The significance of peripheral skin temperature measurement during the acute phase of burn injury: an illustrative case report

An increase in the gradient between core and peripheral skin temperature is a common finding during the early post burn period which is often interpreted as an indication of inadequate circulating blood volume. In this case study we monitored the pattern of rectal and skin surface (toe) temperature and skin blood flow (by laser Doppler imaging) during the first 16 h after a 34% bath scald in a child (female) of 36 months. In the absence of invasive monitoring of cardiac output, clinical assessment of the adequacy of fluid resuscitation was made from changes in hourly urine volumes and regular (4-h) monitoring of haematocrit. Peripheral vasoconstriction, leading to an increase in the temperature gradient between the inside and outside of the body, was not related to either a fall in urine volume or to haemoconcentration. We suggest that during the first 16 h after burn injury, widening of the core-to-peripheral temperature gradient cannot be used reliably as a clinical indicator of inadequate circulating blood volume.