerous. One should differentiate somewhat, since hypothermia significantly worsens the outcome and extensive cooling can result in hypothermia. For babies, large areas, torso and head, you should therefore proceed more cautiously. Likewise, no ice should be used and the water should only be lukewarm!
line 391-395: The definition of an operative intervention can be quite different. In this context, some will describe the removal of the blisters and primary dressing in analgosedation as such, some perhaps first a split-thickness skin graft. This could influence the different results and should be mentioned.
line 431: "space" is missing "increase("
Well done and congratulations again! Good and extensive overview with special attention to the pandemic!
Author Response
Thank you very much for taking the time to review my manuscript and for your thoughtful feedback. Please find the detailed responses in red below and the revisions which have been made based on reviewers comments are highlighted in the document attached.
Overall it is a very good manuscript that provides a comprehensive overview. Congratulations.
I'm a little confused about the title. I would rather use the COVID reference. The 10 years are of course the framework for the literature research, but there is no direct comparison between different time-defined cohorts. Perhaps the following title would be more direct: What changes have occurred in the pattern pediatric burns in the last years with special attention to the covid pandemic? Or something like this, but sounding more fancy... (I just don't have a better idea right now... :) ) I agree with your sentiments here and have hence altered the title to reflect the significance of COVID-19 to my study.
But that's whining on a high level...
Otherwise I would suggest some minor corrections:
line 60: a dot is missing at the end of the sentence. Change completed.
line 93/94: I wouldn't put it that way! In particular, deep burns on the palm of the hand (hopefully) lead to different treatment strategies than, for example, more superficial scalding. this clause can therefore be misinterpreted. Thank you for pointing this out. I can see how this could be misinterpreted. Therefore, I have reworded this section to account for the possibility of this misinterpretation.
line 160: I am not Australian so you most-likely know better, but I would write region or area and not city talking about Victoria. Agreed. I have reworded ‘city’ to ‘region’.
line 339-341: you talk very broadly about the need for cooling. I think that's dangerous. One should differentiate somewhat, since hypothermia significantly worsens the outcome and extensive cooling can result in hypothermia. For babies, large areas, torso and head, you should therefore proceed more cautiously. Likewise, no ice should be used and the water should only be lukewarm! Thank you for highlighting this oversight. I have added a consideration of hypothermia.
line 391-395: The definition of an operative intervention can be quite different. In this context, some will describe the removal of the blisters and primary dressing in analgosedation as such, some perhaps first a split-thickness skin graft. This could influence the different results and should be mentioned. Thank you for highlighting this issue. I have added a sentence (line 394-396) to account for these inconsistencies.
line 431: "space" is missing "increase(" Change completed.
Well done and congratulations again! Good and extensive overview with special attention to the pandemic! Thank you once again for providing feedback on my article!
Reviewer 2 Report
This manuscript gives a very good overview of worldwide changes in pediatric burns especially with regards to the Covid 19 pandemic. It is also extremely important to distinguish btw LMIC and HIC as these are two very different entities and show different evolutions.
Some general and some more specific remarks I would like to deposit:
IN the title the pandemic is not mentioned. In the manuscript each subtitle does focus on this time though and is a crucial part of the manuscript. What are the thoughts behind this choice?
Methods: you state the method of article search but no results of amount of manuscripts retrieved etc are mentioned. Please add.
Titel "Site of burn injury" and "location" can be a little confusing as at first one would think here is talk of the same issue. Obviously, when continuing reading this problem is solved. Maybe the title "location" could be rephrased, for example environement of injury or alike.
Incidence/Management and Outcomes
Incidence reports all patients with burn injuries (in and outpatients) and increased during the pandemic according to some studies. As later on in section 3.83. it is reported of fewer admissions and the two could be confused, please state more specifically in both sections (incidence in and outpatients, hospital admission only). HOspital admissions (line 420), are these all pediatric patients admitted?
Limitations
The interesting results reported are all based on literature available biasing results. I do think this should be mentioned in limitations. Evaluations and conclusions are difficult to make if only scattered centers report of their experience. All centers should be encouraged to publish their data.
Results are extremely important (even if very site/country specific) to adapt prevention programs. Do centers write in their publications about available prevention programs?
One matter has not been highlighted and is mentioned more often in the context of the Covid 19 pandemic which is child abuse. Any mention about child abuse in the reviewed articles?
