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Williford DN, Jackson CB, Durkin K, Langholz A, Aballay A, Duncan CL. Utility of a Pediatric Psychosocial Screener in an Outpatient Burn Clinic. J Burn Care Res 2024; 45:630-637. [PMID: 38050330 PMCID: PMC11073576 DOI: 10.1093/jbcr/irad190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Indexed: 12/06/2023]
Abstract
Psychosocial concerns are common among youth who sustained a burn injury. Detecting psychosocial distress early is essential to ensure appropriate treatment and referrals. Thus far, research has focused largely on the long-term outcomes of pediatric burn survivors. The current quality improvement initiative details the implementation and outcomes of brief, pragmatic screening to assess psychosocial concerns among pediatric burn survivors in an outpatient setting. A primary caregiver completed an age-appropriate psychosocial screener for youth aged 4-10 years (n = 69), while patients aged 11-17 years (n = 72) completed a self-report screener. Total scores were used to categorize patients as acute risk (i.e., emotional concerns requiring immediate attention), moderate risk (i.e., elevated symptoms, but no immediate safety concerns), or low risk (i.e., endorsing few to no symptoms). Patients with acute risk were evaluated by medical staff to determine the need for immediate psychiatric intervention or social services referrals. Patients with moderate risk met with the on-site psychology team during their clinic visit or were contacted by telephone within 1 week. Patients in the low-risk category warranted no additional follow-up post-screening. Most patients scored in the low-risk category (n = 120; 85%), while 11% (n = 16) and 4% (n = 5) endorsed symptoms consistent with moderate and acute risk, respectively. Results demonstrate the utility of implementing pediatric psychosocial screening in an outpatient burn clinic, the importance of detecting psychosocial concerns in this context, and usage of referrals to address concerns. Findings also shed light on key caveats of psychosocial screening, barriers to accessing psychosocial support, and the potential benefits of embedded psychological support during medical visits.
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Affiliation(s)
- Desireé N Williford
- Department of Psychology, West Virginia University, Morgantown, WV 26506, USA
- West Penn Hospital Burn Center, Allegheny Health Network, Pittsburgh, PA 15224, USA
| | - Carrie B Jackson
- Department of Psychology, West Virginia University, Morgantown, WV 26506, USA
- West Penn Hospital Burn Center, Allegheny Health Network, Pittsburgh, PA 15224, USA
| | - Kristine Durkin
- Department of Psychology, West Virginia University, Morgantown, WV 26506, USA
- West Penn Hospital Burn Center, Allegheny Health Network, Pittsburgh, PA 15224, USA
| | - Ariana Langholz
- West Penn Hospital Burn Center, Allegheny Health Network, Pittsburgh, PA 15224, USA
| | - Ariel Aballay
- West Penn Hospital Burn Center, Allegheny Health Network, Pittsburgh, PA 15224, USA
| | - Christina L Duncan
- Department of Psychology, West Virginia University, Morgantown, WV 26506, USA
- West Penn Hospital Burn Center, Allegheny Health Network, Pittsburgh, PA 15224, USA
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Potter M, Aaron D, Mumford R, Ward L. An evaluation of clinical psychology input into burns multidisciplinary follow-up clinics. Scars Burn Heal 2023; 9:20595131221141083. [PMID: 36632429 PMCID: PMC9827515 DOI: 10.1177/20595131221141083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Introduction Research highlights the complex psychological needs that patients and their families can face following a burn injury, regardless of the objective severity of the injury and often beyond the timeframe of physical healing. Identification of psychological needs at different stages post-burn recovery is therefore a key role of clinical psychologists working in burn care services. Method This paper presents audit data collected across a two-year period in routine paediatric and adult multidisciplinary team follow-up clinics in a UK burns service. 808 clinical contacts (331 adults, 477 paediatrics) were recorded. Data gathered related to the identification of patient and/or family psychological need and the level of psychology input within clinic. Results For 43% of adult patients and 46% of paediatric patients seen in clinic, some degree of psychological need for the patient and/or family was identified during the consultation. A large majority of concerns related directly to the burn injury. This is consistent with previous research into the psychological impact of burns. Even for patients with no identified psychological needs, psychology presence enabled the opportunity for brief screening, preventative advice or signposting to take place during clinic. Discussion A substantial number of individuals and families presented with some level of psychological concern in relation to a burn injury when attending burns multidisciplinary team follow-up clinics. Conclusion A substantial number of patients and families presented with psychological needs in relation to a burn injury when attending burns MDT follow-up clinics. The presence of Clinical Psychologists at burns MDT follow-up clinics is beneficial for the identification of burns and non-burns related psychological concerns and is a valuable use of psychological resources within a burns service. Lay Summary The Regional Burns Centre holds regular outpatient scar clinics to monitor recovery and healing. As well as the medical professionals, the clinics are joined by Clinical Psychologists who can assess, refer, and support individuals struggling with their burn or scarring on a mental level. Over 15 months, data was collected about patients attending the clinics and the involvement of the psychologists. 43% of adult patients and 46% of paediatric patients were identified as having some psychological need, either related to their burn or to other aspects of their life. This demonstrates the benefits of having psychology presence within scar clinics, as nearly half of the patients seen in clinic received an assessment and further support (such as signposting and referrals to psychological support). Burns staff also felt that psychology presence enhanced conversations and increased collaboration with decision making around treatment.
