Burn injury in a patient with down syndrome: an urgent call for an inclusive approach in burn management

Timothy Aditya Santoso¹, Jeslyn Tengkawan², Nandita Melati Putri¹, Akhmad Noviandi Syarif¹, Aditya Wardhana¹,
¹Division of Plastic Surgery, Department of Surgery, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Central Jakarta, Jakarta, Indonesia
²Capella Project Foundation, Jakarta, Jakarta, Indonesia

Abstract

Introduction
Children with special needs are more prone to injuries, including burns, especially those who come from low socioeconomic status. This report presents a burn injury in a patient with Down syndrome (DS) from a low-educated family and proposes an inclusive approach for patients with DS as the underrepresented population.

Case Summary
A 9-year-old girl with DS and communication difficulties came to the hospital with mid-dermal to full-thickness burn of 50% body surface area due to flash burn on her face, anterior trunk, and all four limbs, which required early escharotomy. She was left alone in the bedroom when the blast accidentally happened. As the incident occurred, the family prioritized managing the damaged house, yet neglecting the child. Without any immediate burn management, the family brought the child to primary health care 30 minutes later and was then referred to the hospital.

Discussion
To this date, burn management has not been inclusive and taken into account patients with disability. DS inarguably impacts patient’s physical and mental state. We propose a more inclusive strategy for preventing burn injuries and educating patients with DS or other intellectual disabilities and those from low-income families: 1) advocating for burn prevention in poverty areas proactively; 2) educating families in special-needs schools regarding burn injuries; 3) specific training for healthcare workers to provide culturally sensitive care with the non-discriminative and non-stigmatized approach; 4) physical co-morbidities and unique conditions (e.g., respiratory tract anatomy variance, immune defects, and presence of heart disease that might contribute to fluid calculations).

Biography

Timothy Aditya is a second-year Plastic Surgery Resident from Faculty of Medicine Universitas Indonesia. He is passionate about improving health through plastic surgery, specifically in eastern Indonesia, a resource-limited area.