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Won P, Stoycos S, Johnson M, Gillenwater TJ, Yenikomshian HA. Psychiatric Illness and Substance Abuse: Unaddressed Factors in Burn Injury. J Burn Care Res 2023; 44:1393-1399. [PMID: 36976523 PMCID: PMC10533723 DOI: 10.1093/jbcr/irad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Indexed: 03/29/2023]
Abstract
Patients with psychiatric illness and substance use comorbidities have high rates of burn injuries and experience prolonged hospital admissions. This retrospective chart review characterizes this marginalized population's inpatient burn care and examines post-discharge outcomes compared to burn patients without psychiatric or substance use comorbidities treated at our center. Patients admitted to a single burn center from January 1, 2018 to June 1, 2022 were included. Patient demographics, history of psychiatric disorders, treatment course, and post-discharge outcomes were collected. A total of 1660 patients were included in this study, of which 91 (6%) patients were diagnosed for psychiatric comorbidity and/or substance use comorbidity on admission for burn care. In this cohort of 91 patients with psychiatric and/or substance use comorbidities, the majority of patients were undomiciled (66%) and male (67%). In this cohort, 66 (72%) patients reported recent history or had positive urine toxicology results for illicit substances on admission. In this cohort, a total of 25 (28%) patients had psychiatric comorbidity at the time of burn injury or admission and 69 (76%) patients received inpatient psychiatric care, with 31 (46%) patients requiring psychiatric holds. After discharge, the readmission rate within 1 year of patients with psychiatric and/or substance use comorbidity was over four times greater than that of patients without psychiatric and/or substance use comorbidity. The most common causes of readmission were subsequent mental health crisis (40%) and inability to perform burn care (32%). Our study presents strategies to improve burn care for this marginalized and high-risk population.
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Affiliation(s)
- Paul Won
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sarah Stoycos
- Department of Psychiatry and the Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Maxwell Johnson
- Department of Psychiatry and the Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - T. Justin Gillenwater
- Division of Plastic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Haig A. Yenikomshian
- Division of Plastic Surgery, University of Southern California, Los Angeles, CA, USA
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2
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Tiongco RFP, Dane JM, Owens MA, Cemaj SL, Puthumana JS, Ross ES, Redett RJ, Hultman CS, Caffrey JA, Lerman SF. A Systematic Review and Meta-analysis of Sleep Disturbances in Pediatric Burn Survivors. CURRENT SLEEP MEDICINE REPORTS 2022. [DOI: 10.1007/s40675-022-00231-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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3
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Are burns a chronic condition? Examining patient reported outcomes up to 20 years after burn injury-A Burn Model System National Database investigation. J Trauma Acute Care Surg 2022; 92:1066-1074. [PMID: 35081598 PMCID: PMC9133040 DOI: 10.1097/ta.0000000000003547] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND People living with burn injury often face long-term physical and psychological sequelae associated with their injuries. Few studies have examined the impacts of burn injuries on long-term health and function, life satisfaction, and community integration beyond 5 years postinjury. The purpose of this study was to examine these outcomes up to 20 years after burn injury. METHODS Data from the Burn Model System National Longitudinal Database (1993-2020) were analyzed. Patient-reported outcome measures were collected at discharge (preinjury status recall) and 5 years, 10 years, 15 years, and 20 years after injury. Outcomes examined were the SF-12/VR-12 Physical Component Summary and Mental Component Summary, Satisfaction with Life Scale, and Community Integration Questionnaire. Trajectories were developed using linear mixed models with repeated measures of outcome scores over time, controlling for demographic and clinical variables. RESULTS The study population included 421 adult burn survivors with a mean age of 42.4 years. Lower Physical Component Summary scores (worse health) were associated with longer length of hospital stay, older age at injury and greater time since injury. Similarly, lower Mental Component Summary scores were associated with longer length of hospital stay, female sex, and greater time since injury. Satisfaction with Life Scale scores decrease negatively over time. Lower Community Integration Questionnaire scores were associated with burn size and Hispanic/Latino ethnicity. CONCLUSION Burn survivors' physical and mental health and satisfaction with life worsened over time up to 20 years after injury. Results strongly suggest that future studies should focus on long-term follow-up where clinical interventions may be necessary. LEVEL OF EVIDENCE Prognostic and Epidemiologic; Level III.
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4
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Cuttle L, Fear M, Wood FM, Kimble RM, Holland AJA. Management of non-severe burn wounds in children and adolescents: optimising outcomes through all stages of the patient journey. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:269-278. [PMID: 35051408 DOI: 10.1016/s2352-4642(21)00350-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 12/11/2022]
Abstract
Paediatric burn injuries are common, especially in children younger than 5 years, and can lead to poor physical and psychosocial outcomes in the long term. In this Review, we aim to summarise the key factors and interventions before hospital admission and following discharge that can improve the long-term outcomes of paediatric burns. Care can be optimised through first aid treatment, correct initial assessment of burn severity, and appropriate patient referral to a burns centre. Scar prevention or treatment and patient follow-up after discharge are also essential. As most burn injuries in children are comparatively small and readily survivable, this Review does not cover the perioperative management associated with severe burns that require fluid resuscitation, or inhalational injury. Burns disproportionately affect children from low socioeconomic backgrounds and those living in low-income and middle-income countries, with ample evidence to suggest that there remains scope for low-cost interventions to improve care for those patients with the greatest burden of burn injury. Current knowledge gaps and future research directions are discussed.
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Affiliation(s)
- Leila Cuttle
- Centre for Children's Health Research, Faculty of Health, School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Mark Fear
- Burn Injury Research Unit, School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Fiona M Wood
- Burn Injury Research Unit, School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia; Burns Service of Western Australia, Perth Children's Hospital and Fiona Stanley Hospital, Perth, WA, Australia
| | - Roy M Kimble
- Centre for Children's Burns and Trauma Research, The University of Queensland, South Brisbane, QLD, Australia; Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Andrew J A Holland
- The Children's Hospital Burns Research Institute, The Children's Hospital at Westmead, The University of Sydney, NSW, Westmead, Australia
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5
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Hutchinson KA, Amirali Karmali S, Abi-Jaoude J, Edwards T, Homsy C. Sleep Quality Among Burn Survivors And The Importance Of Intervention: A Systematic Review And Meta-Analysis. J Burn Care Res 2022; 43:1358-1379. [PMID: 35349676 DOI: 10.1093/jbcr/irac039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Burn survivors undergo a plethora of physiologic disturbances which can greatly affect quality of life (QOL) and healing processes. This review aimed to systematically examine sleep quality among individuals with burns and to explore the effectiveness of interventions using a meta-analytic approach. A systematic review of the literature was conducted by searching for articles using various databases. Titles and abstracts were screened and full texts of retained articles were assessed based on eligibility criteria. Methodological quality was ascertained in all articles using various scales. Overall, 5,323 articles were screened according to titles and abstracts and 25 articles were retained following full-text screening. Of the twenty-five articles, 17 were assessed qualitatively while 8 were included in the meta-analysis. Based on the qualitative analysis, sleep was found to be negatively affected in burn patients. The subsample of 8 articles included in the meta-analysis showed an overall weighted mean effect size (Hedges's g) of 1.04 (SE = 0.4, 95% CI, z = 3.0; p < 0.01), indicating a large, positive effect of intervention on sleep quality for burn patients. This review was able to demonstrate the detrimental effects of burn injury on sleep quality. Several interventions have been examined throughout the literature and have shown to be beneficial for sleep quality. However, there is great heterogeneity between existing interventions. The results from this review suggest that further research is needed before recommendations can be made as to which intervention is most effective at improving sleep in patients suffering from burn injuries.
