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Tsurumi A, Flaherty PJ, Que YA, Ryan CM, Banerjee A, Chakraborty A, Almpani M, Shankar M, Goverman J, Schulz JT, Sheridan RL, Friedstat J, Hickey SA, Tompkins RG, Rahme LG. A PREVENTIVE TOOL FOR PREDICTING BLOODSTREAM INFECTIONS IN CHILDREN WITH BURNS. Shock 2023; 59:393-399. [PMID: 36597771 PMCID: PMC9991965 DOI: 10.1097/shk.0000000000002075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
ABSTRACT Introduction: Despite significant advances in pediatric burn care, bloodstream infections (BSIs) remain a compelling challenge during recovery. A personalized medicine approach for accurate prediction of BSIs before they occur would contribute to prevention efforts and improve patient outcomes. Methods: We analyzed the blood transcriptome of severely burned (total burn surface area [TBSA] ≥20%) patients in the multicenter Inflammation and Host Response to Injury ("Glue Grant") cohort. Our study included 82 pediatric (aged <16 years) patients, with blood samples at least 3 days before the observed BSI episode. We applied the least absolute shrinkage and selection operator (LASSO) machine-learning algorithm to select a panel of biomarkers predictive of BSI outcome. Results: We developed a panel of 10 probe sets corresponding to six annotated genes ( ARG2 [ arginase 2 ], CPT1A [ carnitine palmitoyltransferase 1A ], FYB [ FYN binding protein ], ITCH [ itchy E3 ubiquitin protein ligase ], MACF1 [ microtubule actin crosslinking factor 1 ], and SSH2 [ slingshot protein phosphatase 2 ]), two uncharacterized ( LOC101928635 , LOC101929599 ), and two unannotated regions. Our multibiomarker panel model yielded highly accurate prediction (area under the receiver operating characteristic curve, 0.938; 95% confidence interval [CI], 0.881-0.981) compared with models with TBSA (0.708; 95% CI, 0.588-0.824) or TBSA and inhalation injury status (0.792; 95% CI, 0.676-0.892). A model combining the multibiomarker panel with TBSA and inhalation injury status further improved prediction (0.978; 95% CI, 0.941-1.000). Conclusions: The multibiomarker panel model yielded a highly accurate prediction of BSIs before their onset. Knowing patients' risk profile early will guide clinicians to take rapid preventive measures for limiting infections, promote antibiotic stewardship that may aid in alleviating the current antibiotic resistance crisis, shorten hospital length of stay and burden on health care resources, reduce health care costs, and significantly improve patients' outcomes. In addition, the biomarkers' identity and molecular functions may contribute to developing novel preventive interventions.
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Affiliation(s)
- Amy Tsurumi
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
- Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA (77 Ave. Louis Pasteur, Boston, MA 02115, USA)
- Shriners Hospitals for Children-Boston, Boston, Massachusetts, USA (51 Blossom St., Boston, MA 02114, USA)
| | - Patrick J. Flaherty
- Department of Mathematics and Statistics, University of Massachusetts at Amherst (Amherst, MA 01003, USA)
| | - Yok-Ai Que
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland (3010 Bern, Switzerland)
| | - Colleen M. Ryan
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
- Shriners Hospitals for Children-Boston, Boston, Massachusetts, USA (51 Blossom St., Boston, MA 02114, USA)
| | - Ankita Banerjee
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
| | - Arijit Chakraborty
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
- Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA (77 Ave. Louis Pasteur, Boston, MA 02115, USA)
- Shriners Hospitals for Children-Boston, Boston, Massachusetts, USA (51 Blossom St., Boston, MA 02114, USA)
| | - Marianna Almpani
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
- Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA (77 Ave. Louis Pasteur, Boston, MA 02115, USA)
- Shriners Hospitals for Children-Boston, Boston, Massachusetts, USA (51 Blossom St., Boston, MA 02114, USA)
| | - Malavika Shankar
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
| | - Jeremy Goverman
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
- Shriners Hospitals for Children-Boston, Boston, Massachusetts, USA (51 Blossom St., Boston, MA 02114, USA)
| | - John T. Schulz
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
- Shriners Hospitals for Children-Boston, Boston, Massachusetts, USA (51 Blossom St., Boston, MA 02114, USA)
| | - Robert L. Sheridan
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
- Shriners Hospitals for Children-Boston, Boston, Massachusetts, USA (51 Blossom St., Boston, MA 02114, USA)
| | - Jonathan Friedstat
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
- Shriners Hospitals for Children-Boston, Boston, Massachusetts, USA (51 Blossom St., Boston, MA 02114, USA)
| | - Sean A. Hickey
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
- Shriners Hospitals for Children-Boston, Boston, Massachusetts, USA (51 Blossom St., Boston, MA 02114, USA)
| | - Ronald G. Tompkins
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
| | - Laurence G. Rahme
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
- Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA (77 Ave. Louis Pasteur, Boston, MA 02115, USA)
- Shriners Hospitals for Children-Boston, Boston, Massachusetts, USA (51 Blossom St., Boston, MA 02114, USA)
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Affiliation(s)
- Robert L Sheridan
- From the Departments of Surgery (R.L.S., J.M.G.) and Radiology (T.G.W.), Massachusetts General Hospital, and Boston Shriners Hospital for Children (R.L.S., J.M.G.) - both in Boston
| | - Jeremy M Goverman
- From the Departments of Surgery (R.L.S., J.M.G.) and Radiology (T.G.W.), Massachusetts General Hospital, and Boston Shriners Hospital for Children (R.L.S., J.M.G.) - both in Boston
| | - T Gregory Walker
- From the Departments of Surgery (R.L.S., J.M.G.) and Radiology (T.G.W.), Massachusetts General Hospital, and Boston Shriners Hospital for Children (R.L.S., J.M.G.) - both in Boston
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3
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Sadeq F, Poster J, Weber JM, Begis MD, Sheridan RL, Uygun K. 710 Specific Patterns of Vital Sign Fluctuations Predict Bloodstream Infection in Pediatric Burn Patients. J Burn Care Res 2022. [PMCID: PMC8945656 DOI: 10.1093/jbcr/irac012.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Early recognition of the clinical signs of bloodstream infection in pediatric burn patients is key to improving survival rates in the burn unit. The objective of this study was to propose a simple scoring criteria that used readily available temperature, heart rate (HR) and mean arterial pressure (MAP) data to accurately predict bloodstream infection in pediatric burn patients.
Methods
A retrospective chart review included 100 patients admitted to the pediatric burn unit for >20% total body surface area (TBSA) burn injuries. Each patient had multiple blood culture tests, and each test was treated as a separate and independent “infection event” for analysis. The time at each blood culture draw was time 0 for that event, and temperature, HR and MAP data was collected for 24 hours after the blood culture was drawn. “Infection events” included in this study had at least six complete sets of temperature, HR and MAP data entries. Median temperature, HR and MAP, as well as mean fever spikes, HR spikes and MAP dips, were compared between infection group (positive blood cultures) and control group (negative blood cultures). These vital sign fluctuations were evaluated individually and as a combination of all three as timely predictors of bloodstream infection. In addition, we tested the prediction of Gram-negative bacteria versus Gram-positive or fungi present in blood cultures.
Results
Patients in the infection group had significantly higher median temperatures (p< 0.001), mean fever spikes (p< 0.001) and mean HR spikes (p< 0.001), compared to the control group. Using the combination scoring criteria to predict bloodstream infection, the strongest predictive values in the 24-hour timeframe had high sensitivity (93%) and specificity (81%). The predictive test metric based on vital sign spikes predicted Gram-negative bacteria, but with limited sensitivity (57%) and specificity (44%).
Conclusions
This study found that using a combination scoring criteria of fever spikes, HR spikes and MAP dips predicted bloodstream infection in pediatric patients with burn injuries with 87% accuracy, which may justify its use in resource-poor environments, or in cases where practical supporting evidence is needed for preemptive antibiotic treatment before culture results are available.
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Affiliation(s)
- Farzin Sadeq
- Shriners Hospitals for Children Boston, Boston, Massachusetts; Shriners Hospitals for Children Boston, Newton, Massachusetts; Shriners Hospitals for Children Boston, Boston, Massachusetts; University of New Hampshire, Amesbury, Massachusetts; Shriners Hospitals for Children Boston, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts
| | - Jonah Poster
- Shriners Hospitals for Children Boston, Boston, Massachusetts; Shriners Hospitals for Children Boston, Newton, Massachusetts; Shriners Hospitals for Children Boston, Boston, Massachusetts; University of New Hampshire, Amesbury, Massachusetts; Shriners Hospitals for Children Boston, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts
| | - Joan M Weber
- Shriners Hospitals for Children Boston, Boston, Massachusetts; Shriners Hospitals for Children Boston, Newton, Massachusetts; Shriners Hospitals for Children Boston, Boston, Massachusetts; University of New Hampshire, Amesbury, Massachusetts; Shriners Hospitals for Children Boston, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts
| | - Maggie D Begis
- Shriners Hospitals for Children Boston, Boston, Massachusetts; Shriners Hospitals for Children Boston, Newton, Massachusetts; Shriners Hospitals for Children Boston, Boston, Massachusetts; University of New Hampshire, Amesbury, Massachusetts; Shriners Hospitals for Children Boston, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts
| | - Robert L Sheridan
- Shriners Hospitals for Children Boston, Boston, Massachusetts; Shriners Hospitals for Children Boston, Newton, Massachusetts; Shriners Hospitals for Children Boston, Boston, Massachusetts; University of New Hampshire, Amesbury, Massachusetts; Shriners Hospitals for Children Boston, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts
| | - Korkut Uygun
- Shriners Hospitals for Children Boston, Boston, Massachusetts; Shriners Hospitals for Children Boston, Newton, Massachusetts; Shriners Hospitals for Children Boston, Boston, Massachusetts; University of New Hampshire, Amesbury, Massachusetts; Shriners Hospitals for Children Boston, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts
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4
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Shoham Y, Narayan RP, Monstrey S, Hoeksema H, Lewis GM, Jha MK, Larson SD, Kravtsov O, Hanganu EM, Gozar HG, Pham TN, Singer A, Sheridan RL, Glat PM, Sander F, Bhavsar D, Wibbenmeyer L. 49 Bromelain Based Enzymatic Debridement of Pediatric Deep Burns: Top Line Results of a Multicenter RCT. J Burn Care Res 2022. [PMCID: PMC8946043 DOI: 10.1093/jbcr/irac012.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Bromelain based debridement (BBD) of deep burns with a concentrate of proteolytic enzymes enriched in Bromelain is approved for use in adults in several regions worldwide. Children are a large part of the patient population in many burn centers around the world. Clinical trial experience and off label reports point to BBD safety and efficacy in children as well. The aim of this study was to further assess the safety and efficacy of BBD in children, in efforts to support regulatory approval for the use of BBD in children.
Methods
One hundred and forty five children aged 0-18 years old suffering from deep thermal burns between 1-30% TBSA were enrolled in a multicenter, multinational, open label, randomized, controlled phase III study. Seventy two children were randomized to eschar removal with BBD and 73 children to standard of care (SOC) surgical and/or non-surgical eschar removal methods, at the investigators' discretion. Patients who did not achieve complete eschar removal after BBD application were rescued with SOC eschar removal methods. Wound care after achieving complete eschar removal was according to routine methods, at the investigators' discretion. Patients are currently in stages of long term follow-up, planned for a duration of >2 years. This abstract reports the top line results of the study including the first year of follow-up.
