Citation

Sheridan RL, Stoddard FJ, Kazis LE, Lee AFS, Li NC, Kagan RJ, Palmieri TL, Meyer WJ, Nicolai M, Stubbs TK, Chan G, Hinson MI, Herndon DN, Tompkins RG. J. Trauma Acute Care Surg. 2014; 76(3): 828-832.

Affiliation

From the Shriners Hospitals for Children (R.L.S., F.J.S., M.I.H., R.G.T.); Massachusetts General Hospital (R.L.S., F.J.S., A.L., R.G.T.); and Center for the Assessment of Pharmaceutical Practices (CAPP) (L.E.K.), Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Children (D.N.H., W.J.M., M.N.), Galveston, Texas; Shriners Hospitals for Children (R.J.K., T.K.S.), Cincinnati, Ohio; Shriners Hospitals for Children (Northern California) (T.L.P., G.C.), Sacramento, California.

Copyright

(Copyright © 2014, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0b013e3182ab111c

PMID

24553556

Abstract

BACKGROUND: Children surviving serious burns are at risk for developing posttraumatic stress disorder (PTSD) as a function both of the injury and of its treatment. Short-term studies in such children have demonstrated reduced PTSD symptoms with intensive early pain control. However, the long-term impact of early pain control strategies on posttraumatic stress symptoms in children recovering from serious burn injuries has not been examined. METHODS: This was a retrospective review of a multiple time point data collection involving a cohort of 147 infants, children, and teenagers with 4 years of follow-up after serious burns conducted at 4 pediatric burn centers to examine the impact of early opiate dosing on long-term posttraumatic stress symptoms. The main outcome measure was the nine-item Short Form Child Stress Disorders Checklist, which is an established and validated assessment. The impact of total opiate dosing during the first 7 days on these scores was assessed. RESULTS: Subjects had an average age of 11 years and average injury size of 22% total body surface area burned (%TBS). The correlation between opiate units (OUs) and %TBS was 0.46 at baseline, OU increasing with increasing %TBS. OUs were strongly predictive of Child Stress Disorders Checklist scores up to 4 years, with higher OU (10 units vs. 6 and 2 units) remaining constantly different up to 4 years in predicting lower stress scores for both smaller and larger burns. CONCLUSION: Early opiate management of pain associated with acute burn wounds and burn treatment predicts the development and resolution rate of PTSD symptoms in a large multicenter sample of children hospitalized for serious burns. The effect seems to be dose related and durable at least up to 4 years in a range of burn sizes. LEVEL OF EVIDENCE: Prognostic/epidemiologic study, level II.

Language: en