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Affiliation(s)
| | | | | | - Thomas Edwards
- University of Ottawa, Faculty of Health Sciences, School of Human Kinetics, Ottawa, Ontario, Canada
| | - Christopher Homsy
- Department of Surgery, Division of Plastic Surgery, Tufts Medical Center, Boston, USA
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6
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Patel KF, Rodríguez-Mercedes SL, Grant GG, Rencken CA, Kinney EM, Austen A, Hou C, Brady KJS, Schneider JC, Kazis LE, Ryan CM. Physical, Psychological, and Social Outcomes in Pediatric Burn Survivors Ages 5 to 18 Years: A Systematic Review. J Burn Care Res 2022; 43:343-352. [PMID: 34922361 PMCID: PMC9272085 DOI: 10.1093/jbcr/irab225] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Acute pediatric burn injuries often result in chronic sequelae that affect physical, psychological, and social outcomes. To date, no review has comprehensively reported on the impact of burn injuries across all three domains in school-aged children. The aim of this systematic review was to identify published literature that focuses on the impact of burn injuries on physical, psychological, or social functioning, and report upon the nature of study characteristics and their outcomes. We included literature published after 1980, focusing on burn outcomes in children aged 5 to 18 years. Each eligible study was systematically reviewed and primary outcomes were classified into outcome domains based on existing frameworks. Fifty-eight studies met inclusion criteria, and reported on physical (n = 24), psychological (n = 47), and social (n = 29) domains. The majority of the studies had sample sizes of <100 participants, burn size of <40%, and findings reported by parents and/or burn survivors. Only eight of 107 different measures were used in three or more studies. Parents and burn survivors generally reported better physical and social outcomes and worse psychological functioning compared to non-burn populations. Physical disabilities were associated with psychological and social functioning in several studies. Follow-up data reported improvements across domains. This review demonstrates the importance of physical, psychological, and social status as long-term outcomes in burn survivors. Mixed findings across three outcome domains warrant long-term research. Findings of this review will guide the foundation of comprehensive burn and age-specific instruments to assess burn recovery.
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Affiliation(s)
- Khushbu F. Patel
- Department of Clinical Research, Shriners Hospitals for Children – Boston®, Massachusetts, Massachusetts, USA
- Department of Surgery, Massachusetts General Hospital, Boston, USA
| | | | | | - Camerin A. Rencken
- Department of Clinical Research, Shriners Hospitals for Children – Boston®, Massachusetts, Massachusetts, USA
- Department of Surgery, Massachusetts General Hospital, Boston, USA
| | - Erin M. Kinney
- Department of Clinical Research, Shriners Hospitals for Children – Boston®, Massachusetts, Massachusetts, USA
| | - Amelia Austen
- Department of Clinical Research, Shriners Hospitals for Children – Boston®, Massachusetts, Massachusetts, USA
| | - Carina Hou
- Department of Clinical Research, Shriners Hospitals for Children – Boston®, Massachusetts, Massachusetts, USA
| | - Keri J. S. Brady
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Massachusetts, USA
| | - Jeffrey C. Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lewis E. Kazis
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Colleen M. Ryan
- Department of Clinical Research, Shriners Hospitals for Children – Boston®, Massachusetts, Massachusetts, USA
- Department of Surgery, Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Shriners Hospitals for Children – Boston®, Massachusetts, USA
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7
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Zuccaro J, Budd D, Kelly C, Fish JS. Pruritus in the Pediatric Burn Population. J Burn Care Res 2022; 43:1175-1179. [DOI: 10.1093/jbcr/irac006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Post-burn pruritus is a significant issue that can have a devastating impact on patient quality of life. Despite its known negative impact, few studies have focused on the pediatric population. Thus, the aim of this study was to determine the incidence of pruritus among pediatric burn patients as well as identify its predictive factors and commonly used treatments, including the novel use of laser therapy. A retrospective analysis of all burn patients treated at our pediatric burn centre from 2009 to 2017 was conducted. The primary outcome measure was the presence or absence of pruritus at any point following the burn. One thousand seven hundred and eighty-three patients met the inclusion criteria for this study. The mean age at injury was 3.67 years (SD 4.02) and the mean burn TBSA was 3.48% (SD 4.81) with most burns resulting from scalds (66%). In total, 665 patients (37.3%) experienced pruritus. Following multivariable logistic regression, TBSA, age > 5 years, burns secondary to fire/flames, and burn depth, were identified as significant predictors of pruritus (p < 0.05). Pruritus was treated with diphenhydramine (85.0%), hydroxyzine (37.3%), and gabapentin (4.2%) as well as massage (45.7%), pressure garments (20.0%), and laser therapy (8.6%). This study addresses the knowledge gap in literature related to post-burn pruritus among pediatric patients and includes one of the largest patient cohorts published to date. Moreover, the results further contribute to our understanding of post-burn pruritus in children and may help us to predict which patients are most likely to be affected, so that treatment can be initiated as soon as possible.
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Affiliation(s)
- Jennifer Zuccaro
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Diandra Budd
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Charis Kelly
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joel S Fish
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
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8
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Wiseman J, Simons M, Kimble R, Ware RS, McPhail SM, Tyack Z. Effectiveness of topical silicone gel and pressure garment therapy for burn scar prevention and management in children 12-months postburn: A parallel group randomised controlled trial. Clin Rehabil 2021; 35:1126-1141. [PMID: 34107792 DOI: 10.1177/02692155211020351] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The longer-term effectiveness of silicone and pressure burn scar interventions was evaluated at 12-months postburn. DESIGN Parallel group, randomised trial. SETTING Hospital outpatient clinics, research centre. PARTICIPANTS Children referred for burn scar management following grafted or spontaneously healed acute burn injuries or scar reconstruction surgery. INTERVENTIONS Participants were randomised to: (1) topical silicone gel only, (2) pressure garment only, or (3) combined topical silicone gel and pressure garment. MAIN MEASURES Primary outcomes were scar thickness (blinded ultrasound measurement) and itch intensity (caregiver proxy-report, numeric rating scale). RESULTS Of 153 participants randomised who received the interventions (silicone n = 51, pressure garment n = 49, combined n = 53), 86 were followed-up at 12-months postburn (n = 34, n = 28, n = 24). No differences were identified for the primary outcomes using intention-to-treat analysis. Scar thickness mean difference (95% confidence interval) = 0.00 cm (-0.04, 0.05); -0.03 cm (-0.07, 0.02); 0.03 cm (-0.02, 0.08) and scar itch = 0.09 (-0.88, 1.06); -0.21 (-1.21, 0.79); 0.30 (-0.73, 1.32) for silicone vs pressure; silicone vs combined and combined vs pressure respectively. No serious adverse effects occurred. CONCLUSION Similar to short-term results, the combined intervention offered no statistically or clinically significant benefit for improving the primary outcomes compared to each intervention alone. No differences in the primary outcomes were identified between the silicone and pressure alone groups.
