Citation

Fassel M, Grieve B, Hosseini S, Oral R, Galet C, Ryan C, Kazis L, Pengsheng N, Wibbenmeyer L. J. Burn Care Res. 2019; 40(3): 294-301.

Affiliation

University of Iowa Hospitals and Clinics, Department of Surgery.

Copyright

(Copyright © 2019, American Burn Association, Publisher Lippincott Williams and Wilkins)

DOI

10.1093/jbcr/irz014

PMID

30873544

Abstract

Adverse Childhood Experiences (ACEs), including child maltreatment and household dysfunction, define adverse events that occur before 18 years of age. National and state data show that between 12.5 and 14.5% of the adult population report ≥4 ACEs (HIGH-ACE), respectively. HIGH-ACEs are associated with more chronic health problems. To date, the interaction between ACEs and burn injuries has not been studied. Herein, we sought to define the ACE exposure in our burn patients and its impact on early outcomes. Inpatient and outpatient adult burn survivors (≥18 years of age) were enrolled. Subjects completed surveys assessing adverse experiences (ACEs-18), needs, strengths, and resiliency at consent, and pain, depression, post-traumatic stress disorder (PTSD), and social participation surveys at 2-weeks to 3-months post injury. Demographics, burn, and hospital course data were also collected. Chi-square and student's t-tests were used for descriptive analysis and to compare the groups (HIGH-ACE vs. LOW-ACE). The HIGH-ACE group (n = 24; 45.3%) reported more depressive symptoms (p < 0.04) than the LOW-ACE group (n = 29, 54.7%). HIGH-ACE patients were less resilient when facing stressful events (p ≤ 0.02) and more likely to screen positive for probable PTSD (p = 0.01) and to score lower on the Life Impact Burn Recovery Evaluation Profile (LIBRE Profile), which assesses for social participation, in the domain of Family and Friends (p = 0.015). Our exploratory study suggests that ACE screening may help detect burn patients at risk for a more complicated recovery, thereby promoting personalized assistance in recovery.

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Language: en

Keywords

Adverse childhood events; Depression; PTSD; burn; burn recovery; outcomes; social participation