C-reactive protein trajectories in children treated for suspected burn wound infection following minor scald burns

Background Burn wound infection (BWI) is a leading cause of morbidity in paediatric burns. Distinguishing infection from post-burn systemic inflammatory response syndrome (SIRS) is challenging in minor burns where biomarker patterns are poorly characterised. C-reactive protein (CRP) is widely used clinically, yet its temporal behaviour in this setting remains unclear. Aim This study aimed to characterise CRP trajectories over seven days post-burn in children with minor scalds, comparing patterns between those treated with systemic antibiotics for clinically suspected BWI and those not treated. A secondary aim was to explore whether CRP elevations associate more strongly with suspected infection than burn size alone. Methods This retrospective single-centre study included 344 children treated for scald injuries between 2015 and 2020. Serial CRP values from day 0–7 were extracted from medical records. Trajectories were compared using mixed-effects modelling, epidemiological differences with non-parametric tests, and antibiotic prescription factors with logistic regression. Results Antibiotics were prescribed in 26% of children. CRP trajectories diverged significantly from day 2 to day 6 post-burn (all p < 0.05), with antibiotic-treated children showing a mean difference of 13 mg/L in the first week ( p = 0.008). Burn size contributed modestly to CRP variation (2 mg/L per 1% TBSA). Children treated for infection had larger burns and longer hospital stays. Conclusion CRP trajectories differ substantially between children treated and not treated with antibiotics for suspected infection, while burn size explains only a small proportion of variation. CRP kinetics may serve as a clinical adjunct when infection is suspected, though cautious interpretation is warranted given the interaction between biomarker levels and treatment decisions.