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Affiliation(s)
- Jodie Wiseman
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, the University of Queensland, Brisbane, QLD, Australia
| | - Megan Simons
- Department of Occupational Therapy, Queensland Children's Hospital, Brisbane, QLD, Australia.,Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Roy Kimble
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, the University of Queensland, Brisbane, QLD, Australia.,Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD, Australia.,Clinical Informatics Directorate, Metro South Health, Woolloongabba, QLD, Australia
| | - Zephanie Tyack
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, the University of Queensland, Brisbane, QLD, Australia.,Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD, Australia
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9
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Issler-Fisher AC, Fisher OM, Haertsch PA, Li Z, Maitz PKM. Effectiveness and safety of ablative fractional CO 2 laser for the treatment of burn scars: A case-control study. Burns 2021; 47:785-795. [PMID: 33121852 DOI: 10.1016/j.burns.2020.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 09/14/2020] [Accepted: 10/02/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Burn scars are a major clinical challenge. The aim of this study was to determine the effectiveness and safety of one treatment with the ablative fractional CO2 laser (AFL-CO2) compared to standard burn scar treatment. METHOD From December 2014 to October 2018 patients were prospectively recruited and treatment effects analyzed by assessing various outcome parameters from the date of first consultation and after treatment. A case control study was conducted looking at the impact of one AFL-CO2 treatment compared to a cohort subjected to conventional conservative treatment. Adverse effects were noted at follow up. RESULTS 187 patients were included, with 167 in the AFL-CO2, and 20 in the control cohort. Baseline demographics and scar characteristics showed no significant differences. Ultrasound measured scar thickness as well as the Vancouver Scar Scale (VSS) revealed a significant reduction in the treatment cohort, but no significant improvement in the control group. The POSAS-O was significantly improved in both cohorts. Subjective parameters (POSAS-P, DN4-Pain, and modified D4Pruritus scores) decreased significantly in the AFL-CO2 cohort but remained unchanged in the control group. The BSHS-B quality of life score increased significantly in the AFL-CO2 group, but worsened at the follow up of the untreated patients. Sub-domain analyses found the biggest differences in Affect, Body Image, Heat Sensitivity, Treatment and Work. Complications occurred in 5 patients (2.9%). CONCLUSIONS This study demonstrates that AFL-CO2 is an effective and safe treatment modality for burn scars improving thickness, symptoms and quality of life of burn survivors when compared to conventional scar treatment.
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Affiliation(s)
- Andrea C Issler-Fisher
- Burns Unit, Concord Repatriation General Hospital, Sydney, Australia; ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia; Concord Clinical School, University of Sydney, Sydney, Australia.
| | - Oliver M Fisher
- School of Medicine, University of Notre Dame, Sydney, NSW 2010, Australia; University of New South Wales Department of Surgery, St George Hospital, Kogarah, Australia
| | - Peter A Haertsch
- Burns Unit, Concord Repatriation General Hospital, Sydney, Australia; Concord Clinical School, University of Sydney, Sydney, Australia
| | - Zhe Li
- Burns Unit, Concord Repatriation General Hospital, Sydney, Australia; ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia; Concord Clinical School, University of Sydney, Sydney, Australia
| | - Peter K M Maitz
- Burns Unit, Concord Repatriation General Hospital, Sydney, Australia; ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia; Concord Clinical School, University of Sydney, Sydney, Australia
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10
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Carrougher GJ, McMullen K, Amtmann D, Wolfe AE, Tenney D, Schneider JC, Yeakley J, Holavanahalli RK, Patterson L, Madison C, Gibran NS. "Living Well" After Burn Injury: Using Case Reports to Illustrate Significant Contributions From the Burn Model System Research Program. J Burn Care Res 2021; 42:398-407. [PMID: 32971531 PMCID: PMC10044562 DOI: 10.1093/jbcr/iraa161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The Burn Model System (BMS) program of research has been funded since 1993 by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). The overarching aim of this program is to improve outcomes and quality of life for people with burns in the areas of health and function, employment, and community living and participation. This review reports on BMS contributions that have affected the lives of individuals with a significant burn injury using case reports to associate BMS contributions with recovery. In January 2020, current BMS grantee researchers assessed peer-reviewed BMS publications from 1994 to 2020. Using case report methodology, contributions were linked to three individuals treated at one of the four Burn Model System institutions. With over 25 years of NIDILRR funding, unique BMS contributions to patient recovery were identified and categorized into one of several domains: treatment, assessment measures, sequelae, peer support, employment, and long-term functional outcomes. A second review for significant results of BMS research that add to the understanding of burn injury, pathophysiology, and recovery research was identified and categorized as injury recovery research. The case study participants featured in this review identified select NIDILRR research contributions as having direct, personal benefit to their recovery. The knowledge generation and clinical innovation that this research program has contributed to our collective understanding of recovery after burn injury is considerable. Using case study methodology with three adult burn survivors, we highlight the impact and individual significance of program findings and reinforce the recognition that the value of any clinical research must have relevance to the lives of the study population.
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Affiliation(s)
| | - Kara McMullen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Audrey E Wolfe
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Loren Patterson
- University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Nicole S Gibran
- Department of Surgery, University of Washington, Seattle, Washington
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11
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Amtmann D, Bamer AM, McMullen K, Kowalske K, Schneider JC, Gibran NS. Development of Proxy and Self-report Burn Model System Pediatric Itch Interference Scales: A National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System Study. J Burn Care Res 2021; 42:212-219. [PMID: 32810205 PMCID: PMC9165661 DOI: 10.1093/jbcr/iraa133] [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] [Indexed: 11/12/2022]
Abstract
Pruritus is a commonly reported symptom after burn injury. Valid and reliable scales to measure itch in pediatric burn survivors are important for treatment and epidemiological studies. This study sought to develop psychometrically sound, publicly available self- and proxy-report measures of itch for use in pediatric burn survivors suitable for use in research and clinical practice. A panel of burn experts developed a definition of itch interference and a set of parallel self- and proxy-report candidate items that covered important activities affected by itch. Candidate items were evaluated in cognitive interviews with pediatric burn survivors (n = 4) and proxies (n = 2). Items were translated to Spanish and administered in both English and Spanish to a sample (N = 264) of pediatric burn survivors and/or their proxy enrolled in the Burn Model System (BMS) longitudinal database. The mean age of the pediatric sample was 13 years and average time since burn 5 years. The final itch interference measures each included 5 parallel items calibrated using a one-parameter graded response item response theory model, with a mean of 50 representing the average itch interference of the sample. Reliability of the scores is excellent between the mean and two standard deviations above. Initial analyses provide support for validity of the score. Concordance between the self- and proxy-report scores was moderate (ICC = 0.68). The results support the reliability and validity of the itch scale in children and youth with burn injury. The new BMS Pediatric Itch Interference scales are freely and publicly available at https://burndata.washington.edu/itch.
