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 journalArticlepeer-review

30 Scopus citations

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

Keywords

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

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

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