Results
Baseline characteristics were similar between the arms. The median age was 3.4 years in the BBD arm and 3.9 years in the SOC arm. The average burn area was 7.0±4.9 %TBSA in the BBD arm and 6.2±4.8 %TBSA in the SOC arm. The study met all 3 primary endpoints: Median time to complete eschar removal was 1 day for BBD and 6 days for SOC (p< 0.001), the percent wound area excised in order to complete eschar removal was 1.5% for BBD and 48% for SOC (p< 0.0001), and the MVSS scores at 12 months were 3.83 for BBD and 4.86 for SOC (non-inferiority endpoint). Secondary endpoints demonstrated 8.3% incidence of surgical excision to complete eschar removal for BBD and 64.4% for SOC (p< 0.0001), mean eschar removal associated blood loss of 32±284ml for BBD and 202±409 for SOC (NS), a 25.9% incidence of autografting in deep partial thickness wounds for BBD and 37.7% for SOC (p=0.054), and a mean percent area of deep partial thickness wound autografting of 15.9±38.6 for BBD and 22.8±43.7 for SOC (NS). Safety endpoints demonstrated a non-inferior time to complete wound closure (median 32 days for BBD, 34 days for SOC) and no significant safety issues were demonstrated during the study.
Conclusions
BBD was shown to be a safe and effective debridement agent in pediatric burns.
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Affiliation(s)
- Yaron Shoham
- Soroka University Medical Center, Beer Sheba, HaDarom; ESIC Medical College & Hospital, Faridabad, New Delhi, Delhi; Ghent University Hospital, GENT, Oost-Vlaanderen; University Hospital Ghent, Gent, Oost-Vlaanderen; University of Utah Burn Center, Salt Lake City, Utah; ABVIMS & Dr. RML Hospital, New Delhi, Delhi, Delhi; University of Florida College of Medicine, Gainesville, Florida; State Insti
| | | | | | | | - Giavonni M Lewis
- Soroka University Medical Center, Beer Sheba, HaDarom; ESIC Medical College & Hospital, Faridabad, New Delhi, Delhi; Ghent University Hospital, GENT, Oost-Vlaanderen; University Hospital Ghent, Gent, Oost-Vlaanderen; University of Utah Burn Center, Salt Lake City, Utah; ABVIMS & Dr. RML Hospital, New Delhi, Delhi, Delhi; University of Florida College of Medicine, Gainesville, Florida; State Insti
| | - Manoj Kumar Jha
- Soroka University Medical Center, Beer Sheba, HaDarom; ESIC Medical College & Hospital, Faridabad, New Delhi, Delhi; Ghent University Hospital, GENT, Oost-Vlaanderen; University Hospital Ghent, Gent, Oost-Vlaanderen; University of Utah Burn Center, Salt Lake City, Utah; ABVIMS & Dr. RML Hospital, New Delhi, Delhi, Delhi; University of Florida College of Medicine, Gainesville, Florida; State Insti
| | - Shawn D Larson
- Soroka University Medical Center, Beer Sheba, HaDarom; ESIC Medical College & Hospital, Faridabad, New Delhi, Delhi; Ghent University Hospital, GENT, Oost-Vlaanderen; University Hospital Ghent, Gent, Oost-Vlaanderen; University of Utah Burn Center, Salt Lake City, Utah; ABVIMS & Dr. RML Hospital, New Delhi, Delhi, Delhi; University of Florida College of Medicine, Gainesville, Florida; State Insti
| | - Oleksii Kravtsov
- Soroka University Medical Center, Beer Sheba, HaDarom; ESIC Medical College & Hospital, Faridabad, New Delhi, Delhi; Ghent University Hospital, GENT, Oost-Vlaanderen; University Hospital Ghent, Gent, Oost-Vlaanderen; University of Utah Burn Center, Salt Lake City, Utah; ABVIMS & Dr. RML Hospital, New Delhi, Delhi, Delhi; University of Florida College of Medicine, Gainesville, Florida; State Insti
| | - Elena M Hanganu
- Soroka University Medical Center, Beer Sheba, HaDarom; ESIC Medical College & Hospital, Faridabad, New Delhi, Delhi; Ghent University Hospital, GENT, Oost-Vlaanderen; University Hospital Ghent, Gent, Oost-Vlaanderen; University of Utah Burn Center, Salt Lake City, Utah; ABVIMS & Dr. RML Hospital, New Delhi, Delhi, Delhi; University of Florida College of Medicine, Gainesville, Florida; State Insti
| | - Horea G Gozar
- Soroka University Medical Center, Beer Sheba, HaDarom; ESIC Medical College & Hospital, Faridabad, New Delhi, Delhi; Ghent University Hospital, GENT, Oost-Vlaanderen; University Hospital Ghent, Gent, Oost-Vlaanderen; University of Utah Burn Center, Salt Lake City, Utah; ABVIMS & Dr. RML Hospital, New Delhi, Delhi, Delhi; University of Florida College of Medicine, Gainesville, Florida; State Insti
| | - Tam N Pham
- Soroka University Medical Center, Beer Sheba, HaDarom; ESIC Medical College & Hospital, Faridabad, New Delhi, Delhi; Ghent University Hospital, GENT, Oost-Vlaanderen; University Hospital Ghent, Gent, Oost-Vlaanderen; University of Utah Burn Center, Salt Lake City, Utah; ABVIMS & Dr. RML Hospital, New Delhi, Delhi, Delhi; University of Florida College of Medicine, Gainesville, Florida; State Insti
| | - Adam Singer
- Soroka University Medical Center, Beer Sheba, HaDarom; ESIC Medical College & Hospital, Faridabad, New Delhi, Delhi; Ghent University Hospital, GENT, Oost-Vlaanderen; University Hospital Ghent, Gent, Oost-Vlaanderen; University of Utah Burn Center, Salt Lake City, Utah; ABVIMS & Dr. RML Hospital, New Delhi, Delhi, Delhi; University of Florida College of Medicine, Gainesville, Florida; State Insti
| | - Robert L Sheridan
- Soroka University Medical Center, Beer Sheba, HaDarom; ESIC Medical College & Hospital, Faridabad, New Delhi, Delhi; Ghent University Hospital, GENT, Oost-Vlaanderen; University Hospital Ghent, Gent, Oost-Vlaanderen; University of Utah Burn Center, Salt Lake City, Utah; ABVIMS & Dr. RML Hospital, New Delhi, Delhi, Delhi; University of Florida College of Medicine, Gainesville, Florida; State Insti
| | - Paul M Glat
- Soroka University Medical Center, Beer Sheba, HaDarom; ESIC Medical College & Hospital, Faridabad, New Delhi, Delhi; Ghent University Hospital, GENT, Oost-Vlaanderen; University Hospital Ghent, Gent, Oost-Vlaanderen; University of Utah Burn Center, Salt Lake City, Utah; ABVIMS & Dr. RML Hospital, New Delhi, Delhi, Delhi; University of Florida College of Medicine, Gainesville, Florida; State Insti
| | | | - Dhaval Bhavsar
- Soroka University Medical Center, Beer Sheba, HaDarom; ESIC Medical College & Hospital, Faridabad, New Delhi, Delhi; Ghent University Hospital, GENT, Oost-Vlaanderen; University Hospital Ghent, Gent, Oost-Vlaanderen; University of Utah Burn Center, Salt Lake City, Utah; ABVIMS & Dr. RML Hospital, New Delhi, Delhi, Delhi; University of Florida College of Medicine, Gainesville, Florida; State Insti
| | - Lucy Wibbenmeyer
- Soroka University Medical Center, Beer Sheba, HaDarom; ESIC Medical College & Hospital, Faridabad, New Delhi, Delhi; Ghent University Hospital, GENT, Oost-Vlaanderen; University Hospital Ghent, Gent, Oost-Vlaanderen; University of Utah Burn Center, Salt Lake City, Utah; ABVIMS & Dr. RML Hospital, New Delhi, Delhi, Delhi; University of Florida College of Medicine, Gainesville, Florida; State Insti
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Grant GG, Brady KJS, Stoddard FJ, Meyer WJ, Romanowski KS, Chang PH, Painting LE, Fowler LA, Nelson JK, Patel KF, Sheldrick RC, Carter A, Sheridan RL, Slavin MD, Warner P, Palmieri TL, Schneider JC, Kazis LE, Ryan CM. Measuring the impact of burn injury on the parent-reported health outcomes of children 1-to-5 years: Item pool development for the Preschool 1-5 Life Impact Burn Recovery Evaluation (LIBRE) Profile. Burns 2021; 47:1511-1524. [PMID: 33832799 PMCID: PMC8711655 DOI: 10.1016/j.burns.2021.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 11/23/2022]
Abstract
Modern, reliable, and valid outcome measures are essential to understanding the health needs of young children with burn injuries. Burn-specific and age-appropriate legacy assessment tools exist for this population but are hindered by the limitations of existing paper-based instruments. The purpose of this study was to develop item pools comprised of questions appropriate for children aged 1-5 with burn injuries. Item development was based on a framework provided by previous work to develop the Preschool Life Impact Burn Recovery Evaluation (LIBRE) Conceptual Model. The Preschool LIBRE Conceptual Model work established four sub-domains of functioning for children with burns aged 1-5. Item development involved a systematic literature review, a qualitative item review process with clinical experts, and parent cognitive interviews. Four item pools were established: (1) communication and language development; (2) physical functioning; (3) psychological functioning and (4) social functioning for preschool-aged children with burn injuries. We selected and refined candidate items, recall periods, survey instructions, and response option choices through clinical and parental feedback during the qualitative review and cognitive interview processes. Item pools are currently being field-tested as part of the process to calibrate and validate the Preschool1-5 LIBRE Computer Adaptive Test (CAT) Profile.
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Affiliation(s)
- Gabrielle G Grant
- Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Surgery, Massachusetts General Hospital, Boston, MA, United States; University of North Carolina at Chapel Hill, School of Nursing, Hillman Scholars in Nursing Innovation, Chapel Hill, NC, United States
| | - Keri J S Brady
- Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Surgery, Massachusetts General Hospital, Boston, MA, United States; Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States
| | - Frederick J Stoddard
- Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Walter J Meyer
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, TX, United States; Shriners Hospitals for Children - Galveston, Galveston, TX, United States
| | - Kathleen S Romanowski
- Shriners Hospital for Children - Northern California, Sacramento, CA, United States; University of California Davis School of Medicine, Department of Surgery, Division of Burn Surgery, Sacramento, CA, United States
| | | | - Lynda E Painting
- Shriners Hospital for Children - Northern California, Sacramento, CA, United States; University of California Davis School of Medicine, Department of Surgery, Division of Burn Surgery, Sacramento, CA, United States
| | - Laura A Fowler
- Shriners Hospital for Children - Cincinnati, Cincinnati, OH, United States
| | - Judith K Nelson
- Shriners Hospital for Children - Cincinnati, Cincinnati, OH, United States
| | - Khushbu F Patel
- Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - R Christopher Sheldrick
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States
| | - Alice Carter
- Department of Psychology, University of Massachusetts - Boston, Boston, MA, United States
| | - Robert L Sheridan
- Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Surgery, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Mary D Slavin
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States
| | - Petra Warner
- Shriners Hospital for Children - Cincinnati, Cincinnati, OH, United States; Department of Surgery, University of Cincinnati, Cincinnati, OH, United States
| | - Tina L Palmieri
- Shriners Hospital for Children - Northern California, Sacramento, CA, United States; University of California Davis School of Medicine, Department of Surgery, Division of Burn Surgery, Sacramento, CA, United States
| | - Jeffrey C Schneider
- Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, United States; Spaulding Research Institute, Boston, MA, United States
| | - Lewis E Kazis
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States
| | - Colleen M Ryan
- Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Surgery, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
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6
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DePamphilis MA, Cauley RP, Sadeq F, Lydon M, Sheridan RL, Winograd JM, Driscoll DN. Reconstruction of the Upper Extremity High-Voltage Electrical Injury: A Pediatric Burn Hospital's 13-Year Experience. J Burn Care Res 2021; 43:696-703. [PMID: 34534315 DOI: 10.1093/jbcr/irab177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
High-voltage electrical injury is a rare yet destructive class of burn injury that persists as a serious public health issue. High-voltage exposure is commonly associated with complex wounds to the upper extremities, which can be a significant challenge for burn and plastic surgeons to reconstruct. This intensive and multistage reconstructive process is especially difficult in the growing child. Maximizing upper extremity function is a top priority, as it can have a significant impact on a patient's quality of life. Therefore, this retrospective review describes lessons learned during a 13-year experience at a specialized pediatric burn hospital with reconstruction of the upper extremity after severe high-voltage injury in 37 children. We found that adherence to the following principles can help promote meaningful functional recovery. These include: (1) frequent assessment during early acute care for the evolving need of decompression or amputation, (2) serial surgical debridement that follows a tissue-sparing technique, (3) wound closure by skin grafting or use of flaps (particularly groin or abdominal pedicled flaps) when deep musculoskeletal structures are involved, (4) early multidisciplinary intervention for contracture prevention and management including physical and occupational therapy, splinting, and fixation, (5) secondary reconstruction that focuses on the simplest possible techniques to repair chronic skin defects such as laser therapy, local tissue rearrangements, and skin grafting, (6) complex secondary reconstruction to address deeper tissue contractures or tendon and peripheral nerve deficits, and (7) amputation with preservation of growth plates, soft tissue transfer, and long-term prosthetic management when limb salvage is unlikely.
