TY - JOUR
T1 - Recovery curves for pediatric burn survivors advances in patient-oriented outcomes
AU - Kazis, Lewis E.
AU - Lee, Austin F.
AU - Rose, Mary
AU - Liang, Matthew H.
AU - Li, Nien Chen
AU - Ren, Xinhua S.
AU - Sheridan, Robert
AU - Gilroy-Lewis, Janet
AU - Stoddard, Fred
AU - Hinson, Michelle
AU - Warden, Glenn
AU - Stubbs, Kim
AU - Blakeney, Patricia
AU - Meyer, Walter
AU - McCauley, Robert
AU - Herndon, David
AU - Palmieri, Tina
AU - Mooney, Kate
AU - Wood, David
AU - Pidcock, Frank
AU - Reilly, Debra
AU - Cullen, Marc
AU - Calvert, Catherine
AU - Ryan, Colleen M.
AU - Schneider, Jeffrey C.
AU - Soley-Bori, Marina
AU - Tompkins, Ronald G.
N1 - Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2016/6
Y1 - 2016/6
N2 - IMPORTANCE: Patient-reported outcomes serving as benchmarks for recovery of pediatric burn survivors are lacking, and new approaches using longitudinal cohorts for monitoring their expected recovery based on statistical models are needed for patient management during the early years following the burn. OBJECTIVE: To describe multidimensional patient-reported outcomes among pediatric burn survivors younger than 5 years to establish benchmarks using recovery curve methods. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study of pediatric burn survivors younger than 5years at 12 burn centers. Age-matched nonburned reference groups were studied to define expected results in normal growth and development. The Burn Outcomes Questionnaire for children aged 0 to 5 years (BOQ0-5) was administered to parents of children who had burns and were younger than 5 years. Mixed models were used to generate 48-month recovery curves for eachof the 10 BOQ0-5 domains. The study was conducted between January1999 and December 2008. MAINOUTCOMESAND MEASURES: The 10 BOQ0-5 domains including play, language, fine motor skills, gross motor skills, emotional behavior, family functioning, pain/itching, appearance, satisfaction with care, and worry/concern up to 48 months after burn injury. RESULTS: A total of 336 pediatric burn survivors younger than 5 years (mean [SD] age, 2.0 [1.2] years; 58.4% male; 60.2% white, 18.6% black, and 12.0% Hispanic) and 285 age-matched nonburned controls (mean [SD] age, 2.4 [1.3] years; 51.1% male; 67.1% white, 8.9% black, and 15.0% Hispanic) completed the study. Predicted scores improved exponentially over time for 5 of the BOQ0-5 domains (predicted scores at 1 month vs 24 months: play, 48.6 vs 52.1 [P =.03]; language, 49.2 vs 54.4 [P <.001]; gross motor skills, 48.7 vs 53.0 [P =.002]; pain/itching, 15.8 vs 33.5 [P <.001]; and worry/concern, 31.6 vs 44.9 [P <.001]). Pediatric burn survivors had higher scores in language, emotional behavior, and family functioning domains compared with healthy children in later months. CONCLUSIONS AND RELEVANCE: This study demonstrates significant deficits in multiple functional domains across pediatric burn survivors compared with controls. Recovery curves can be used to recognize deviation from the expected course and tailor care to patient needs.
AB - IMPORTANCE: Patient-reported outcomes serving as benchmarks for recovery of pediatric burn survivors are lacking, and new approaches using longitudinal cohorts for monitoring their expected recovery based on statistical models are needed for patient management during the early years following the burn. OBJECTIVE: To describe multidimensional patient-reported outcomes among pediatric burn survivors younger than 5 years to establish benchmarks using recovery curve methods. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study of pediatric burn survivors younger than 5years at 12 burn centers. Age-matched nonburned reference groups were studied to define expected results in normal growth and development. The Burn Outcomes Questionnaire for children aged 0 to 5 years (BOQ0-5) was administered to parents of children who had burns and were younger than 5 years. Mixed models were used to generate 48-month recovery curves for eachof the 10 BOQ0-5 domains. The study was conducted between January1999 and December 2008. MAINOUTCOMESAND MEASURES: The 10 BOQ0-5 domains including play, language, fine motor skills, gross motor skills, emotional behavior, family functioning, pain/itching, appearance, satisfaction with care, and worry/concern up to 48 months after burn injury. RESULTS: A total of 336 pediatric burn survivors younger than 5 years (mean [SD] age, 2.0 [1.2] years; 58.4% male; 60.2% white, 18.6% black, and 12.0% Hispanic) and 285 age-matched nonburned controls (mean [SD] age, 2.4 [1.3] years; 51.1% male; 67.1% white, 8.9% black, and 15.0% Hispanic) completed the study. Predicted scores improved exponentially over time for 5 of the BOQ0-5 domains (predicted scores at 1 month vs 24 months: play, 48.6 vs 52.1 [P =.03]; language, 49.2 vs 54.4 [P <.001]; gross motor skills, 48.7 vs 53.0 [P =.002]; pain/itching, 15.8 vs 33.5 [P <.001]; and worry/concern, 31.6 vs 44.9 [P <.001]). Pediatric burn survivors had higher scores in language, emotional behavior, and family functioning domains compared with healthy children in later months. CONCLUSIONS AND RELEVANCE: This study demonstrates significant deficits in multiple functional domains across pediatric burn survivors compared with controls. Recovery curves can be used to recognize deviation from the expected course and tailor care to patient needs.
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U2 - 10.1001/jamapediatrics.2015.4722
DO - 10.1001/jamapediatrics.2015.4722
M3 - Article
C2 - 26953515
AN - SCOPUS:84973647676
SN - 2168-6203
VL - 170
SP - 534
EP - 542
JO - JAMA pediatrics
JF - JAMA pediatrics
IS - 6
ER -