Long-term posttraumatic stress symptoms vary inversely with early opiate dosing in children recovering from serious burns: Effects durable at 4 years

Robert L. Sheridan, Frederick J. Stoddard, Lewis E. Kazis, Austin Lee, Nien Chen Li, Richard J. Kagan, Tina L Palmieri, Walter J. Meyer, Marc Nicolai, Teresa K. Stubbs, Grace Chan, Michelle I. Hinson, David N. Herndon, Ronald G. Tompkins

Research output: Contribution to journalArticle

28 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)828-832
Number of pages5
JournalJournal of Trauma and Acute Care Surgery
Volume76
Issue number3
DOIs
StatePublished - Mar 2014
Externally publishedYes

Fingerprint

Opiate Alkaloids
Burns
Post-Traumatic Stress Disorders
Wounds and Injuries
Checklist
Burn Units
Pain
Hospitalized Child
Body Surface Area
Pain Management
Outcome Assessment (Health Care)
Pediatrics

Keywords

  • Burns
  • Outcomes
  • Pain control
  • Pediatric
  • Posttraumatic stress

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Long-term posttraumatic stress symptoms vary inversely with early opiate dosing in children recovering from serious burns : Effects durable at 4 years. / Sheridan, Robert L.; Stoddard, Frederick J.; Kazis, Lewis E.; Lee, Austin; Li, Nien Chen; Kagan, Richard J.; Palmieri, Tina L; Meyer, Walter J.; Nicolai, Marc; Stubbs, Teresa K.; Chan, Grace; Hinson, Michelle I.; Herndon, David N.; Tompkins, Ronald G.

In: Journal of Trauma and Acute Care Surgery, Vol. 76, No. 3, 03.2014, p. 828-832.

Research output: Contribution to journalArticle

Sheridan, RL, Stoddard, FJ, Kazis, LE, Lee, A, Li, NC, Kagan, RJ, Palmieri, TL, Meyer, WJ, Nicolai, M, Stubbs, TK, Chan, G, Hinson, MI, Herndon, DN & Tompkins, RG 2014, 'Long-term posttraumatic stress symptoms vary inversely with early opiate dosing in children recovering from serious burns: Effects durable at 4 years', Journal of Trauma and Acute Care Surgery, vol. 76, no. 3, pp. 828-832. https://doi.org/10.1097/TA.0b013e3182ab111c
Sheridan, Robert L. ; Stoddard, Frederick J. ; Kazis, Lewis E. ; Lee, Austin ; Li, Nien Chen ; Kagan, Richard J. ; Palmieri, Tina L ; Meyer, Walter J. ; Nicolai, Marc ; Stubbs, Teresa K. ; Chan, Grace ; Hinson, Michelle I. ; Herndon, David N. ; Tompkins, Ronald G. / Long-term posttraumatic stress symptoms vary inversely with early opiate dosing in children recovering from serious burns : Effects durable at 4 years. In: Journal of Trauma and Acute Care Surgery. 2014 ; Vol. 76, No. 3. pp. 828-832.
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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.",
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T1 - Long-term posttraumatic stress symptoms vary inversely with early opiate dosing in children recovering from serious burns

T2 - Effects durable at 4 years

AU - Sheridan, Robert L.

AU - Stoddard, Frederick J.

AU - Kazis, Lewis E.

AU - Lee, Austin

AU - Li, Nien Chen

AU - Kagan, Richard J.

AU - Palmieri, Tina L

AU - Meyer, Walter J.

AU - Nicolai, Marc

AU - Stubbs, Teresa K.

AU - Chan, Grace

AU - Hinson, Michelle I.

AU - Herndon, David N.

AU - Tompkins, Ronald G.

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N2 - 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.

AB - 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.

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