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Affiliation(s)
- Matthew A DePamphilis
- Department of Clinical Research, Shriners Hospitals for Children-Boston; Boston MA.,Boston University School of Medicine;Boston MA
| | - Ryan P Cauley
- Department of Surgery, Harvard Medical School; Boston MA.,Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center; Boston MA
| | - Farzin Sadeq
- Department of Clinical Research, Shriners Hospitals for Children-Boston; Boston MA
| | - Martha Lydon
- Department of Clinical Research, Shriners Hospitals for Children-Boston; Boston MA
| | - Robert L Sheridan
- Department of Clinical Research, Shriners Hospitals for Children-Boston; Boston MA.,Department of Surgery, Harvard Medical School; Boston MA.,Burn Surgery Service, Shriners Hospitals for Children-Boston; Boston MA
| | - Jonathan M Winograd
- Department of Surgery, Harvard Medical School; Boston MA.,Division of Plastic, Reconstructive, and Laser Surgery, Shriners Hospitals for Children-Boston; Boston MA.,Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital; Boston MA
| | - Daniel N Driscoll
- Department of Clinical Research, Shriners Hospitals for Children-Boston; Boston MA.,Department of Surgery, Harvard Medical School; Boston MA.,Division of Plastic, Reconstructive, and Laser Surgery, Shriners Hospitals for Children-Boston; Boston MA.,Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital; Boston MA
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7
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Sadeq F, Riobueno-Naylor A, DePamphilis MA, Lydon M, Sheridan RL, Ceranoglu TA. Evaluating Burn Recovery Outcomes in Children with Neurodevelopmental Symptoms. J Burn Care Res 2021; 43:679-684. [PMID: 34520544 DOI: 10.1093/jbcr/irab172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Neurodevelopmental symptoms (NS) including attention and behavioral problems, developmental delays, intellectual disabilities and learning problems are prevalent in children with burn injuries. The presence of NS may predispose children to poorer burn injury recovery outcomes compared to children without these symptoms (non-NS). The Multi-Center Benchmarking Study (MCBS) monitored recovery outcomes in children with burn injuries in real time utilizing the Burn Outcomes Questionnaire (BOQ). The objective of this study was to retrospectively assess the long term burn recovery outcomes in NS patients versus non-NS patients from the MCBS population. This study assessed parent-reported BOQ outcomes in a sample of 563 patients aged 5 to 18 years who were admitted for burn injuries to a pediatric burn center. A subsample of patients had reported NS (n=181). Analyses compared BOQ outcomes within the NS subsample and the non-NS subsample (n=382) across three longitudinal points post-discharge. The prevalence rate of NS was 32.1% in the full sample. Findings revealed statistically significant improvement in the recovery curves in all five BOQ subscales for the non-NS group and all subscales except for Compliance for the NS group across all longitudinal points. When compared to non-NS patients, NS patients had significantly poorer burn recovery outcomes on the Satisfaction and Compliance subscales. Although it is important to educate all clinicians, parents, and children on burn prevention efforts, targeted education is necessary for children with NS since they may be at greater risk for burn injury as well as worse recovery outcomes.
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Affiliation(s)
- Farzin Sadeq
- Shriners Hospitals for Children - Boston, Boston MA, USA
| | | | | | - Martha Lydon
- Shriners Hospitals for Children - Boston, Boston MA, USA
| | - Robert L Sheridan
- Shriners Hospitals for Children - Boston, Boston MA, USA.,Massachusetts General Hospital, Boston MA, USA.,Harvard Medical School, Boston MA, USA
| | - Tolga A Ceranoglu
- Shriners Hospitals for Children - Boston, Boston MA, USA.,Massachusetts General Hospital, Boston MA, USA.,Harvard Medical School, Boston MA, USA
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8
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Rencken CA, Rodríguez-Mercedes SL, Patel KF, Grant GG, Kinney EM, Sheridan RL, Brady KJS, Palmieri TL, Warner PM, Fabia RB, Schneider JC, Stoddard FJ, Kazis LE, Ryan CM. Development of the School-Aged Life Impact Burn Recovery Evaluation (SA-LIBRE5-12) Profile: A Conceptual Framework. J Burn Care Res 2021; 42:1067-1075. [PMID: 34228121 DOI: 10.1093/jbcr/irab104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Pediatric burn injuries can alter the trajectory of the survivor's entire life. Patient-centered outcome measures are helpful to assess unique physical and psychosocial needs and long-term recovery. This study aimed to develop a conceptual framework to measure pediatric burn outcomes in survivors aged 5 to 12 years as a part of the School-Aged Life Impact Burn Recovery Evaluation Computer Adaptive Test (SA-LIBRE5-12 CAT) development. This study conducted a systematic literature review guided by the WHO International Classification of Functioning - Child and Youth and domains in the American Burn Association/Shriners Hospitals for Children Burn Outcomes Questionnaire5-18. Interviews with eight parents and seven clinicians were conducted to identify important domains in child recovery. One clinician focus group with four clinicians was completed to identify gaps in the preliminary framework, and semi-weekly expert consensus meetings were conducted with three experts to solidify the framework. Qualitative data were analyzed by grounded theory methodology. Three major thematic outcome domains emerged: 1) Physical Functioning: fine motor and upper extremity, gross motor and lower extremity, pain, skin symptoms, sleep and fatigue, and physical resilience; 2) Psychological Functioning: cognitive, behavioral, emotional, resilience, and body image; and 3) Family and Social Functioning: family relationships, and parental satisfaction, school, peer relations and community participation. The framework will be used to develop item banks for a CAT-based assessment of school-aged children's health and developmental outcomes, which will be designed for clinical and research use to optimize interventions, personalize care, and improve long-term health outcomes for burned children.
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Affiliation(s)
| | | | - Khushbu F Patel
- Shriners Hospitals for Children - Boston,® Boston, MA.,Department of General Surgery Research, Massachusetts General Hospital, Boston, MA
| | | | - Erin M Kinney
- Shriners Hospitals for Children - Boston,® Boston, MA
| | | | - Keri J S Brady
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA
| | - Tina L Palmieri
- Division of Burn Surgery, Department of Surgery, University of California Davis.,Shriners Hospital for Children - Northern California®, 2425 Stockton Boulevard, Suite 718, Sacramento, CA 95817, USA
| | - Petra M Warner
- Shriners Hospital for Children - Cincinnati,® Cincinnati, OH.,University of Cincinnati, 3229 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Renata B Fabia
- Nationwide Children's Hospital, General Pediatric Surgery, Director of the Burn Program, Columbus, OH
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA.,Spaulding Research Institute, Boston, MA.,Harvard Medical School, Boston, MA
| | - Frederick J Stoddard
- Harvard Medical School, Boston, MA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Lewis E Kazis
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA
| | - Colleen M Ryan
- Shriners Hospitals for Children - Boston,® Boston, MA.,Harvard Medical School, Boston, MA.,Department of Surgery, Massachusetts General Hospital, Boston, MA
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9
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Riobueno-Naylor A, Williamson H, Canenguez K, Kogosov A, Drexler A, Sadeq F, DePamphilis M, Holcomb JM, Stoddard FJ, Lydon M, Murphy JM, Sheridan RL. Appearance Concerns, Psychosocial Outcomes, and the Feasibility of Implementing an Online Intervention for Adolescents Receiving Outpatient Burn Care. J Burn Care Res 2021; 42:32-40. [PMID: 32594128 DOI: 10.1093/jbcr/iraa108] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The current study assessed the prevalence of appearance concerns, psychosocial difficulty, and use of an appearance-focused social and psychological support resource (Young Person's Face IT; YPF) within a population of teens (12-17 year-olds) receiving outpatient burn care with the goal to assess the feasibility of routine use of the resource in outpatient burn care. The study sample included 78 patients ages 12 to 17 receiving outpatient care for burns at one hospital. Appearance concerns were measured via the Burn Outcomes Questionnaire Appearance Subscale, the Appearance Subscale of the Body Esteem Scale for Adolescents, and a 2-part question which asked participants directly about appearance concerns related to the burn injury. A large majority (70.0%) of study participants reported appearance concerns on at least one appearance measure and girls reported more burn-related appearance concerns compared with boys. Psychosocial difficulty was measured via the Pediatric Symptom Checklist-17 (PSC-17) and measures of social functioning were collected and compared within the sample by burn size, burn location, sex, and appearance concerns. Internalizing symptoms were prevalent on the PSC-17 (18.6% risk) and decreased self-worth and increased social anxiety symptoms were significantly associated with having appearance concerns. Although interest in YPF was high (78.3%), actual use of the resource among those who signed up to pilot it (n = 46 participants) was low (19.4% use). Results indicate that there is a need for and interest in appearance-focused social anxiety resources for adolescents with burn injuries such as YPF, but more research is needed to understand its feasibility in clinical practice.
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Affiliation(s)
- Alexa Riobueno-Naylor
- Department of Clinical Research, Shriners Hospitals for Children-Boston, Boston, Massachusetts.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Heidi Williamson
- Department of Health and Social Sciences, University of the West England, Bristol, UK
| | - Katia Canenguez
- Department of Clinical Research, Shriners Hospitals for Children-Boston, Boston, Massachusetts.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Ann Kogosov
- Department of Clinical Research, Shriners Hospitals for Children-Boston, Boston, Massachusetts
| | - Alana Drexler
- Department of Clinical Research, Shriners Hospitals for Children-Boston, Boston, Massachusetts
| | - Farzin Sadeq
- Department of Clinical Research, Shriners Hospitals for Children-Boston, Boston, Massachusetts
| | - Matthew DePamphilis
- Department of Clinical Research, Shriners Hospitals for Children-Boston, Boston, Massachusetts
| | - Juliana M Holcomb
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Frederick J Stoddard
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,Department of Psychiatry, Shriners Hospitals for Children-Boston, Boston, Massachusetts
| | - Martha Lydon
- Department of Clinical Research, Shriners Hospitals for Children-Boston, Boston, Massachusetts
| | - J Michael Murphy
- Department of Clinical Research, Shriners Hospitals for Children-Boston, Boston, Massachusetts.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Robert L Sheridan
- Department of Surgery, Shriners Hospitals for Children-Boston, Boston, Massachusetts.,Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.,Department of Surgery, Harvard Medical School, Boston, Massachusetts
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10
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Thorpe CR, Ucer Ozgurel S, Simko LC, Goldstein R, Grant GG, Pagani C, Hwang C, Vasquez K, Sorkin M, Vaishampayan A, Goverman J, Sheridan RL, Friedstat J, Schulz JT, Schneider JC, Levi B, Ryan CM. Investigation into Possible Association of Oxandrolone and Heterotopic Ossification Following Burn Injury. J Burn Care Res 2020; 40:398-405. [PMID: 31053861 DOI: 10.1093/jbcr/irz063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Oxandrolone, a testosterone analog, is used to counteract the catabolic effects of burn injury. Recent animal studies suggest a possible hormonal association with heterotopic ossification (HO) development postburn. This work examines oxandrolone administration and HO development by exploring historical clinical data bridging the introduction of oxandrolone into clinical practice. Additionally, we examine associations between oxandrolone administration and HO in a standardized mouse model of burn/trauma-related HO. Acutely burned adults admitted between 2000 and 2014, survived through discharge, and had a HO risk factor of 7 or higher were selected for analysis from a single burn center. Oxandrolone administration, clinical and demographic data, and elbow HO were recorded and were analyzed with logistic regression. Associations of oxandrolone with HO were examined in a mouse model. Mice were administered oxandrolone or vehicle control following burn/tenotomy to examine any potential effect of oxandrolone on HO and were analyzed by Student's t test. Subjects who received oxandrolone had a higher incidence of elbow HO than those that did not receive oxandrolone. However, when controlling for oxandrolone administration, oxandrolone duration, postburn day oxandrolone initiation, HO risk score category, age, sex, race, burn size, and year of injury, there was no significant difference between rates of elbow HO between the two populations. In agreement with the review, in the mouse model, while there was a trend toward the oxandrolone group developing a greater volume of HO, this did not reach statistical significance.
