Skull burns resulting in calvarial defects: Cognitive and affective outcomes

Objective: To determine the extent of cognitive and affective difficulties experienced in children with full thickness burns of the calvaria caused by flame and electrical sources. Methods: Medical records were examined retrospectively to identify patients with full thickness burns of the calvaria. Data were reviewed from the acute period and long term for these patients and their matched controls. Results: Fourteen children were identified who sustained full thickness burns. The average age of injury was 7.1 ± 7.3 years and average percent TBSA was 39.7 ± 26.3. Of these 14 patients, 8 were under the age of 4 years at the time of injury and suffered flame injuries. Six children were over 11 years old at injury and suffered electrical burns. Imaging was performed on 10 patients acutely and revealed 5 with major brain injury. The youngest patients suffering flame injuries experienced significant difficulty with developmental functioning acutely and a trend towards long-term cognitive difficulty. Older children did not differ from their matched controls at any time. Conclusions: Children with burns to the calvarium can be at risk for affective and cognitive sequalae. Therefore, we recommend comprehensive neuropsychological evaluations at multiple time points to adequately assess functioning across time.