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Affiliation(s)
- Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Alyssa M Bamer
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Kara McMullen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Karen Kowalske
- Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, Texas
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Nicole S Gibran
- Department of Surgery, University of Washington, Seattle, Washington
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12
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McBride CA, Patel B, Kimble RM, Stockton KA. Surgeon's practices and beliefs in Australia and New Zealand regarding the donor site wound for paediatric skin grafts. J Paediatr Child Health 2021; 57:58-63. [PMID: 32770784 DOI: 10.1111/jpc.15117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/15/2020] [Accepted: 07/13/2020] [Indexed: 11/30/2022]
Abstract
AIM Children's burns care in Australasia is performed by paediatric surgeons and by plastic surgeons. The aim was to determine practices regarding the donor site wound (DSW), and to explore any differences by training scheme or nature of unit (paediatric vs. mixed). METHODS Online survey of Australasian burns surgeons. RESULTS Forty surgeons responded. 23/40 paediatric surgeons, 23/40 worked in a stand-alone children's burns unit. All used powered dermatomes. Alginates were the most common DSW dressing. Idealised dressings favour patient factors over cost. Plastic, and mixed-practice, surgeons use a broader range of dermatome settings in children >1 year. Mixed practice surgeons use thicker settings. All surgeons see pain as a common DSW problem. Paediatric surgeons recognise itch as a problem. CONCLUSIONS While there are differences related to training scheme and the mix of patients being treated, there is a broader commonality of practice.
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Affiliation(s)
- Craig A McBride
- Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Bhaveshkumar Patel
- Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Roy M Kimble
- Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Kellie A Stockton
- Department of Physiotherapy, Queensland Children's Hospital, Brisbane, Queensland, Australia
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13
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Liang CY, Chen CC, Wang KY, Chung CH, Chang NW, Chien WC. Increased risk for sleep disorders in burn patients: A 14-year nationwide, population-based cohort study. Burns 2020; 47:1408-1415. [PMID: 33941399 DOI: 10.1016/j.burns.2020.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Burn is a major trauma that causes physical and psychosocial impairments, leading to sleep disorders. However, the data about risks for sleep disorders in patients over 3 years following burn injury are limited. AIM To investigate the long-term risks for sleep disorders in patients after burn injury and identify the high-risk population. METHODS A 14-year population-based cohort study was performed using data from the 2000-2013 Taiwan National Health Insurance Research Database (NHIRD) which was a valid representative sample of the total population. All diagnoses of medical records in NHIRD were made by physicians and coded according to the ICD-9-CM. Cases diagnosed with burns (ICD-9 CM: N-code 940-949 and E-code 890-899) were included. The control group (non-burn injury group) was comprised quadruple the number of cases matched by index date, sex and age. RESULTS In 2000-2013, among the 10,289 burn patients included and followed-up after the index year, burn injury significantly increased the risks for sleep disorders (Hazard Ratio; HR = 1.36, p = 0.044), including insomnia (HR = 1.41, p = 0.036), sleep disturbance (HR = 2.39, p = 0.005) and sleep apnoea (HR = 1.38, p = 0.029). Compared with the control group, those who were women (HR = 1.73, p = 0.021), adolescents (HR = 5.45, p < 0.001), aged 19-24 years (HR = 1.36, p = 0.034), aged 25-44 years (HR = 1.67, p = 0.007), had low income (HR = 2.14, p = 0.001), and without a history of mental disorders (HR = 1.41, p = 0.024) had significantly higher risks for developing sleep disorders when suffered burn injury. CONCLUSION Burn had long-term negative effects on sleep during both the first year of burn injury and the subsequent follow-up 14 years. It is important for physicians to long-term assess the sleep quality of burn patients regardless of the number of years after burn injury.
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Affiliation(s)
- Chun-Yu Liang
- School of Nursing, National Defense Medical Center, 4F., No.161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei City, Taiwan.
| | - Chien-Chang Chen
- Department of Nursing, Tri-Service General Hospital, No.325, Section 2, Cheng-Kung Road, Neihu District, Taipei City, Taiwan.
| | - Kwua-Yun Wang
- School of Nursing, National Defense Medical Center, 4F., No.161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei City, Taiwan; Department of Nursing, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City, Taiwan.
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei City, Taiwan; Taiwanese Injury Prevention and Safety Promotion Association, Room 4112, No.161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei City, Taiwan.
| | - Nai-Wen Chang
- School of Nursing, National Defense Medical Center, 4F., No.161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei City, Taiwan.
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei City, Taiwan; Department of Medical Research, Tri-Service General Hospital, No.325, Section 2, Cheng-Kung Road, Neihu District, Taipei City, Taiwan; Graduate Institute of Life Sciences, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei City, Taiwan.
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14
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Stewart D, Caradec J, Ziegfeld S, Reynolds E, Ostrander R, Parrish C. Predictors and Correlates of Pediatric Postburn Pruritus in Preschool Children of Ages 0 to 4. J Burn Care Res 2020; 40:930-935. [PMID: 31304968 DOI: 10.1093/jbcr/irz125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Pruritus is a common problem following burn injuries; however, the literature to date has focused on adult survivors and/or pediatric survivors of large burns. The current study examines acute postburn pruritus in children under the age of 4 years (N = 256) with smaller burns (mean TBSA = 3.99%), which represents the most common type of patient typically treated in pediatric burn centers. Parents rated their child for pruritus, irritability, and sleep disturbances; additionally, parents completed a self-report of distress. Nearly half (47.3%) were rated by parents as displayed some level of pruritus, with the greatest proportion rated as mild. Regression analysis indicated that child minority status, greater burn TBSA, and more days elapsed since burn predicted higher levels of pruritus. In turn, pruritus was positively correlated with child irritability, delayed sleep onset, sleep disturbance, and parent distress. Thus, our results indicate that parent-rated pruritus in young pediatric burn patients is important to evaluate, as itch is significantly associated with other important clinical outcomes as early as the first month of the burn for pediatric patients and their parents.
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Affiliation(s)
- Dylan Stewart
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jill Caradec
- Department of Psychology, Loyola University Maryland, Baltimore
| | - Susan Ziegfeld
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elizabeth Reynolds
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rick Ostrander
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Carisa Parrish
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland
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15
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Sibbett SH, Carrougher GJ, Pham TN, Mandell SP, Arbabi S, Stewart BT, Gibran NS. Burn survivors' perception of recovery after injury: A Northwest Regional Burn Model System investigation. Burns 2020; 46:1768-1774. [PMID: 33268159 DOI: 10.1016/j.burns.2020.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 09/10/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Previous reports suggest that many factors impact recovery from burn injury. To improve our understanding of these factors, we queried adult burn survivors using a mixed method design during the first year after injury. METHODS An anonymous, 2-page survey was developed and administered to adult burn survivors during routine outpatient clinic follow-up visits at a regional burn center. Participants rated issues of concern and their impacts on return to pre-burn activity levels. Both quantitative and qualitative data were obtained. Descriptive statistics were used to analyze quantitative data and thematic analysis was used to identify, analyze and report patterns from open-ended responses. RESULTS Over seven months in 2016, 187 patients completed the anonymous survey. Study participants were predominantly male, white, and non-Hispanic. Participants who had not yet returned to pre-burn function reported worse outcomes for all issues queried compared to those who had. Burn survivors from racial and ethnic minority groups reported greater difficulty with accessing medical care and information about their injury as well as higher levels of self-identified posttraumatic stress, issues related to appearance and concerns for loss of strength. Several themes and sub-themes were identified that had both negative and positive impact on early recovery. Such themes included: healing process, psychological recovery and emotional health, and community reintegration/employment. CONCLUSIONS Several themes from responses provided insight into challenges as well as key support systems during the first year of recovery after injury. Collectively, these findings can be used to direct clinical outpatient care, patient education and psychosocial support services.