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Affiliation(s)
- Catherine R Thorpe
- Massachusetts General Hospital, Boston.,Shriners Hospitals for Children-Boston, Massachusetts
| | | | - Laura C Simko
- Shriners Hospitals for Children-Boston, Massachusetts.,Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
| | | | - Gabrielle G Grant
- Massachusetts General Hospital, Boston.,Shriners Hospitals for Children-Boston, Massachusetts
| | | | | | | | | | | | - Jeremy Goverman
- Massachusetts General Hospital, Boston.,Harvard Medical School, Cambridge, Massachusetts
| | - Robert L Sheridan
- Massachusetts General Hospital, Boston.,Shriners Hospitals for Children-Boston, Massachusetts.,Harvard Medical School, Cambridge, Massachusetts
| | - Jonathan Friedstat
- Massachusetts General Hospital, Boston.,Shriners Hospitals for Children-Boston, Massachusetts.,Harvard Medical School, Cambridge, Massachusetts
| | - John T Schulz
- Massachusetts General Hospital, Boston.,Shriners Hospitals for Children-Boston, Massachusetts.,Harvard Medical School, Cambridge, Massachusetts
| | - Jeffrey C Schneider
- Massachusetts General Hospital, Boston.,Spaulding Rehabilitation Hospital, Charlestown, Massachusetts.,Harvard Medical School, Cambridge, Massachusetts
| | - Benjamin Levi
- Shriners Hospitals for Children-Boston, Massachusetts
| | - Colleen M Ryan
- Massachusetts General Hospital, Boston.,Shriners Hospitals for Children-Boston, Massachusetts.,Harvard Medical School, Cambridge, Massachusetts
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11
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Mert S, Bulutoglu B, Chu C, Dylewski M, Lin FM, Yu YM, Yarmush ML, Sheridan RL, Uygun K. Multiorgan Metabolomics and Lipidomics Provide New Insights Into Fat Infiltration in the Liver, Muscle Wasting, and Liver-Muscle Crosstalk Following Burn Injury. J Burn Care Res 2020; 42:269-287. [PMID: 32877506 DOI: 10.1093/jbcr/iraa145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Burn injury mediated hypermetabolic syndrome leads to increased mortality among severe burn victims, due to liver failure and muscle wasting. Metabolic changes may persist up to 2 years following the injury. Thus, understanding the underlying mechanisms of the pathology is crucially important to develop appropriate therapeutic approaches. We present detailed metabolomic and lipidomic analyses of the liver and muscle tissues in a rat model with a 30% body surface area burn injury located at the dorsal skin. Three hundred and thirty-eight of 1587 detected metabolites and lipids in the liver and 119 of 1504 in the muscle tissue exhibited statistically significant alterations. We observed excessive accumulation of triacylglycerols, decreased levels of S-adenosylmethionine, increased levels of glutamine and xenobiotics in the liver tissue. Additionally, the levels of gluconeogenesis, glycolysis, and tricarboxylic acid cycle metabolites are generally decreased in the liver. On the other hand, burn injury muscle tissue exhibits increased levels of acyl-carnitines, alpha-hydroxyisovalerate, ophthalmate, alpha-hydroxybutyrate, and decreased levels of reduced glutathione. The results of this preliminary study provide compelling observations that liver and muscle tissues undergo distinctly different changes during hypermetabolism, possibly reflecting liver-muscle crosstalk. The liver and muscle tissues might be exacerbating each other's metabolic pathologies, via excessive utilization of certain metabolites produced by each other.
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Affiliation(s)
- Safak Mert
- Burns Department, Shriners Hospitals for Children, Boston, Massachusetts.,Department of Surgery, Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Beyza Bulutoglu
- Burns Department, Shriners Hospitals for Children, Boston, Massachusetts.,Department of Surgery, Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Christopher Chu
- Burns Department, Shriners Hospitals for Children, Boston, Massachusetts.,Department of Surgery, Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Maggie Dylewski
- Burns Department, Shriners Hospitals for Children, Boston, Massachusetts
| | - Florence M Lin
- Burns Department, Shriners Hospitals for Children, Boston, Massachusetts
| | - Yong-Ming Yu
- Burns Department, Shriners Hospitals for Children, Boston, Massachusetts.,Department of Surgery, Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Martin L Yarmush
- Burns Department, Shriners Hospitals for Children, Boston, Massachusetts.,Department of Surgery, Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston.,Department of Biomedical Engineering, Rutgers University, Piscataway, New Jersey
| | - Robert L Sheridan
- Burns Department, Shriners Hospitals for Children, Boston, Massachusetts
| | - Korkut Uygun
- Burns Department, Shriners Hospitals for Children, Boston, Massachusetts.,Department of Surgery, Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
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12
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Poster J, Chu C, Weber JM, Lydon M, Dylewski M, Uygun K, Sheridan RL. Specific Patterns of Postoperative Temperature Elevations Predict Blood Infection in Pediatric Burn Patients. J Burn Care Res 2020; 40:220-227. [PMID: 30668737 DOI: 10.1093/jbcr/irz002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Using readily available temperature data, we seek to propose a scoring criteria that can facilitate accurate and immediate prediction of blood infection. The standard in diagnosing blood infection is a positive blood culture result that may take up to 3 days to process, requiring providers to make a prediction about which febrile patient is actually bacteremic. This prediction is difficult in burned children as systemic inflammation can cause fever in the absence of infection. An ability to make this prediction more accurate using readily available information would be useful. A retrospective chart review was performed for 28 pediatric patients, with a burn size 20% or greater, admitted to the burn unit between 2010 and 2014. All children had blood cultures drawn. They were divided into either infection (positive blood cultures) or control (negative blood cultures) groups. Median temperature and mean number of temperature elevations were compared between the two groups. We evaluated the predictive accuracy of using temperature elevation, pattern, and timing to predict blood infection. A significant difference was seen in the mean number of temperature elevations above 39°C. This was significant for each time stage, especially in the 0- to 24-hour post-surgery period. We found the most predictive accuracy in the 0- to 12-, 12- to 38-, and 12- to 48-hour time periods. We found a strong association between mean number of fever spikes above 39°C and blood infection, especially 12 to 24 hours after surgery. This readily available data can be useful to clinicians as they access children with burns.
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Affiliation(s)
- Jonah Poster
- Clinical Research Department, Shriners Hospitals for Children - Boston, Boston, Massachusetts.,Department of Surgery, Massachusetts General Hospital, Boston.,Center for Engineering in Medicine, Massachusetts General Hospital, Boston
| | - Chris Chu
- Clinical Research Department, Shriners Hospitals for Children - Boston, Boston, Massachusetts.,Department of Surgery, Massachusetts General Hospital, Boston.,Center for Engineering in Medicine, Massachusetts General Hospital, Boston
| | - Joan M Weber
- Clinical Research Department, Shriners Hospitals for Children - Boston, Boston, Massachusetts
| | - Martha Lydon
- Clinical Research Department, Shriners Hospitals for Children - Boston, Boston, Massachusetts
| | - Maggie Dylewski
- Clinical Research Department, Shriners Hospitals for Children - Boston, Boston, Massachusetts
| | - Korkut Uygun
- Clinical Research Department, Shriners Hospitals for Children - Boston, Boston, Massachusetts.,Department of Surgery, Massachusetts General Hospital, Boston
| | - Robert L Sheridan
- Clinical Research Department, Shriners Hospitals for Children - Boston, Boston, Massachusetts.,Department of Surgery, Massachusetts General Hospital, Boston
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13
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Jayawardena ADL, Bouhabel S, Sheridan RL, Hartnick CJ. Laryngotracheal Reconstruction in the Pediatric Burn Patient: Surgical Techniques and Decision Making. J Burn Care Res 2020; 41:882-886. [PMID: 32112103 DOI: 10.1093/jbcr/iraa032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The management of laryngotracheal stenosis (LTS) in the pediatric burn patient is complex and requires a multidisciplinary approach. The mainstay of treatment for LTS is laryngotracheal reconstruction (LTR), however, limited reports of burn-specific LTR techniques exist. Here, we provide insight into the initial airway evaluation, surgical decision making, anesthetic challenges, and incision modifications based on our experience in treating patients with this pathology. The initial airway evaluation can be complicated by microstomia, trismus, and neck contractures-the authors recommend treatment of these complications prior to initial airway evaluation to optimize safety. The surgical decision making regarding pursuing single-stage LTR, double-stage LTR, and 1.5-stage LTR can be challenging-the authors recommend 1.5-stage LTR when possible due to the extra safety of rescue tracheostomy and the decreased risk of granuloma, which is especially important in pro-inflammatory burn physiology. Anesthetic challenges include obtaining intravenous access, securing the airway, and intravenous induction-the authors recommend peripherally inserted central catheter when appropriate, utilizing information from the initial airway evaluation to secure the airway, and avoidance of succinylcholine upon induction. Neck and chest incisions are often within the TBSA covered by the burn injury-the authors recommend modifying typical incisions to cover unaffected skin whenever possible in order to limit infection and prevent wound healing complications. Pediatric LTR in the burn patient is challenging, but can be safe when the surgeon is thoughtful in their decision making.
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Affiliation(s)
- Asitha D L Jayawardena
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston
| | - Sarah Bouhabel
- Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montréal, Canada
| | | | - Christopher J Hartnick
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston
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14
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Grant GG, Wolfe AE, Thorpe CR, Gibran NS, Carrougher GJ, Wiechman SA, Holavanahalli R, Stoddard FJ, Sheridan RL, Kazis LE, Schneider JC, Ryan CM. Exploring the Burn Model System National Database: Burn injuries, substance misuse, and the CAGE questionnaire. Burns 2020; 46:745-747. [PMID: 31901407 DOI: 10.1016/j.burns.2019.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 12/22/2019] [Indexed: 10/25/2022]
Abstract
Burn survivors who misuse alcohol and/other substances have been associated with poorer long-term outcomes and clinical complications following injury. The self-reported CAGE questionnaire (Cut down, Annoyed, Guilty, and Eye-opener) is an outcomes assessment tool used to screen for potential substance misuse. Understanding the persistence and emergence of potential substance misuse through examination of CAGE scores may provide important information about this population. Using data collected from the Burn Model System National Database, demographic and clinical characteristics of individuals who reported positive CAGE scores (total score of ≥2) and those who reported negative CAGE scores (total score of 0 or 1) for either alcohol or other drugs were compared.