In general: as it is a review, there are obviously no figures. But I do think that some charts could be added for more "ease" and for better overview.
Author Response
Thank you very much for taking the time to review my manuscript and for your thoughtful feedback. Please find the detailed responses in red below and the revisions which have been made based on reviewers comments are highlighted in the document attached.
This manuscript gives a very good overview of worldwide changes in pediatric burns especially with regards to the Covid 19 pandemic. It is also extremely important to distinguish btw LMIC and HIC as these are two very different entities and show different evolutions.
Some general and some more specific remarks I would like to deposit:
IN the title the pandemic is not mentioned. In the manuscript each subtitle does focus on this time though and is a crucial part of the manuscript. What are the thoughts behind this choice? Thank you for your thoughts here. I agree and have therefore adjusted the title to account for the contributions of COVID-19.
Methods: you state the method of article search but no results of amount of manuscripts retrieved etc are mentioned. Please add. Upon your recommendation, I have added a sentence to record the number of papers retrieved.
Titel "Site of burn injury" and "location" can be a little confusing as at first one would think here is talk of the same issue. Obviously, when continuing reading this problem is solved. Maybe the title "location" could be rephrased, for example environement of injury or alike. Thank you for providing your perspective here. I have rephrased “Site of burn injury” to “Body area affected” to clarify to the audience the difference between the two categories.
Incidence/Management and Outcomes
Incidence reports all patients with burn injuries (in and outpatients) and increased during the pandemic according to some studies. As later on in section 3.83. it is reported of fewer admissions and the two could be confused, please state more specifically in both sections (incidence in and outpatients, hospital admission only). HOspital admissions (line 420), are these all pediatric patients admitted? I agree that there could be confusion here for readers. Therefore, I have added some specificity to the incidence section and have specified inpatient and paediatric in section 3.8.3 as needed.
Limitations
The interesting results reported are all based on literature available biasing results. I do think this should be mentioned in limitations. Evaluations and conclusions are difficult to make if only scattered centers report of their experience. All centers should be encouraged to publish their data. This is an important consideration and I have incorporated this feedback by adding this potential bias to the limitations section.
Results are extremely important (even if very site/country specific) to adapt prevention programs. Do centers write in their publications about available prevention programs? Agree. After a literature search, I found a lack of literature on the implementation of prevention programs. As such, I referenced one such study I was able to fund and highlighted this further limitation to the end of the limitations section.
One matter has not been highlighted and is mentioned more often in the context of the Covid 19 pandemic which is child abuse. Any mention about child abuse in the reviewed articles? Thank you for suggesting this new area to look into. I did some research into the incidence of NAI during COVID-19, specifically looking at burns. There are limited articles explicitly referencing NAI during COVID-19 but I added a study looking at NAI in general during the COVID-19 pandemic into the aetiology section.
In general: as it is a review, there are obviously no figures. But I do think that some charts could be added for more "ease" and for better overview. This is an interesting point you have highlighted. After much consideration, I have decided to continue with no figures. I struggled to generate any high impact charts which would reflect more than what the text currently says. This decision also helps me use space efficiently and maintain flow.
Reviewer 3 Report
The article entitled "What changes have occurred in the pattern of paediatric burns over the last decade?" is a general review of trends in pediatric burn epidemiology over the past ten years, with a special focus on changes during the COVID-19 pandemic.
Overall, the review is well crafted, well structured and appropriately referenced. While it is not a 'systematic review', I do not think this takes away from the overall message in any meaningful way. The conclusions are solid and not over-reaching. It highlights at times a lack of pediatric burn epidemiology that is published, and will serve as a guide for future researches who wish to tackle this patient population.
Author Response
Thank you very much for taking the time to review my manuscript and for your thoughtful feedback. The revisions which have been made based on reviewers comments are highlighted in the document attached.
The article entitled "What changes have occurred in the pattern of paediatric burns over the last decade?" is a general review of trends in pediatric burn epidemiology over the past ten years, with a special focus on changes during the COVID-19 pandemic.
Overall, the review is well crafted, well structured and appropriately referenced. While it is not a 'systematic review', I do not think this takes away from the overall message in any meaningful way. The conclusions are solid and not over-reaching. It highlights at times a lack of pediatric burn epidemiology that is published, and will serve as a guide for future researches who wish to tackle this patient population.