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Affiliation(s)
- Stephen H Sibbett
- UW Medicine Regional Burn Center, Department of Surgery, University of Washington, 325 9th Avenue, Seattle, WA, 98104, United States.
| | - Gretchen J Carrougher
- UW Medicine Regional Burn Center, Department of Surgery, University of Washington, 325 9th Avenue, Seattle, WA, 98104, United States
| | - Tam N Pham
- UW Medicine Regional Burn Center, Department of Surgery, University of Washington, 325 9th Avenue, Seattle, WA, 98104, United States
| | - Samuel P Mandell
- UW Medicine Regional Burn Center, Department of Surgery, University of Washington, 325 9th Avenue, Seattle, WA, 98104, United States
| | - Saman Arbabi
- UW Medicine Regional Burn Center, Department of Surgery, University of Washington, 325 9th Avenue, Seattle, WA, 98104, United States
| | - Barclay T Stewart
- UW Medicine Regional Burn Center, Department of Surgery, University of Washington, 325 9th Avenue, Seattle, WA, 98104, United States
| | - Nicole S Gibran
- UW Medicine Regional Burn Center, Department of Surgery, University of Washington, 325 9th Avenue, Seattle, WA, 98104, United States
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Fractional Ablative Laser Therapy is an Effective Treatment for Hypertrophic Burn Scars. Ann Surg 2019; 274:e574-e580. [DOI: 10.1097/sla.0000000000003576] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hahn JM, Combs KA, Lloyd CM, McFarland KL, Boyce ST, Supp DM. Identification of Merkel cells associated with neurons in engineered skin substitutes after grafting to full thickness wounds. PLoS One 2019; 14:e0213325. [PMID: 30835771 PMCID: PMC6400390 DOI: 10.1371/journal.pone.0213325] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 02/18/2019] [Indexed: 02/07/2023] Open
Abstract
Engineered skin substitutes (ESS), prepared using primary human fibroblasts and keratinocytes with a biopolymer scaffold, were shown to provide stable closure of excised burns, but relatively little is known about innervation of ESS after grafting. This study investigated innervation of ESS and, specifically, whether Merkel cells are present in healed grafts. Merkel cells are specialized neuroendocrine cells required for fine touch sensation in skin. We discovered cells positive for keratin 20 (KRT20), a general marker for Merkel cells, in the basal epidermis of ESS after transplantation to mice, suggesting the presence of Merkel cells. Cells expressing KRT20 were not observed in ESS in vitro. However, widely separated KRT20-positive cells were observed in basal epidermis of ESS by 2 weeks after grafting. By 4 weeks, these cells increased in number and expressed keratins 18 and 19, additional Merkel cells markers. Putative Merkel cell numbers increased further between weeks 6 and 14; their densities varied widely and no specific pattern of organization was observed, similar to Merkel cell localization in human skin. KRT20-positive cells co-expressed epidermal markers E-cadherin and keratin 15, suggesting derivation from the epidermal lineage, and neuroendocrine markers synaptophysin and chromogranin A, consistent with their identification as Merkel cells. By 4 weeks after grafting, some Merkel cells in engineered skin were associated with immature afferents expressing neurofilament-medium. By 8 weeks, Merkel cells were complexed with more mature neurons expressing neurofilament-heavy. Positive staining for human leukocyte antigen demonstrated that the Merkel cells in ESS were derived from grafted human cells. The results identify, for the first time, Merkel cell-neurite complexes in engineered skin in vivo. This suggests that fine touch sensation may be restored in ESS after grafting, although this must be confirmed with future functional studies.
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Affiliation(s)
- Jennifer M. Hahn
- Research Department, Shriners Hospitals for Children – Cincinnati, Cincinnati, Ohio, United States of America
| | - Kelly A. Combs
- Research Department, Shriners Hospitals for Children – Cincinnati, Cincinnati, Ohio, United States of America
| | - Christopher M. Lloyd
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
| | - Kevin L. McFarland
- Research Department, Shriners Hospitals for Children – Cincinnati, Cincinnati, Ohio, United States of America
| | - Steven T. Boyce
- Research Department, Shriners Hospitals for Children – Cincinnati, Cincinnati, Ohio, United States of America
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
| | - Dorothy M. Supp
- Research Department, Shriners Hospitals for Children – Cincinnati, Cincinnati, Ohio, United States of America
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
- * E-mail:
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18
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Prasad A, Thode HC, Sandoval S, Singer AJ. The association of patient and burn characteristics with itching and pain severity. Burns 2019; 45:348-353. [PMID: 30686696 DOI: 10.1016/j.burns.2018.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/02/2018] [Accepted: 06/16/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Itch after burn injury causes significant distress to patients and can hamper functional recovery. Itching can persist on a time scale ranging from several weeks to even years after injury. In this study, we sought to determine predictors of itching after burn injury. METHODS We compared itch and pain severity among patients included in a burn registry at a level 1 trauma center. Both itch and pain severity was based on a 5-point scale. ANOVA, chi-squared, and multivariate analyses were performed to determine predictors of itch and pain severity. RESULTS Of the 1159 patients enrolled in the registry, 58% were male and 42% female, with a median age (IQR) of 27 (8-47) years. Most patients were diagnosed with 2nd degree superficial (41%) or deep (43%) burns. Upper extremities were the most common location of burn injury (59%), followed by lower extremities (31%), trunk (22%), and face/neck (20%). More than half (53%) of enrolled patients reported itching, ranging from minimal (19%) to severe (7%) itching. Multivariate analyses revealed age, sex (female), extent of burn injuries, and location (face/neck) to be predictors of itch after burn. Predictors of pain after burn were slightly different: age, extent of burn, and depth of burn. CONCLUSION Pain and itch after burn injuries are predicted by slightly different variables, presumably secondary to different underlying mechanisms. We conclude that age, sex (female), extent of burn injuries (total body surface area %), and injuries to the face/neck predict itching of greater severity. Patients with burn injuries that match these parameters would require greater care and closer follow up to reduce itching after healing.
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Affiliation(s)
- Atulya Prasad
- Department of Emergency Medicine, HSC-L4-080 Stony Brook Medicine, Stony Brook, NY 11794-8350, United States
| | - Henry C Thode
- Department of Emergency Medicine, HSC-L4-080 Stony Brook Medicine, Stony Brook, NY 11794-8350, United States
| | - Steven Sandoval
- Department of Surgery, HSC-L19 Stony Brook Medicine, Stony Brook, NY 11794, United States
| | - Adam J Singer
- Department of Emergency Medicine, HSC-L4-080 Stony Brook Medicine, Stony Brook, NY 11794-8350, United States.