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Affiliation(s)
- Gabrielle G Grant
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - Audrey E Wolfe
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Catherine R Thorpe
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States
| | - Nicole S Gibran
- Department of Surgery, University of Washington, Seattle, WA, United States
| | | | - Shelley A Wiechman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Radha Holavanahalli
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, TX, United States
| | - Frederick J Stoddard
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Robert L Sheridan
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Surgery, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Lewis E Kazis
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Colleen M Ryan
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Surgery, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
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15
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Ryan CM, Lee A, Stoddard FJ, Li NC, Schneider JC, Shapiro GD, Griggs CL, Wang C, Palmieri T, Meyer WJ, Pidcock FS, Reilly D, Sheridan RL, Kazis LE, Tompkins RG. The Effect of Facial Burns on Long-Term Outcomes in Young Adults: A 5-Year Study. J Burn Care Res 2019; 39:497-506. [PMID: 29901795 DOI: 10.1093/jbcr/irx006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Long-term functional outcomes in young adults with facial burns remain poorly studied. This 5-year (2003-2008) prospective multicenter study includes burn survivors (age 19-30 years) who completed the Young Adult Burn Outcome Questionnaire (YABOQ) from 0 to 36 months after baseline survey administration. A composite canonical score was developed from 15 YABOQ domains using discriminant analysis, maximizing the difference at the baseline between burn-injured patients with face involved and not involved. A generalized linear model with the generalized estimation equation technique was used to track the changing pattern of the composite score over time. Individual domain scores with high correlation to the canonical score were used to evaluate recovery patterns in facial burns. A total of 153 burned (31% with face burns) and 112 nonburned subjects completed 620 questionnaires. Canonical analysis showed that early postburn, facial burns were associated with a difference in outcome, but this overall difference diminished over time. Regression analysis showed that for survivors with facial injury, Emotion and Sexual Function scores were persistently lower (worse), while Religion scores were persistently higher. Satisfaction with Role was initially better than the nonface burned group, but over time got worse, while Perceived Appearance was initially worse in the face burned group but this difference diminished over time. Social Function Limited by Appearance was initially similar between the groups, but over time the group with face burns scored lower. The overall difference in recovery between survivors with and without facial burns diminished over time while the individual domains had various patterns of recovery.
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Affiliation(s)
- Colleen M Ryan
- Surgical Services, Massachusetts General Hospital, Boston, USA.,Shriners Hospitals for Children®, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Austin Lee
- Surgical Services, Massachusetts General Hospital, Boston, USA.,Spaulding Rehabilitation Hospital, Boston, MA, USA.,School of Insurance and Economics, University of International Business and Economics, Beijing, China
| | - Frederick J Stoddard
- Shriners Hospitals for Children®, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, USA
| | - Nien Chen Li
- Department of Health Law, Policy, and Management, Boston University School of Public Health, MA, USA
| | - Jeffrey C Schneider
- Shriners Hospitals for Children®, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, USA
| | - Gabriel D Shapiro
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Cornelia L Griggs
- Surgical Services, Massachusetts General Hospital, Boston, USA.,Harvard Medical School, Boston, MA, USA
| | - Chao Wang
- Boston University Metropolitan College, MA, USA
| | - Tina Palmieri
- Shriners Hospital for Children Northern California, Sacramento.,Department of Surgery, University of California Davis, Sacramento, USA
| | - Walter J Meyer
- Shriners Hospital for Children, Galveston, TX, USA.,Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, USA
| | - Frank S Pidcock
- Department of Physical Medicine and Rehabilitation, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Debra Reilly
- Department of Surgery, University of Nebraska, Omaha, NE
| | - Robert L Sheridan
- Surgical Services, Massachusetts General Hospital, Boston, USA.,Shriners Hospitals for Children®, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Lewis E Kazis
- Department of Health Law, Policy, and Management, Boston University School of Public Health, MA, USA
| | - Ronald G Tompkins
- Surgical Services, Massachusetts General Hospital, Boston, USA.,Harvard Medical School, Boston, MA, USA
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16
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Riobueno-Naylor A, Romo S, Kazis L, Wang S, Lydon M, Nelson J, Fowler L, Drexler A, Kogosov A, Haile H, Ryan CM, Chang P, Warner P, Palmieri TL, Lee AF, Stoddard F, Murphy JM, Sheridan RL. Usefulness of a Novel System for Feedback of Patient-Reported Outcome Measures in Children Recovering From Burns. J Burn Care Res 2019; 40:776-784. [PMID: 31102446 DOI: 10.1093/jbcr/irz082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The Burn Outcomes Questionnaire for children ages 5-18 years (BOQ5-18) is a widely used, reliable, and valid parent-reported outcome measure designed to assess children's recovery from burn injuries in 12 physical and psychosocial domains. This study evaluated the feasibility, acceptability, and usefulness of a feedback system that delivered BOQ and Pediatric Symptom Checklist (PSC-17; a widely used measure of psychosocial functioning) results to burn care clinicians prior to an outpatient appointment or a postoperative surgical encounter. The BOQ and the PSC-17 were administered to the parents of 147 children receiving outpatient or surgical care in two pediatric burn hospitals. Clinician and parent perceptions of the feedback system were evaluated using debriefing questionnaires. Over half of all patients were at-risk on at least one BOQ subscale, and risk on three or more BOQ domains was significantly associated with a higher likelihood of poor psychological scores on the PSC-17 (P < .001). Significant differences in BOQ scores were found between the two hospital sites on four BOQ subscales, three related to physical ability and one to psychosocial well-being. Parent ratings of the feedback system were positive, with 90% of parents in both settings agreeing that the BOQ tablet experience was easy and helpful. Clinician attitudes differed across the two settings with more positive clinician ratings of the system in the outpatient setting (P < .001). Clinician interviews revealed that the data was especially useful in bringing to light psychosocial aspects of functioning relevant to long-term recovery from burn injuries.
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Affiliation(s)
- Alexa Riobueno-Naylor
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Massachusetts.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Stephanie Romo
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Massachusetts
| | - Lewis Kazis
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Massachusetts
| | - Shirley Wang
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Massachusetts
| | - Martha Lydon
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Massachusetts
| | - Judith Nelson
- Department of Clinical Research, Shriners Hospitals for Children - Cincinnati, Ohio
| | - Laura Fowler
- Department of Clinical Research, Shriners Hospitals for Children - Cincinnati, Ohio
| | - Alana Drexler
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Massachusetts
| | - Ann Kogosov
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Massachusetts
| | - Haregnesh Haile
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Colleen M Ryan
- Department of Surgery, Shriners Hospitals for Children - Boston, Massachusetts.,Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Philip Chang
- Department of Surgery, Shriners Hospitals for Children - Cincinnati, Ohio
| | - Petra Warner
- Department of Surgery, Shriners Hospitals for Children - Cincinnati, Ohio
| | - Tina L Palmieri
- Department of Surgery, Shriners Hospitals for Children - Northern California, Sacramento, California.,Department of Surgery, University of California Davis, Sacramento, California
| | - Austin F Lee
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Frederick Stoddard
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Department of Psychiatry, Shriners Hospitals for Children - Boston, Massachusetts
| | - J Michael Murphy
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Massachusetts.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Robert L Sheridan
- Department of Surgery, Shriners Hospitals for Children - Boston, Massachusetts.,Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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17
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Cartwright S, Saret C, Shapiro GD, Ni P, Sheridan RL, Lee AF, Marino M, Acton A, Kazis LE, Schneider JC, Ryan CM. Burn survivors injured as children exhibit resilience in long-term community integration outcomes: A life impact burn recovery evaluation (LIBRE) study. Burns 2019; 45:1031-1040. [DOI: 10.1016/j.burns.2019.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 01/31/2019] [Accepted: 02/07/2019] [Indexed: 12/20/2022]
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18
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Brady KJS, Grant GG, Stoddard FJ, Meyer WJ, Romanowski KS, Chang PH, Painting LE, Fowler LA, Nelson JK, Rivas P, Epperson K, Sheridan RL, Murphy M, O’Donnell EH, Ceranoglu TA, Sheldrick RC, Ni P, Slavin MD, Warner P, Palmieri TL, Schneider JC, Kazis LE, Ryan CM. Measuring the Impact of Burn Injury on the Parent-Reported Health Outcomes of Children 1 to 5 Years: A Conceptual Framework for Development of the Preschool Life Impact Burn Recovery Evaluation Profile CAT. J Burn Care Res 2019; 41:84-94. [DOI: 10.1093/jbcr/irz110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AbstractDue to the rapid developmental growth in preschool-aged children, more precise measurement of the effects of burns on child health outcomes is needed. Expanding upon the Shriners Hospitals for Children/American Burn Association Burn Outcome Questionnaire 0 to 5 (BOQ0–5), we developed a conceptual framework describing domains important in assessing recovery from burn injury among preschool-aged children (1–5 years). We developed a working conceptual framework based on the BOQ0–5, the National Research Council and Institute of Medicine’s Model of Child Health, and the World Health Organization’s International Classification of Functioning, Disability, and Health for Children and Youth. We iteratively refined our framework based on a literature review, focus groups, interviews, and expert consensus meetings. Data were qualitatively analyzed using methods informed by grounded theory. We reviewed 95 pediatric assessments, conducted two clinician focus groups and six parent interviews, and consulted with 23 clinician experts. Three child health outcome domains emerged from our analysis: symptoms, functioning, and family. The symptoms domain describes parents’ perceptions of their child’s pain, skin-related discomfort, and fatigue. The functioning domain describes children’s physical functioning (gross and fine motor function), psychological functioning (internalizing, externalizing, and dysregulation behavior; trauma; toileting; resilience), communication and language development (receiving and producing meaning), and social functioning (connecting with family/peers, friendships, and play). The family domain describes family psychological and routine functioning outcomes.
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Affiliation(s)
- Keri J S Brady
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Massachusetts
- Shriners Hospitals for Children—Boston, Massachusetts
- Department of Surgery, Massachusetts General Hospital
| | - Gabrielle G Grant
- Shriners Hospitals for Children—Boston, Massachusetts
- Department of Surgery, Massachusetts General Hospital
| | - Frederick J Stoddard
- Shriners Hospitals for Children—Boston, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Walter J Meyer
- Department of Psychiatry and Behavioral Sciences, The University of Texas Medical Branch, Galveston
- Shriners Hospitals for Children—Galveston, Texas
| | - Kathleen S Romanowski
- Shriners Hospital for Children—Northern California, Sacramento
- Department of Surgery, Division of Burn Surgery, University of California Davis School of Medicine, Sacramento
| | | | | | | | | | - Perla Rivas
- Shriners Hospitals for Children—Galveston, Texas
| | | | - Robert L Sheridan
- Shriners Hospitals for Children—Boston, Massachusetts
- Department of Surgery, Massachusetts General Hospital
- Harvard Medical School, Boston, Massachusetts
| | - Michael Murphy
- Shriners Hospitals for Children—Boston, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Ellen H O’Donnell
- Shriners Hospitals for Children—Boston, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - T Atilla Ceranoglu
- Shriners Hospitals for Children—Boston, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - R Christopher Sheldrick
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Massachusetts
| | - Pengsheng Ni
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Massachusetts
| | - Mary D Slavin
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Massachusetts
| | - Petra Warner
- Shriners Hospital for Children—Cincinnati, Ohio
- Department of Surgery, University of Cincinnati, Ohio
| | - Tina L Palmieri
- Shriners Hospital for Children—Northern California, Sacramento
- Department of Surgery, Division of Burn Surgery, University of California Davis School of Medicine, Sacramento
| | - Jeffrey C Schneider
- Shriners Hospitals for Children—Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
| | - Lewis E Kazis
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Massachusetts
| | - Colleen M Ryan
- Shriners Hospitals for Children—Boston, Massachusetts
- Department of Surgery, Massachusetts General Hospital
- Harvard Medical School, Boston, Massachusetts
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19
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Driscoll IR, Mann-Salinas EA, Boyer NL, Pamplin JC, Serio-Melvin ML, Salinas J, Borgman MA, Sheridan RL, Melvin JJ, Peterson WC, Graybill JC, Rizzo JA, King BT, Chung KK, Cancio LC, Renz EM, Stockinger ZT. Burn Casualty Care in the Deployed Setting. Mil Med 2019; 183:161-167. [PMID: 30189062 DOI: 10.1093/milmed/usy076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Indexed: 11/12/2022] Open
Abstract
Management of wartime burn casualties can be very challenging. Burns frequently occur in the setting of other blunt and penetrating injuries. This clinical practice guideline provides a manual for burn injury assessment, resuscitation, wound care, and specific scenarios including chemical and electrical injuries in the deployed or austere setting. The clinical practice guideline also reviews considerations for the definitive care of local national patients, including pediatric patients, who are unable to be evacuated from theater. Medical providers are encouraged to contact the US Army Institute of Surgical Research (USAISR) Burn Center when caring for a burn casualty in the deployed setting.