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Affiliation(s)
- Melissa Potter
- Department of Clinical Health Psychology, Mid Yorkshire
Hospitals NHS Trust, Wakefield, Yorkshire, UK,Melissa Potter, Department of Clinical
Health Psychology, Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefield
WF1 4DG, Yorkshire, UK.
| | - David Aaron
- Department of Clinical Health Psychology, Mid Yorkshire
Hospitals NHS Trust, Wakefield, Yorkshire, UK
| | - Rachel Mumford
- Department of Clinical Health Psychology, Mid Yorkshire
Hospitals NHS Trust, Wakefield, Yorkshire, UK
| | - Lucy Ward
- Department of Clinical Health Psychology, Mid Yorkshire
Hospitals NHS Trust, Wakefield, Yorkshire, UK
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Screening for Depression and Posttraumatic Stress Disorder in Patients With Burns. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2021.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Nosanov LB, Prindeze NJ, Schneider DM, Clemente LE, Parrish KR, Travis TE, Shupp JW, Johnson LS. Prevalence and risk factors for acute stress disorder and posttraumatic stress disorder after burn injury. Am J Surg 2021; 223:151-156. [PMID: 34330520 DOI: 10.1016/j.amjsurg.2021.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/10/2021] [Accepted: 07/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Psychological consequences of burn injury can be profound. Acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) are known sequelae, but routine identification is challenging. This study aims to identify patient characteristics associated with outpatient positive screens. METHODS The Primary Care Posttraumatic Stress Disorder questionnaire (PC-PTSD-4) was administered at initial outpatient Burn Center visits between 5/2018-12/2018. Demographics, injury mechanism, and total body surface area (TBSA) were recorded. Those with ≥3 affirmative answers were considered positive. Patients with positive and negative screens were compared. RESULTS Of 307 surveys collected, 292 (median TBSA 1.5 %, IQR 0.5-4.0 %) remained for analysis after exclusions. Of those, 24.0 % screened positive. Positive screens were associated with presence of a deep component of the injury, injury mechanism, upper extremity involvement, ICU admission, and prolonged hospital length of stay. CONCLUSIONS Numerous factors distinguish burn injury from other traumatic mechanisms and contribute to disproportionate rates of traumatic stress disorders. Optimization of burn-oriented ASD and PTSD screening protocols can enable earlier intervention.
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Affiliation(s)
- Lauren B Nosanov
- Department of Surgery, Weill Cornell Medicine, New York, NY, USA; Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA
| | - Nicholas J Prindeze
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA; The Burn Center, Department of Surgery, MedStar Washington Hospital Center, USA; Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA
| | - Daniel M Schneider
- The Burn Center, Department of Surgery, MedStar Washington Hospital Center, USA; Department of Psychiatry, Georgetown University School of Medicine, Washington, DC, USA
| | - Lisa E Clemente
- The Burn Center, Department of Surgery, MedStar Washington Hospital Center, USA
| | - Katherine R Parrish
- The Burn Center, Department of Surgery, MedStar Washington Hospital Center, USA; Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA
| | - Taryn E Travis
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA; The Burn Center, Department of Surgery, MedStar Washington Hospital Center, USA; Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA
| | - Jeffrey W Shupp
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA; The Burn Center, Department of Surgery, MedStar Washington Hospital Center, USA; Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA; Department of Biochemistry and Molecular and Cellular Biology, Georgetown University School of Medicine, Washington, DC, USA
| | - Laura S Johnson
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA; The Burn Center, Department of Surgery, MedStar Washington Hospital Center, USA; Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA.
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Lerman SF, Sylvester S, Hultman CS, Caffrey JA. Suicidality After Burn Injuries: A Systematic Review. J Burn Care Res 2021; 42:357-364. [PMID: 33482003 DOI: 10.1093/jbcr/irab014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Burn survivors may be at increased risk for suicide due to the nature of their injury and psychiatric comorbidities. The purpose of this review is to assess the evidence as to the prevalence of suicidal ideations and behaviors (attempts and completed suicides) in burn survivors as well as evaluate risk and protective factors. PubMed, EMBASE, CINAHL, Cochrane, PsycINFO, and Web Science databases were searched using search terms regarding suicide, suicidality, and burn. Fourteen full-text manuscripts and two published abstracts were included in the review. Overall, burn survivors demonstrate elevated suicidal ideations and a higher lifetime prevalence of suicide attempts compared to the general population. There is mixed evidence as to rates of completed suicide postburn injury, though rates appear to be relatively low. Risk factors include pain at discharge, perceived level of disfigurement, premorbid psychiatric comorbidities, and past suicide attempts. Results of this systematic review shed light on the scarcity of data on rates of suicidality among burn survivors, which is surprising given the multiple risk factors burn survivors possess including chronic pain, sleep disturbances, history of substance abuse, posttraumatic stress disorder, social isolation, and depression which are linked to suicidality in the general population. Suicide risk screening should be included as an integral part of burn survivors' care, and more research is needed to better understand the magnitude of this phenomenon and offer targeted interventions to vulnerable individuals.
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Affiliation(s)
- Sheera F Lerman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Scott Sylvester
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - C Scott Hultman
- Department of Plastic and Reconstructive Surgery, Division of Burn Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Julie A Caffrey
- Department of Plastic and Reconstructive Surgery, Division of Burn Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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