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19
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Blankers K, Dankerlui N, van Loey N, Pursad M, Rode H, van Dijk M. Cross-cultural validation of the Itch Man Scale in pediatric burn survivors in a South African setting. Burns 2018; 45:725-731. [PMID: 30527642 DOI: 10.1016/j.burns.2018.09.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 07/18/2018] [Accepted: 09/28/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Pruritus or itch is a common symptom after burn injuries. The Itch Man Scale has been recommended to assess itch severity in children. The aim of this prospective observational study was to perform a cross-cultural validation of the Itch Man Scale by comparing it with the Numeric Rating Scale (NRS) and the Toronto Pediatric Itch Scale. METHOD At Red Cross War Memorial Children's Hospital in Cape Town, South Africa, parents of pediatric burn patients assessed their child's itch with the Itch Man Scale, NRS and Toronto Pediatric Itch Scale. Children from the age of 6years also rated the Itch Man Scale and NRS themselves. The Spearman rank order correlation between the different scales was calculated to determine construct validity. RESULTS Over a two-month period, 255 pediatric burn survivors with a median age of 2.3years (IQR 1.4-4.0) were included; 35 of them were aged 6-13years. Parents' Itch Man Scale ratings correlated significantly with parents' NRS ratings (0.82, 95% CI 0.78-0.86) and with the Toronto Pediatric Itch Scale of the parent (0.80, 95% CI 0.75-0.84). The correlation between the older children's Itch Man Scale rating and those of their parents was 0.66 (95% CI 0.37-0.83). CONCLUSION We concluded that the Itch Man Scale has promising validity and is a user-friendly tool to use in clinical practice to determine the itch intensity in children younger than 13years in a South African setting.
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Affiliation(s)
- Karlijn Blankers
- Department of Paediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Nick Dankerlui
- Department of Paediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Nancy van Loey
- Association of Dutch Burn Centers, Department Behavioral Research, Beverwijk, The Netherlands; Utrecht University, Department Clinical Psychology, Utrecht, The Netherlands
| | - Mereille Pursad
- Department of Occupational Therapy, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Heinz Rode
- Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Monique van Dijk
- Department of Paediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
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20
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Ciprandi G, Ramsay S, Budkevich L, Strack A, van Capellen P, Marathovouniotis N. A retrospective systematic data review on the use of a polihexanide-containing product on burns in children. J Tissue Viability 2018; 27:244-248. [DOI: 10.1016/j.jtv.2018.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 07/29/2018] [Accepted: 08/06/2018] [Indexed: 12/28/2022]
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21
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Herndon D, Capek KD, Ross E, Jay JW, Prasai A, Ayadi AE, Foncerrada-Ortega G, Blears E, Sommerhalder C, McMullen K, Amtmann D, Cox R, Hundeshagen G, Jennings K, Sousse LE, Suman OE, Meyer WJ, Finnerty CC. Reduced Postburn Hypertrophic Scarring and Improved Physical Recovery With Yearlong Administration of Oxandrolone and Propranolol. Ann Surg 2018; 268:431-441. [PMID: 30048322 PMCID: PMC6478032 DOI: 10.1097/sla.0000000000002926] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Massive burns induce a hypermetabolic response that leads to total body wasting and impaired physical and psychosocial recovery. The administration of propranolol or oxandrolone positively affects postburn metabolism and growth. The combined administration of oxandrolone and propranolol (OxProp) for 1 year restores growth in children with large burns. Here, we investigated whether the combined administration of OxProp for 1 year would reduce scarring and improve quality of life compared with control. STUDY DESIGN Children with large burns (n = 480) were enrolled into this institutional review board-approved study; patients were randomized to control (n = 226) or administration of OxProp (n = 126) for 1 year postburn. Assessments were conducted at discharge and 6, 12, and 24 months postburn. Scar biopsies were obtained for histology. Physical scar assessments and patient reported outcome measures of physical and psychosocial function were obtained. RESULTS Reductions in cellularity, vascular structures, inflammation, and abnormal collagen (P < 0.05) occurred in OxProp-treated scars. With OxProp, scar severity was attenuated and pliability increased (both P < 0.05). Analyses of patient-reported outcomes showed improved general and emotional health within the OxProp-treated group (P < 0.05). CONCLUSIONS Here, we have shown improvements in objective and subjective measures of scarring and an increase in overall patient-reported physical function. The combined administration of OxProp for up to a year after burn injury should be considered for the reduction of postburn scarring and improvement of long-term psychosocial outcomes in children with massive burns.
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Affiliation(s)
- David Herndon
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX
- Shriners Hospitals for Children - Galveston, Galveston, TX
- Institute for Translational Sciences, The University of Texas Medical Branch, Galveston, TX
| | - Karel D Capek
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX
- Shriners Hospitals for Children - Galveston, Galveston, TX
| | - Evan Ross
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX
- Shriners Hospitals for Children - Galveston, Galveston, TX
| | - Jayson W Jay
- Shriners Hospitals for Children - Galveston, Galveston, TX
- Institute for Translational Sciences, The University of Texas Medical Branch, Galveston, TX
| | - Anesh Prasai
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX
- Shriners Hospitals for Children - Galveston, Galveston, TX
| | - Amina El Ayadi
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX
- Shriners Hospitals for Children - Galveston, Galveston, TX
| | - Guillermo Foncerrada-Ortega
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX
- Shriners Hospitals for Children - Galveston, Galveston, TX
| | - Elizabeth Blears
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX
- Shriners Hospitals for Children - Galveston, Galveston, TX
- Institute for Translational Sciences, The University of Texas Medical Branch, Galveston, TX
| | - Christian Sommerhalder
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX
- Shriners Hospitals for Children - Galveston, Galveston, TX
| | - Kara McMullen
- Department of Rehabilitation Medicine, The University of Washington, Seattle, WA
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, The University of Washington, Seattle, WA
| | - Robert Cox
- Shriners Hospitals for Children - Galveston, Galveston, TX
- Department of Pathology, The University of Texas Medical Branch, Galveston, TX
| | - Gabriel Hundeshagen
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX
- Shriners Hospitals for Children - Galveston, Galveston, TX
- Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Heidelberg, Germany
| | - Kristofer Jennings
- Department of Preventative Medicine and Community Health, The University of Texas Medical Branch, Galveston, TX
| | - Linda E Sousse
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX
- Shriners Hospitals for Children - Galveston, Galveston, TX
| | - Oscar E Suman
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX
- Shriners Hospitals for Children - Galveston, Galveston, TX
| | - Walter J Meyer
- Department of Psychiatry and Behavioral Science, The University of Texas Medical Branch, Galveston, TX
| | - Celeste C Finnerty
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX
- Shriners Hospitals for Children - Galveston, Galveston, TX
- Institute for Translational Sciences, The University of Texas Medical Branch, Galveston, TX
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Reasons for Distress Among Burn Survivors at 6, 12, and 24 Months Postdischarge: A Burn Injury Model System Investigation. Arch Phys Med Rehabil 2018; 99:1311-1317. [DOI: 10.1016/j.apmr.2017.11.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 10/20/2017] [Accepted: 11/07/2017] [Indexed: 11/22/2022]
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Nieuwendijk SMP, de Korte IJ, Pursad MM, van Dijk M, Rode H. Post burn pruritus in pediatric burn patients. Burns 2018; 44:1151-1158. [PMID: 29563015 DOI: 10.1016/j.burns.2018.02.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 02/05/2018] [Accepted: 02/22/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Pruritus is a common problem seen in the healing process of a burn wound and gives great discomfort for the patient. Most research in this field has been done in the adult population, so evidence in the pediatric population is still lacking PURPOSE: The aims of this study were to assess the incidence and severity of post-burn pruritus, identify predictors for pruritus and evaluate the pharmacological treatments in a pediatric setting. METHODS Pruritus was assessed in this prospective observational study using a numeric rating scale and the Itch Man Scale applied by the patients' caregiver. The predictive values of candidate predictors for pruritus were compared using Fisher exact tests and Kruskal-Wallis tests. RESULTS 413 patients were included in this study. Pruritus was reported in 71.7% of the patients. Complete symptom relief was only achieved in 29.8% of the patients who used medication. Time since burn (p<0.001), depth of the injury (p=0.017), TBSA burned (p=0.001) and skin grafting (p=0.001) were found to be significant predictors for post-burn pruritus. CONCLUSION Post-burn pruritus is still a highly prevalent problem in pediatric burn care. Its intensity and frequency are higher especially in the first three months or with a deeper wound or a higher TBSA.