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Affiliation(s)
- Ian R Driscoll
- Joint Trauma System, 3698 Chambers Pass, JBSA Fort Sam Houston, TX
| | | | - Nathan L Boyer
- Joint Trauma System, 3698 Chambers Pass, JBSA Fort Sam Houston, TX
| | - Jeremy C Pamplin
- Joint Trauma System, 3698 Chambers Pass, JBSA Fort Sam Houston, TX
| | | | - Jose Salinas
- Joint Trauma System, 3698 Chambers Pass, JBSA Fort Sam Houston, TX
| | | | | | - John J Melvin
- Joint Trauma System, 3698 Chambers Pass, JBSA Fort Sam Houston, TX
| | - Wylan C Peterson
- Joint Trauma System, 3698 Chambers Pass, JBSA Fort Sam Houston, TX
| | - John C Graybill
- Joint Trauma System, 3698 Chambers Pass, JBSA Fort Sam Houston, TX
| | - Julie A Rizzo
- Joint Trauma System, 3698 Chambers Pass, JBSA Fort Sam Houston, TX
| | - Booker T King
- Joint Trauma System, 3698 Chambers Pass, JBSA Fort Sam Houston, TX
| | - Kevin K Chung
- Joint Trauma System, 3698 Chambers Pass, JBSA Fort Sam Houston, TX
| | | | - Evan M Renz
- Joint Trauma System, 3698 Chambers Pass, JBSA Fort Sam Houston, TX
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20
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Brady KJ, Grant G, Schneider JC, Sheldrick RC, Romanowski KS, Painting LE, Chang PH, Fowler LA, Nelson JK, Sheridan RL, Stoddard FJ, Kazis LE, Ryan CM. 98 Measuring the Impact of Burns on the Health Outcomes of Young Children: A Conceptual Framework for Development of the Preschool Life Impact Burn Recovery Evaluation (Preschool LIBRE) CAT. J Burn Care Res 2019. [DOI: 10.1093/jbcr/irz013.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- K J Brady
- Boston University School of Public Health; Shriners Hospitals for Children - Boston, Boston, MA; Shriners Hospitals for Children - Boston, Boston, MA; Spaulding Rehabilitation Hospital; Harvard Medical School, Charlestown/Boston, MA; Boston University School of Public Health, Boston, MA; Shriners Hospitals for Children - Northern California; UC Davis Division of Burn Surgery, Sacramento, CA; Shri
| | - G Grant
- Boston University School of Public Health; Shriners Hospitals for Children - Boston, Boston, MA; Shriners Hospitals for Children - Boston, Boston, MA; Spaulding Rehabilitation Hospital; Harvard Medical School, Charlestown/Boston, MA; Boston University School of Public Health, Boston, MA; Shriners Hospitals for Children - Northern California; UC Davis Division of Burn Surgery, Sacramento, CA; Shri
| | - J C Schneider
- Boston University School of Public Health; Shriners Hospitals for Children - Boston, Boston, MA; Shriners Hospitals for Children - Boston, Boston, MA; Spaulding Rehabilitation Hospital; Harvard Medical School, Charlestown/Boston, MA; Boston University School of Public Health, Boston, MA; Shriners Hospitals for Children - Northern California; UC Davis Division of Burn Surgery, Sacramento, CA; Shri
| | - R C Sheldrick
- Boston University School of Public Health; Shriners Hospitals for Children - Boston, Boston, MA; Shriners Hospitals for Children - Boston, Boston, MA; Spaulding Rehabilitation Hospital; Harvard Medical School, Charlestown/Boston, MA; Boston University School of Public Health, Boston, MA; Shriners Hospitals for Children - Northern California; UC Davis Division of Burn Surgery, Sacramento, CA; Shri
| | - K S Romanowski
- Boston University School of Public Health; Shriners Hospitals for Children - Boston, Boston, MA; Shriners Hospitals for Children - Boston, Boston, MA; Spaulding Rehabilitation Hospital; Harvard Medical School, Charlestown/Boston, MA; Boston University School of Public Health, Boston, MA; Shriners Hospitals for Children - Northern California; UC Davis Division of Burn Surgery, Sacramento, CA; Shri
| | - L E Painting
- Boston University School of Public Health; Shriners Hospitals for Children - Boston, Boston, MA; Shriners Hospitals for Children - Boston, Boston, MA; Spaulding Rehabilitation Hospital; Harvard Medical School, Charlestown/Boston, MA; Boston University School of Public Health, Boston, MA; Shriners Hospitals for Children - Northern California; UC Davis Division of Burn Surgery, Sacramento, CA; Shri
| | - P H Chang
- Boston University School of Public Health; Shriners Hospitals for Children - Boston, Boston, MA; Shriners Hospitals for Children - Boston, Boston, MA; Spaulding Rehabilitation Hospital; Harvard Medical School, Charlestown/Boston, MA; Boston University School of Public Health, Boston, MA; Shriners Hospitals for Children - Northern California; UC Davis Division of Burn Surgery, Sacramento, CA; Shri
| | - L A Fowler
- Boston University School of Public Health; Shriners Hospitals for Children - Boston, Boston, MA; Shriners Hospitals for Children - Boston, Boston, MA; Spaulding Rehabilitation Hospital; Harvard Medical School, Charlestown/Boston, MA; Boston University School of Public Health, Boston, MA; Shriners Hospitals for Children - Northern California; UC Davis Division of Burn Surgery, Sacramento, CA; Shri
| | - J K Nelson
- Boston University School of Public Health; Shriners Hospitals for Children - Boston, Boston, MA; Shriners Hospitals for Children - Boston, Boston, MA; Spaulding Rehabilitation Hospital; Harvard Medical School, Charlestown/Boston, MA; Boston University School of Public Health, Boston, MA; Shriners Hospitals for Children - Northern California; UC Davis Division of Burn Surgery, Sacramento, CA; Shri
| | - R L Sheridan
- Boston University School of Public Health; Shriners Hospitals for Children - Boston, Boston, MA; Shriners Hospitals for Children - Boston, Boston, MA; Spaulding Rehabilitation Hospital; Harvard Medical School, Charlestown/Boston, MA; Boston University School of Public Health, Boston, MA; Shriners Hospitals for Children - Northern California; UC Davis Division of Burn Surgery, Sacramento, CA; Shri
| | - F J Stoddard
- Boston University School of Public Health; Shriners Hospitals for Children - Boston, Boston, MA; Shriners Hospitals for Children - Boston, Boston, MA; Spaulding Rehabilitation Hospital; Harvard Medical School, Charlestown/Boston, MA; Boston University School of Public Health, Boston, MA; Shriners Hospitals for Children - Northern California; UC Davis Division of Burn Surgery, Sacramento, CA; Shri
| | - L E Kazis
- Boston University School of Public Health; Shriners Hospitals for Children - Boston, Boston, MA; Shriners Hospitals for Children - Boston, Boston, MA; Spaulding Rehabilitation Hospital; Harvard Medical School, Charlestown/Boston, MA; Boston University School of Public Health, Boston, MA; Shriners Hospitals for Children - Northern California; UC Davis Division of Burn Surgery, Sacramento, CA; Shri
| | - C M Ryan
- Boston University School of Public Health; Shriners Hospitals for Children - Boston, Boston, MA; Shriners Hospitals for Children - Boston, Boston, MA; Spaulding Rehabilitation Hospital; Harvard Medical School, Charlestown/Boston, MA; Boston University School of Public Health, Boston, MA; Shriners Hospitals for Children - Northern California; UC Davis Division of Burn Surgery, Sacramento, CA; Shri
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21
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Weed VF, Canenguez K, Romo S, Wang SL, Kazis L, Lee AF, Herndon D, Palmieri TL, Warner P, Haile H, Sheridan RL, Murphy JM. The Use of a Brief Measure to Assess Longitudinal Changes in Appearance Concerns for Youth Recovering From Burn Injuries. J Burn Care Res 2019; 40:97-103. [PMID: 30371792 DOI: 10.1093/jbcr/iry054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Burns are among the most common injuries to children, and, although survival rates have improved, many burn survivors are left with scars and/or other visible differences, which may be associated with anxiety, depression, and/or low self-esteem. A better understanding of the prevalence and persistence of these problems in child and adolescent burn survivors might lead to an expanded paradigm of care and possibly to better outcomes. The present study provides longitudinal prevalence data for the Appearance Concerns (AC) subscale of the parent-reported Burn Outcomes Questionnaire (BOQ) for 5- to 18-year-old children and identifies patient characteristics associated with higher risk for appearance concerns. Subjects were 799 pediatric burn survivors who were assessed prospectively using the parent-reported BOQ5-18, which was administered soon after their discharge from acute care and again every 3 to 6 months for up to 4 years. Approximately 20% of all youth were reported to have appearance concerns over the first 2 years, after which the rate declined gradually, falling to around 10% after 3 years. This study showed that such concerns were prevalent and persistent years after burn injuries and suggested that larger burns, facial burns, and country of origin outside of the United States were all associated with higher scores on the AC subscale. These findings highlight the importance of assessing appearance concerns in the long-term care of young burn survivors and suggest that the BOQ5-18 AC subscale could be used to identify individuals with heightened appearance concerns and to measure their response to interventions.