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Affiliation(s)
- Sophie Maria Pierrette Nieuwendijk
- Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Pediatric Surgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Iris Johanne de Korte
- Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Pediatric Surgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Mereille Marren Pursad
- Department of Pediatric Surgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Monique van Dijk
- Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Pediatric Surgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
| | - Heinz Rode
- Department of Pediatric Surgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
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Čapek KD, Culnan DM, Desai MH, Herndon DN. Fifty Years of Burn Care at Shriners Hospitals for Children, Galveston. Ann Plast Surg 2018; 80:S90-S94. [PMID: 29461291 PMCID: PMC5825277 DOI: 10.1097/sap.0000000000001376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
More than 50 years ago, Shriners Hospitals for Children expanded their philanthropy to include care for burned children. In so doing, the effects of their work weightily expanded from rehabilitation and quality of life outcomes to include survival proper. As the first facility dedicated to the care of burned children, originally designated the Shriners Burn Institute, the Galveston hospital remains the cornerstone of this endeavor. Shriners maintains charitable pediatric hospitals, provide care irrespective of the patient's or the family's ability to pay, and promote research. The sole criterion for admission at Shriners Hospitals for Children is the determination by a surgeon at a Shriners hospital that "the child's trouble may be corrected or improved." This philanthropic effort to provide medical care for children is one expression of the human commonality recognized by Shriners. In this article, we provide some background information on how this hospital came into existence as well as a global summary of its interventions toward greater survival and more complete rehabilitation of burned children. Based on the findings presented herein, we assert that there is less suffering and less loss of life due to childhood burns today than in previous years. We attribute much of this improvement to the simple voluntary collective decision by Shriners to provide alms for burned children.
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The National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System: Twenty Years of Contributions to Clinical Service and Research. J Burn Care Res 2018; 38:e240-e253. [PMID: 27294859 DOI: 10.1097/bcr.0000000000000361] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) established the Burn Model System (BMS) in 1993 to improve the lives of burn survivors. The BMS program includes 1) a multicenter longitudinal database describing the functional and psychosocial recovery of burn survivors; 2) site-specific burn-related research; and 3) a knowledge dissemination component directed toward patients and providers. Output from each BMS component was analyzed. Database structure, content, and access procedures are described. Publications using the database were identified and categorized to illustrate the content area of the work. Unused areas of the database were identified for future study. Publications related to site-specific projects were cataloged. The most frequently cited articles are summarized to illustrate the scope of these projects. The effectiveness of dissemination activities was measured by quantifying website hits and information downloads. There were 25 NIDILRR-supported publications that utilized the database. These articles covered topics related to psychological outcomes, functional outcomes, community reintegration, and burn demographics. There were 172 site-specific publications; highly cited articles demonstrate a wide scope of study. For information dissemination, visits to the BMS website quadrupled between 2013 and 2014, with 124,063 downloads of educational material in 2014. The NIDILRR BMS program has played a major role in defining the course of burn recovery, and making that information accessible to the general public. The accumulating information in the database serves as a rich resource to the burn community for future study. The BMS is a model for collaborative research that is multidisciplinary and outcome focused.
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Shahid F, Ismail M, Khan S. Assessment of quality of life in post burn survivors: A cross-sectional single-center first validation study from Pakistan. BURNS OPEN 2018. [DOI: 10.1016/j.burnso.2017.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Miraval FK, Shie VL, Morales-Quezada L, Santiago C, Fernandes-Marcondes B, Nadler D, Ryan CM, Schneider JC, Fregni F. A Preliminary Study on qEEG in Burn Patients With Chronic Pruritus. Ann Rehabil Med 2017; 41:693-700. [PMID: 28971055 PMCID: PMC5608678 DOI: 10.5535/arm.2017.41.4.693] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 11/20/2015] [Indexed: 11/05/2022] Open
Abstract
Objective To explore and determine the reorganizational changes in the cortical neural circuits associated with pruritis, this study was undertaken to compare the electroencephalography (EEG) changes in burn patients having primary symptoms of chronic itching (pruritis) and their paired healthy subjects. Methods Eight subjects were recruited for this exploratory pilot study: 4 patients with pruritus after burn injury matched by gender and age with 4 healthy subjects. EEG recordings were analyzed for absolute alpha, low beta, high beta, and theta power for both groups. Results The mean age of the burn patients was 41.75 years; while the mean age for the matched healthy subjects was 41.5 years. All subjects were male. A decreased alpha activity was observed in the occipital channels (0.82 vs. 1.4; p=0.01) and a decreased low beta activity in the frontal area (0.22 vs. 0.4; p=0.049) in eyes closed conditions. An overall decreased theta trend was observed in both the eyes open and eyes closed conditions in burn patients, compared to healthy individuals. Conclusion This preliminary study presents initial evidence that chronic pruritus in burn subjects may be associated with brain reorganizational changes at the cortical level characterized by an EEG pattern.
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Affiliation(s)
- Fiorella K Miraval
- Spaulding Center of Neuromodulation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Vivian L Shie
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Leon Morales-Quezada
- Spaulding Center of Neuromodulation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Bianca Fernandes-Marcondes
- Spaulding Center of Neuromodulation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Deborah Nadler
- Spaulding Center of Neuromodulation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Colleen M Ryan
- Surgical Services, Sumner M. Redstone Burn Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Shriners Hospitals for Children-Boston, Boston, MA, USA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Felipe Fregni
- Spaulding Center of Neuromodulation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
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DeJong HM, Phillips M, Edgar DW, Wood FM. Patient opinion of scarring is multidimensional: An investigation of the POSAS with confirmatory factor analysis. Burns 2016; 43:58-68. [PMID: 27576936 DOI: 10.1016/j.burns.2016.06.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/22/2016] [Accepted: 06/17/2016] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Scarring is a significant consequence for patients following a burn. Understanding how patients perceive the physiological scar and define scar severity may provide valuable information regarding how the scar influences quality of life after burn. The Patient and Observer Scar Assessment Scale was the first scar assessment tool validated to include the patients' evaluation of the scars physical qualities, following a burn. Validation studies of this tool have previously been conducted for a discrete scar-site after burn. The aim of this study was to assess the structural validity of the POSAS to capture the patients' evaluation of the total area of burn scar(s). METHOD Statistical analysis was based on 508 completed POSAS forms from 358 patients. Exploratory factor analysis (EFA) was used initially to identify the number of factors within the tool, then confirmatory factor analysis (CFA) using structural equation modelling explored areas of misfit within each factor and whether the model provided a predicable structure to capture patient perception of scar severity. RESULTS/DISCUSSION The CFA analysis confirmed that a two dimensional model was superior to a unidimensional model when assessing the patient opinion of their total burn scar. The two dimensions were the physical scar (color, stiffness, thickness and irregularity) and the sensory scar (pain and itch). Further strain analysis of the two factor model identified additional domains. Independent factors influenced the perception of color forming a separate subdomain within the physical domain. Color is a visual characteristic, whereas the other three are predominantly tactile characteristics. A significant relationship between thickness and irregularity suggested they may form another subdomain, however further research is required to confirm this. Both pain and itch were recognized as independent, multidimensional latent variables, which require assessment tools with multidimensional structures. CONCLUSIONS When assessing the entire burn scar, three independent dimensions influence patient perception: (1) the physical scar, (2) pain and (3) itch. Within the physical domain, color formed a visual subdomain separate to a tactile subdomain. Further development of these domains within a high-order multi-dimensional structure is recommended.
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Affiliation(s)
- Helen M DeJong
- Perth Scar and Pain Clinic, Mt Pleasant, 6153, WA, Australia; Medical Sciences, Edith Cowan Universtiy, Joondaplup, 6027, WA, Australia; Harry Perkins Institute for Medical Research, Nedlands, 6009, WA, Australia; Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, 6150, WA, Australia; Burn Injury Research Unit, University of Western Australia, Crawley, 6009, WA, Australia.
| | - Michael Phillips
- Harry Perkins Institute for Medical Research, Nedlands, 6009, WA, Australia; Centre for Medical Research, University of Western Australia, Crawley, 6009, WA, Australia; Royal Perth Hospital, Perth 6000, WA, Australia
| | - Dale W Edgar
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, 6150, WA, Australia; Burn Injury Research Unit, University of Western Australia, Crawley, 6009, WA, Australia; Burn Injury Research Node, The Universtiy of Notre Dame Australia, Fremantle, 6160, WA, Australia; State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, 6150, WA, Australia.
| | - Fiona M Wood
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, 6150, WA, Australia; Burn Injury Research Unit, University of Western Australia, Crawley, 6009, WA, Australia; Burn Injury Research Node, The Universtiy of Notre Dame Australia, Fremantle, 6160, WA, Australia; State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, 6150, WA, Australia; Child and Adolescent Health Service of Western Australia, Princess Margaret Hospital, Subiaco, 6008, WA, Australia.
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Risk factors for the development of heterotopic ossification in seriously burned adults: A National Institute on Disability, Independent Living and Rehabilitation Research burn model system database analysis. J Trauma Acute Care Surg 2016; 79:870-6. [PMID: 26496115 DOI: 10.1097/ta.0000000000000838] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Heterotopic ossification (HO) is a debilitating complication of burn injury; however, incidence and risk factors are poorly understood. In this study, we use a multicenter database of adults with burn injuries to identify and analyze clinical factors that predict HO formation. METHODS Data from six high-volume burn centers, in the Burn Injury Model System Database, were analyzed. Univariate logistic regression models were used for model selection. Cluster-adjusted multivariate logistic regression was then used to evaluate the relationship between clinical and demographic data and the development of HO. RESULTS Of 2,979 patients in the database with information on HO that addressed risk factors for development of HO, 98 (3.5%) developed HO. Of these 98 patients, 97 had arm burns, and 96 had arm grafts. When controlling for age and sex in a multivariate model, patients with greater than 30% total body surface area burn had 11.5 times higher odds of developing HO (p < 0.001), and those with arm burns that required skin grafting had 96.4 times higher odds of developing HO (p = 0.04). For each additional time a patient went to the operating room, odds of HO increased by 30% (odds ratio, 1.32; p < 0.001), and each additional ventilator day increased odds by 3.5% (odds ratio, 1.035; p < 0.001). Joint contracture, inhalation injury, and bone exposure did not significantly increase odds of HO. CONCLUSION Risk factors for HO development include greater than 30% total body surface area burn, arm burns, arm grafts, ventilator days, and number of trips to the operating room. Future studies can use these results to identify highest-risk patients to guide deployment of prophylactic and experimental treatments. LEVEL OF EVIDENCE Prognostic study, level III.
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Valenciano PJ, Itakussu EY, Trelha PhD CS, Fujisawa PhD DS. Quantitative postural analysis and pain in children and adolescents victims of burns. J Phys Ther Sci 2016; 27:3635-40. [PMID: 26834321 PMCID: PMC4713760 DOI: 10.1589/jpts.27.3635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 09/01/2015] [Indexed: 02/06/2023] Open
Abstract
[Purpose] This study aimed to quantitatively assess postural alignment in both frontal
and sagittal planes, as well as pain in children and adolescents victims of burn injuries.
[Subjects and Methods] This cross-sectional study included 21 victims of burns, nine
children (age [mean ± SD], 7.3 ± 1.1 yrs) and 12 adolescents (12,0 ± 1.4 yrs), classified
as medium and large burns, being investigated on pain and postural alignment evaluated by
photogrammetry. Pain intensity was assessed by face scales and postural examination
included the assessment of global and thoraco-lumbo-pelvic alignment by previously
designed protocols. [Results] Only two adolescents reported mild pain associated with burn
injuries, whereas deviations of the projection of the gravity center; forward head
posture, and scapular asymmetry were observed in both groups. In the analysis of the
thoraco-lumbo-pelvic alignment, children tended to have anterior inclination trunk,
increased thoracic kyphosis and lumbar lordosis, while in adolescents, increased thoracic
kyphosis and lumbar lordosis were observed. [Conclusion] The results indicate that due to
the postural alterations and asymmetries in both frontal and sagittal planes, there is an
increased risk of developing scoliosis and possible future pain. Thus, physiotherapy is
indicated and should be maintained until complete growth is reached.
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Affiliation(s)
- Paola Janeiro Valenciano
- Master's Program in Rehabilitation Sciences, Universidade Estadual de Londrina, Hospital Universitário, Brazil
| | - Edna Yukimi Itakussu
- Master's Program in Rehabilitation Sciences, Universidade Estadual de Londrina, Hospital Universitário, Brazil
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