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Affiliation(s)
- Valerie F Weed
- Clinical Research, Shriners Hospitals for Children-Boston, Massachusetts
| | - Katia Canenguez
- Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Stephanie Romo
- Clinical Research, Shriners Hospitals for Children-Boston, Massachusetts
| | - Shirley L Wang
- Clinical Research, Shriners Hospitals for Children-Boston, Massachusetts
| | - Lewis Kazis
- Public Health, Boston University, Massachusetts
| | - Austin F Lee
- Mathematical Sciences, Bentley University, Waltham, Massachusetts
| | - David Herndon
- Surgery, Shriners Hospitals for Children-Galveston, Texas
| | - Tina L Palmieri
- Surgery, Shriners Hospitals for Children-Northern California, Sacramento
| | - Petra Warner
- Surgery, Shriners Hospitals for Children-Cincinnati, Ohio
| | - Haregnesh Haile
- Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | | | - J Michael Murphy
- Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
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22
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Affiliation(s)
- Robert L Sheridan
- Burn Service, Boston Shriners Hospital for Children; Division of Burns, Massachusetts General Hospital; and Department of Surgery, Harvard Medical School, Boston, MA
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23
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Nodoushani AY, Murphy JM, Wang SL, Stoddard FJ, Kazis L, Lydon M, Lee A, Warner P, Palmieri T, Herndon D, Sheridan RL. 269 Prevalence of Depressive Symptoms Over Time in Pediatric Burn Survivors. J Burn Care Res 2018. [DOI: 10.1093/jbcr/iry006.191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- A Y Nodoushani
- Shriners Hospital For Children - Boston, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University School of Public Health, Boston, MA; Bentley University, Waltham, MA; Shriners Hospital For Children - Cincinnati, Cincinnati, OH; Shriners Hospital For Children - Northern California, Sacramento, CA; Shriners Hospital For Children - Galveston, Galveston, TX
| | - J M Murphy
- Shriners Hospital For Children - Boston, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University School of Public Health, Boston, MA; Bentley University, Waltham, MA; Shriners Hospital For Children - Cincinnati, Cincinnati, OH; Shriners Hospital For Children - Northern California, Sacramento, CA; Shriners Hospital For Children - Galveston, Galveston, TX
| | - S L Wang
- Shriners Hospital For Children - Boston, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University School of Public Health, Boston, MA; Bentley University, Waltham, MA; Shriners Hospital For Children - Cincinnati, Cincinnati, OH; Shriners Hospital For Children - Northern California, Sacramento, CA; Shriners Hospital For Children - Galveston, Galveston, TX
| | - F J Stoddard
- Shriners Hospital For Children - Boston, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University School of Public Health, Boston, MA; Bentley University, Waltham, MA; Shriners Hospital For Children - Cincinnati, Cincinnati, OH; Shriners Hospital For Children - Northern California, Sacramento, CA; Shriners Hospital For Children - Galveston, Galveston, TX
| | - L Kazis
- Shriners Hospital For Children - Boston, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University School of Public Health, Boston, MA; Bentley University, Waltham, MA; Shriners Hospital For Children - Cincinnati, Cincinnati, OH; Shriners Hospital For Children - Northern California, Sacramento, CA; Shriners Hospital For Children - Galveston, Galveston, TX
| | - M Lydon
- Shriners Hospital For Children - Boston, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University School of Public Health, Boston, MA; Bentley University, Waltham, MA; Shriners Hospital For Children - Cincinnati, Cincinnati, OH; Shriners Hospital For Children - Northern California, Sacramento, CA; Shriners Hospital For Children - Galveston, Galveston, TX
| | - A Lee
- Shriners Hospital For Children - Boston, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University School of Public Health, Boston, MA; Bentley University, Waltham, MA; Shriners Hospital For Children - Cincinnati, Cincinnati, OH; Shriners Hospital For Children - Northern California, Sacramento, CA; Shriners Hospital For Children - Galveston, Galveston, TX
| | - P Warner
- Shriners Hospital For Children - Boston, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University School of Public Health, Boston, MA; Bentley University, Waltham, MA; Shriners Hospital For Children - Cincinnati, Cincinnati, OH; Shriners Hospital For Children - Northern California, Sacramento, CA; Shriners Hospital For Children - Galveston, Galveston, TX
| | - T Palmieri
- Shriners Hospital For Children - Boston, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University School of Public Health, Boston, MA; Bentley University, Waltham, MA; Shriners Hospital For Children - Cincinnati, Cincinnati, OH; Shriners Hospital For Children - Northern California, Sacramento, CA; Shriners Hospital For Children - Galveston, Galveston, TX
| | - D Herndon
- Shriners Hospital For Children - Boston, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University School of Public Health, Boston, MA; Bentley University, Waltham, MA; Shriners Hospital For Children - Cincinnati, Cincinnati, OH; Shriners Hospital For Children - Northern California, Sacramento, CA; Shriners Hospital For Children - Galveston, Galveston, TX
| | - R L Sheridan
- Shriners Hospital For Children - Boston, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University School of Public Health, Boston, MA; Bentley University, Waltham, MA; Shriners Hospital For Children - Cincinnati, Cincinnati, OH; Shriners Hospital For Children - Northern California, Sacramento, CA; Shriners Hospital For Children - Galveston, Galveston, TX
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24
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Affiliation(s)
- S K Golden
- Shriners Hospitals for Children--Boston, Boston, MA
| | - S L Wang
- Shriners Hospitals for Children--Boston, Boston, MA
| | - M Lydon
- Shriners Hospitals for Children--Boston, Boston, MA
| | - R L Sheridan
- Shriners Hospitals for Children--Boston, Boston, MA
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25
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Abstract
Although every disaster scenario is unique, certain themes have emerged repeatedly during management of burn disasters. These lessons learned are useful when planning an individual burn unit's role in future disaster response.
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Affiliation(s)
- Robert L Sheridan
- Boston Shriners Hospital for Children, 51 Blossom Street, Boston, MA 02114, USA.
| | - Jonathan Friedstat
- Boston Shriners Hospital for Children, 51 Blossom Street, Boston, MA 02114, USA
| | - Kaitlyn Votta
- Boston Shriners Hospital for Children, 51 Blossom Street, Boston, MA 02114, USA
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26
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Ren Y, Chang P, Sheridan RL. Negative wound pressure therapy is safe and useful in pediatric burn patients. Int J Burns Trauma 2017; 7:12-16. [PMID: 28533933 PMCID: PMC5435647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 01/07/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Negative Pressure Wound Therapy (NPWT) has proven to be a powerful tool in facilitating healing of difficult wounds of a variety of etiologies. The pediatric experience with NPWT has been limited due to concerns about vascular compression and pain associated with treatment. METHOD A retrospective review was performed to evaluate the therapeutic effect of NPWT on children with difficult wounds due to burns or soft-tissue trauma. NPWT was instituted in the operating room under general anesthesia using a commercially available system. NPWT was not initiated until all necrotic material was removed from the wounds. Negative pressure applied ranged from 50-125 mmHg continuous suction, with younger children being prescribed less negative pressures. NPWT dressings were changed every 5-7 days, in the operating room. When wounds were clean and had granulated they were closed with split-thickness skin grafts. RESULTS 29 children with an average age of 9.34 ± 1.95 years (range 2 months to 18 years) were treated with NPWT. Average total wound size was 24.8 ± 8.9 (range 0 to 95) percent of the body surface in those patients who had suffered burns and non-burn injuries. Injury mechanisms included hot liquid (2 children), contact with hot object (4 children), electricity (7 children), flame (9 children), and other non-burn injuries such as abrasion and Stevens-Johnson syndrome (7 children). Over 90% of the patients required central venous or bladder catheters. Perceived benefits of the treatment included reduced numbers of dressing changes and more rapid wound granulation. There were no episodes of bleeding associated with NPWT. All patients healed their wounds, were successfully grafted, and survived. CONCLUSION NPWT has a useful role in the pediatric burn unit in facilitating wounds healing and improving life qualities. We also found that a significant correlation between third degree burned wound size and the number of negative pressure therapies received, which indicated that NPWT could be more effective in treating complicated burned wounds. NPWT seems safe and effective when applied to well-debrided wounds. It does not seem to be associated with excessive bleeding or discomfort in children.
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Affiliation(s)
- Yanhan Ren
- Shriners Hospital for ChildrenBoston, MA, America
| | - Philip Chang
- Shriners Hospital for ChildrenBoston, MA, America
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27
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Murphy RA, Nisenbaum L, Labar AS, Sheridan RL, Ronat JB, Dilworth K, Pena J, Kilborn E, Teicher C. Invasive Infection and Outcomes in a Humanitarian Surgical Burn Program in Haiti. World J Surg 2017; 40:1550-7. [PMID: 26913733 DOI: 10.1007/s00268-016-3458-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Compare to high-income settings, survival in burn units in low-income settings is lower with invasive infections one leading cause of death. Médecins Sans Frontières is involved in the treatment of large burns in adults and children in Haiti. METHODS In 2014, we performed a review of 228 patients admitted consecutively with burn injury during a 6-month period to determine patient outcomes and infectious complications. Microbiology was available through a linkage with a Haitian organization. Regression analysis was performed to determine covariates associated with bloodstream infection and mortality. RESULTS 102 (45 %) patients were male, the median age was 8 years (IQR, 2-28), and the majority of patients (60 %) were admitted to the unit within 6 h of injury. There were 20 patients (9 %) with culture-proven bacteremia. Among organisms in blood, common isolates were Staphylococcus aureus (42 %), Pseudomonas aeruginosa (23 %), and Acinetobacter baumannii (15 %). Among patients with burns involving <40 % total body area, 4 (2 %) of 192 died and 20 (65 %) of 31 with ≥40 % body surface area involvement died. Factors associated with mortality included involvement of ≥40 % of body surface, depth, and flame as the mechanism. Multidrug-resistant infections were common; 18 % of S. aureus isolates were methicillin resistant, and 83 % of P. aeruginosa isolates were imipenem resistant. CONCLUSIONS A low mortality rate was observed in a humanitarian burn surgery project in patients with burns involving <40 % of total body surface. Invasive infection was common and alarming rates of antibiotic resistance were observed, including infections not treatable with antibiotics available locally.
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Affiliation(s)
- Richard A Murphy
- Division of Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1000 W. Carson St, Box 466, Torrance, CA, 90509, USA.
| | - Luba Nisenbaum
- Médecins Sans Frontières/Doctors Without Borders, 8, Rue Saint Sabin, 75011, Paris, France.,Rowan University School of Osteopathic Medicine, One Medical Center Drive, Stratford, NJ, 08084-1501, USA
| | | | - Robert L Sheridan
- Division of Burns, Massachusetts General Hospital, 55 Blossom St., Boston, MA, 02114, USA
| | - Jean-Baptiste Ronat
- Médecins Sans Frontières/Doctors Without Borders, 8, Rue Saint Sabin, 75011, Paris, France
| | - Kelly Dilworth
- Médecins Sans Frontières/Doctors Without Borders, 8, Rue Saint Sabin, 75011, Paris, France
| | - Jade Pena
- Médecins Sans Frontières/Doctors Without Borders, 8, Rue Saint Sabin, 75011, Paris, France
| | - Erin Kilborn
- Médecins Sans Frontières/Doctors Without Borders, 8, Rue Saint Sabin, 75011, Paris, France
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Prelack K, Yu YM, Dylewski M, Lydon M, Keaney TJ, Sheridan RL. Measures of Total Energy Expenditure and Its Components Using the Doubly Labeled Water Method in Rehabilitating Burn Children. JPEN J Parenter Enteral Nutr 2016; 41:470-480. [DOI: 10.1177/0148607115597665] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kathy Prelack
- Shriners Hospitals for Children, Boston, Massachusetts, USA
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Yong Ming Yu
- Shriners Hospitals for Children, Boston, Massachusetts, USA
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Martha Lydon
- Shriners Hospitals for Children, Boston, Massachusetts, USA
| | - Timothy J. Keaney
- Shriners Hospitals for Children, Boston, Massachusetts, USA
- Lawrence General Hospital, Lawrence, Massachusetts, USA
| | - Robert L. Sheridan
- Shriners Hospitals for Children, Boston, Massachusetts, USA
- Massachusetts General Hospital, Boston, Massachusetts, USA
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Affiliation(s)
- Robert L Sheridan
- From the Burn Service, Shriners Hospital for Children, the Division of Burns, Massachusetts General Hospital, and the Department of Surgery, Harvard Medical School - all in Boston
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Prelack K, Yu YM, Sheridan RL. Nutrition and metabolism in the rehabilitative phase of recovery in burn children: a review of clinical and research findings in a speciality pediatric burn hospital. Burns Trauma 2015; 3:7. [PMID: 27574653 PMCID: PMC4964101 DOI: 10.1186/s41038-015-0004-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 04/06/2015] [Indexed: 11/10/2022]
Abstract
During the rehabilitation phase of burn injury, patient care transitions from critical care medicine to restorative treatment strategies that encompass physical and occupational therapies, nutrition repletion, and psychosocial support for community reintegration. As pediatric burn patients undergo rehabilitation, nutrition assessment remains ongoing to define nutritional status and any alterations in metabolism that may take place. For some, a persistent hypermetabolic state appears evident, and weight loss may continue. The severity and duration however varies among patients. Many patients enter their rehabilitative phase with visible lean body mass depletion, and the focus of nutritional therapy for them shifts to replenishing nutritional status, while supporting rehabilitative efforts. Over the past decade, we have conducted studies on energy and protein metabolism, body composition, including bone mineralization, and general wellness in over 130 patients to better understand changes in metabolism and nutritional status during the rehabilitative phase of recovery. This abstract summarizes our findings.
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Affiliation(s)
- Kathy Prelack
- Shriners Hospitals For Children, Boston, Massachusetts USA
| | - Yong Ming Yu
- Shriners Hospitals For Children, Boston, Massachusetts USA
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Weber JM, Sheridan RL, Schulz JT, Tompkins RG, Ryan CM. Effectiveness of Bacteria-Controlled Nursing Units in Preventing Cross-Colonization With Resistant Bacteria in Severely Burned Children. Infect Control Hosp Epidemiol 2015; 23:549-51. [PMID: 12269456 DOI: 10.1086/502106] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractBacteria-controlled nursing units (BCNUs) are laminar air-flow patient isolation units. The rate of cross-colonization with resistant organisms in 66 critically ill pediatric burn patients with massive open wounds and ventilators housed in BCNUs during 5 years was examined and found to be extremely low (3.2 cases per 1,000 patient-days)
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Affiliation(s)
- Joan M Weber
- Shriners Burns Hospital, Boston, Massachusetts, USA
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Quinn KP, Golberg A, Broelsch GF, Khan S, Villiger M, Bouma B, Austen WG, Sheridan RL, Mihm MC, Yarmush ML, Georgakoudi I. An automated image processing method to quantify collagen fibre organization within cutaneous scar tissue. Exp Dermatol 2014; 24:78-80. [PMID: 25256009 DOI: 10.1111/exd.12553] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2014] [Indexed: 11/30/2022]
Abstract
Standard approaches to evaluate scar formation within histological sections rely on qualitative evaluations and scoring, which limits our understanding of the remodelling process. We have recently developed an image analysis technique for the rapid quantification of fibre alignment at each pixel location. The goal of this study was to evaluate its application for quantitatively mapping scar formation in histological sections of cutaneous burns. To this end, we utilized directional statistics to define maps of fibre density and directional variance from Masson's trichrome-stained sections for quantifying changes in collagen organization during scar remodelling. Significant increases in collagen fibre density are detectable soon after burn injury in a rat model. Decreased fibre directional variance in the scar was also detectable between 3 weeks and 6 months after injury, indicating increasing fibre alignment. This automated analysis of fibre organization can provide objective surrogate endpoints for evaluating cutaneous wound repair and regeneration.
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Affiliation(s)
- Kyle P Quinn
- Department of Biomedical Engineering, Tufts University, Medford, MA, USA
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Abstract
Burn units provide a unique set of resources to patients with complex wounds, sepsis, and organ failures. This resource set is useful in a number of traumatic, infectious, and medical conditions as well. Further, many burn patients have sustained simultaneous non-burn trauma which will be managed in burn programs.
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Affiliation(s)
- Robert L Sheridan
- Boston Shriners Hospital for Children, 51 Blossom Street, Boston, MA 02114, USA.
| | - David Greenhalgh
- Department of Surgery, Shriners Hospitals for Children Northern California, University of California, Davis, 2425 Stockton Boulevard, Sacramento, CA 95817, USA
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Sheridan RL. Commentary on: surgical skills needed for humanitarian missions in resource-limited settings: common operative procedures performed at Médecins Sans Frontières facilities. Surgery 2014; 156:650. [PMID: 24984803 DOI: 10.1016/j.surg.2014.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 05/06/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Robert L Sheridan
- Department of Surgery, Boston Shriners Hospital for Children, Massachusetts General Hospital, and Harvard Medical School, Boston, MA.
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Golberg A, Broelsch GF, Vecchio D, Khan S, Hamblin MR, Austen WG, Sheridan RL, Yarmush ML. Eradication of multidrug-resistant A. baumannii in burn wounds by antiseptic pulsed electric field. Technology (Singap World Sci) 2014; 2:153-160. [PMID: 25089285 PMCID: PMC4117356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Emerging bacterial resistance to multiple drugs is an increasing problem in burn wound management. New non-pharmacologic interventions are needed for burn wound disinfection. Here we report on a novel physical method for disinfection: antiseptic pulsed electric field (PEF) applied externally to the infected burns. In a mice model, we show that PEF can reduce the load of multidrug resistant Acinetobacter baumannii present in a full thickness burn wound by more than four orders of magnitude, as detected by bioluminescence imaging. Furthermore, using a finite element numerical model, we demonstrate that PEF provides non-thermal, homogeneous, full thickness treatment for the burn wound, thus, overcoming the limitation of treatment depth for many topical antimicrobials. These modeling tools and our in vivo results will be extremely useful for further translation of the PEF technology to the clinical setting, as they provide the essential elements for planning of electrode design and treatment protocol.
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Sheridan RL, Shumaker PR, King DR, Wright CD, Itani KMF, Cancio LC. Case records of the Massachusetts General Hospital. Case 15-2014. A man in the military who was injured by an improvised explosive device in Afghanistan. N Engl J Med 2014; 370:1931-40. [PMID: 24827038 DOI: 10.1056/nejmcpc1310008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Golberg A, Bei M, Sheridan RL, Yarmush ML. Regeneration and control of human fibroblast cell density by intermittently delivered pulsed electric fields. Biotechnol Bioeng 2013; 110:1759-68. [DOI: 10.1002/bit.24831] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 12/20/2012] [Accepted: 12/21/2012] [Indexed: 12/20/2022]
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Golberg A, Bei M, Sheridan RL, Yarmush ML. Regeneration and control of human fibroblast cell density by intermittently delivered pulsed electric fields. Biotechnol Bioeng 2013. [DOI: 10.1002/bit.24832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Weber JM, Sheridan RL, Fagan S, Ryan CM, Pasternack MS, Tompkins RG. Incidence of catheter-associated bloodstream infection after introduction of minocycline and rifampin antimicrobial-coated catheters in a pediatric burn population. J Burn Care Res 2012; 33:539-43. [PMID: 22210071 DOI: 10.1097/bcr.0b013e31823c4cd5] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Centers for Disease Control and Prevention guidelines for prevention of intravascular catheter-related infections suggest that antimicrobial-coated catheters can decrease the risk of developing catheter-related bloodstream infection in a variety of adult patient populations. There are limited data on their efficacy in the pediatric population, particularly among children with burn injuries. A study was conducted at Shriners Hospitals for Children®, Boston, to determine whether minocycline/rifampin (MR)-coated catheters could decrease the incidence of catheter-associated bloodstream infection (CABSI) in a pediatric burn population. A historical control group included all patients with double- or triple-lumen catheters inserted in the 18-month period from January 2006 to June 2007. The study group included all patients with MR antimicrobial double- or triple-lumen catheters inserted in the subsequent 18-month period, July 2007 to December 2008. Data collected included name, age, date of burn/injury, date of admission, percent TBSA area burn injury or other diagnosis, catheter site (subclavian, internal jugular, or femoral), method of insertion (new percutaneous stick or guidewire), type of catheter (double or triple lumen), date inserted, duration of catheter placement (days), and positive blood cultures recovered while the central venous catheter was in place. CABSI was defined using the Centers for Disease Control and Prevention definition of laboratory-confirmed bloodstream infection. There were a total of 66 patients with 252 catheters (1780 catheter days) in the control group and 75 patients with 263 catheters (1633 catheter days) in the study group. Age, percent burn injury, catheter site, and method of insertion were not statistically different between the two groups. The percentage of infected catheters and the rate of infection were significantly different for the two groups, with the MR antimicrobial catheters only half as likely to become infected. In a subset of these patients with catheters in place for more than 4 days, the percentage of infected catheters and rate of infection were also significantly different with results similar to those in the entire group. MR antimicrobial-coated catheters significantly reduced the incidence of CABSI in this pediatric burn population compared with noncoated catheters.
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Affiliation(s)
- Joan M Weber
- Shriners Hospitals for Children, Boston, Massachusetts 02114, USA
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Sheridan RL, Schaefer PW, Whalen M, Fagan S, Stoddard FJ, Schneider JC, McConkey B, Cancio LC. Case records of the Massachusetts General Hospital. Case 36-2012. Recovery of a 16-year-old girl from trauma and burns after a car accident. N Engl J Med 2012; 367:2027-37. [PMID: 23171100 DOI: 10.1056/nejmcpc1200088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Burns and environmental injuries are common as primary or secondary problems in survivors of natural disasters, terrorist incidents, and combat operations. In recent years, intensive military medical experience has resulted in substantial progress in treatment of these important problems. This article reviews practical applications of this new knowledge.
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Affiliation(s)
- Leopoldo C Cancio
- U.S. Army Institute of Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX 78234-6315, USA
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Sheridan RL. An inconvenient epidemic. J Trauma Acute Care Surg 2012; 72:1117-1118. [PMID: 22491639 DOI: 10.1097/ta.0b013e31824237e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Stoddard FJ, Luthra R, Sorrentino EA, Saxe GN, Drake J, Chang Y, Levine JB, Chedekel DS, Sheridan RL. A randomized controlled trial of sertraline to prevent posttraumatic stress disorder in burned children. J Child Adolesc Psychopharmacol 2011; 21:469-77. [PMID: 22040192 DOI: 10.1089/cap.2010.0133] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND This study evaluated the potential benefits of a centrally acting selective serotonin reuptake inhibitor, sertraline, versus placebo for prevention of symptoms of posttraumatic stress disorder (PTSD) and depression in burned children. This is the first controlled investigation based on our review of the early use of a medication to prevent PTSD in children. METHODS Twenty-six children aged 6-20 were assessed in a 24-week double-blind placebo-controlled design. Each child received either flexibly dosed sertraline between 25-150 mg/day or placebo. At each reassessment, information was collected in compliance with the study medication, parental assessment of the child's symptomatology and functioning, and the child's self-report of symptomatology. The protocol was approved by the Human Studies Committees of Massachusetts General Hospital and Shriners Hospitals for Children. RESULTS The final sample was 17 subjects who received sertraline versus 9 placebo control subjects matched for age, severity of injury, and type of hospitalization. There was no significant difference in change from baseline with child-reported symptoms; however, the sertraline group demonstrated a greater decrease in parent-reported symptoms over 8 weeks (-4.1 vs. -0.5, p=0.005), over 12 weeks (-4.4 vs. -1.2, p=.008), and over 24 weeks (-4.0 vs. -0.2, p=0.017). CONCLUSIONS Sertraline was a safe drug, and it was somewhat more effective in preventing PTSD symptoms than placebo according to parent report but not child report. Based on this study, sertraline may prevent the emergence of PTSD symptoms in children.
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Affiliation(s)
- Frederick J Stoddard
- Shriners Hospitals for Children and Harvard Medical School at Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
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Fusco HN, Bonato P, Mancinelli C, Ryan CM, Sheridan RL. Poster 404 Development and Feasibility of a Novel Gaming System for Children With Upper Extremity Burn Contractures. PM R 2011. [DOI: 10.1016/j.pmrj.2011.08.434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
| | - Paolo Bonato
- Spaulding Rehab Hospital, Boston, MA, United States
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Dylewski ML, Prelack K, Weber JM, Keaney T, Ryan CM, Sheridan RL, Fagan SP. Malnutrition among pediatric burn patients: A consequence of delayed admissions. Burns 2010; 36:1185-9. [DOI: 10.1016/j.burns.2010.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Revised: 03/26/2010] [Accepted: 04/01/2010] [Indexed: 10/19/2022]
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Dylewski ML, Bender JC, Smith AM, Prelack K, Lydon M, Weber JM, Sheridan RL. The selenium status of pediatric patients with burn injuries. ACTA ACUST UNITED AC 2010; 69:584-8; discussion 588. [PMID: 20838129 DOI: 10.1097/ta.0b013e3181e74c54] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Dietary selenium (Se) requirements during critical illness are not well known. The objective of this study was to assess the longitudinal Se status of pediatric patients with burns. METHODS Twenty patients admitted to our hospital with burns exceeding 10% of their total body surface area were studied longitudinally during the first 8 weeks of admission or until 95% wound closure was achieved. Dietary Se intake was calculated daily, and plasma and urine samples were collected weekly for analyses of plasma Se, urinary Se, and glutathione peroxidase activity. RESULTS Patients included in this study were individuals with an average age of 6.5 years ± 5.3 years and with burn injury of a mean total body surface area of 42% ± 21%. Dietary Se intake throughout the study (mean = 60 μg/d ± 39 μg/d) was consistent with established standards for healthy children and did not change throughout the study. Plasma Se (mean = 1.08 μmol/L ± 0.34 μmol/L) and plasma glutathione peroxidase (mean = 3.2 U/g protein ± 1.42 U/g protein) were below reported normal values for healthy American children. Mean urinary Se excretion (65.9 μg/L ± 50 μg/L) exceed dietary Se intake. Plasma Se was inversely related to incidence of total infection (p = 0.04). CONCLUSIONS Results from this study indicate that Se status is depressed among pediatric patients with burns and that recommended Se intake for healthy children is likely insufficient for this population. Further studies are necessary to elucidate the amount of dietary Se required to maximize Se stores among pediatric patients with burn injuries.
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Affiliation(s)
- Maggie L Dylewski
- Department of Surgery, Shriners Hospitals for Children, Boston, Massachusetts 02114, USA.
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