Publication YearTitlePublication Reference typeAccession NoJournalPublication VolumePublication IssuePublication PagesPublication WebsiteAbstractStaff MembersPublication Author(s)Participating CentersPublished statusName
2020“Living well” after burn injury: Using case reports to illustrate significant contributions from the Burn Model System research program.JournalJournal of Burn Care and ResearchEpubhttps://pubmed.ncbi.nlm.nih.gov/32971531/Introduction: The Burn Model System (BMS) program of research has been funded since 1993 by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). The overarching aim of this program is to improve outcomes and quality of life for people with burns in the areas of health and function; employment; community living and participation. This review reports on BMS contributions that have impacted the lives of individuals with a significant burn injury using case reports to associate BMS contributions with recovery. Methods: In December 2019, current BMS grantee researchers assessed peer-reviewed BMS publications from 1994 to 2020 . Using case report methodology, contributions were linked to three individuals treated at one of four Burn Model System institutions. Results: With over 25 years of NIDILRR funding, unique BMS contributions to patient recovery were identified and categorized into one of several domains: Treatment, Assessment measures, Sequelae, Peer support, Employment, and Long-term functional outcomes. A second review for significant results of BMS research that add to the understanding of burn injury, pathophysiology and recovery research were identified and categorized as Injury and recovery research. The case study participants featured in this review identified select NIDRR/NIDILRR research contributions as having direct, personal benefit to their recovery. Conclusions: The knowledge generation and clinical innovation that this research program has contributed to our collective understanding of recovery after burn injury is considerable. Using case study methodology with three adult burn survivors, we highlight the impact and individual significance of program findings and reinforce the recognition that the value of any clinical research must have relevance to the lives of the study population. Gretchen J. Carrougher, MN, RN, Kara McMullen, MPH, Dagmar Amtmann, PhD, Audrey E. Wolfe, MPH, Diana Tenney, Jeffrey C. Schneider, MD, Joseph Yeakley, Radha K. Holavanahalli, Loren Patterson, BS, Christopher Madison and Nicole S. Gibran, MD, FACSNorthwest Regional Burn Model System, Boston-Harvard Burn Injury Model System, North Texas Burn Rehabilitation Model SystemYescheberle
2017The burn model systems outcome measures: A content analysis using the international classification of functioning, disability, and healthJournalJ77157Disability and Rehabilitation39252584-2593Study examined the extent to which the outcome measures for the Burn Injury Model Systems (BMS) collect data that encompass the entire experience of burn patients over time. Each meaningful concept included in the BMS assessments was linked to the International Classification of Functioning, Disability and Health (ICF) in order to classify and describe the content of each measure. The linking was completed by two experienced coders. The perspective of each assessment was also defined to determine if it addressed health status (disability and functioning), quality of life, and environmental factors (barriers and facilitators). A total of 1,327 concepts were identified among 754 items in all of the BMS assessments combined. A total of 61 percent (816 concepts) were linkable to the ICF. The body function component was most frequently addressed overall, followed by the activities and participation component. The component body structures and environmental factors are not extensively covered in the BMS assessments. ICF chapter and category distribution varied greatly between assessments. The assessments were of the health status perspective. This study suggests a need to revisit the item composition of the BMS assessments to more evenly distribute ICF topics and subtopics that are pertinent to burn injury which will ensure a broader but more precise understanding of burn injury recovery.Osborne, Candice L., Petersson, Christina, Graham, James E., Meyer III, Walter J., Simeonsson, Rune J., Suman, Oscar E., Ottenbacher, Kenneth J.Nodevopsadmin
2020Racial/ethnic disparities in longitudinal trajectories of community integration after burn injury.JournalAmerican Journal of Physical Medicine & Rehabilitation997602-607https://pubmed.ncbi.nlm.nih.gov/31876543/Objectives: The aim of this study was to examine potential racial/ethnic disparities in community integration for the 2 yrs after burn injury. Design: A sample of 1773 adults with burn injury from the Burn Model Systems database was used with data on community integration collected at discharge (preinjury recall), 6, 12, and 24 mos after discharge. Methods: Four sets of hierarchal linear models determined the most appropriate model for understanding racial/ethnic differences in Community Integration Questionnaire trajectories over time. Results: Data indicated a decrease in community integration between discharge and 6 mos, a slight increase between 6 mos and 1 yr, and then a plateau between 1 and 2 yrs. White individuals had higher community integration score trajectories over time than black (b = 0.53, P < 0.001) and Hispanic (b = 0.58, P < 0.001) individuals, and community integration scores were similar between black and Hispanic individuals (b = -0.05, P = 0.788). These racial/ethnic disparities remained after accounting for age, sex, total burned surface area, number of days in rehabilitation, and active range of motion deficits. Conclusions: Additional rehabilitation resources should be targeted to helping black and Hispanic individuals integrate back into their communities after burn injury. Bradford S Pierce, Paul B Perrin, Mickeal Pugh, Annahir N Cariello, Richard S Henry, Megan E Sutter, Shelley A Wiechman, Jeffrey C SchneiderNorthwest Regional Burn Model System, Boston-Harvard Burn Injury Model SystemYescheberle
2020Evaluation of patient-reported outcomes in burn survivors undergoing reconstructive surgery in the rehabilitative period.JournalPlastic and Reconstructive Surgery 1461171-182https://journals.lww.com/plasreconsurg/Abstract/2020/07000/Evaluation_of_Patient_Reported_Outcomes_in_Burn.29.aspxBackground: Health-related quality of life is decreased in burn survivors, with scars implicated as a cause. The authors aim to characterize the use of reconstructive surgery following hospitalization and determine whether patient-reported outcomes change over time. The authors hypothesized improvement in health-related quality of life following reconstructive surgery. Methods: Adult burn survivors undergoing reconstructive surgery within 24 months after injury were extracted from a prospective, longitudinal database from 5 U.S. burn centers (Burn Model System). Surgery was classified by problem as follows: scar, contracture, and open wound. The authors evaluated predictors of surgery using logistic regression. Short Form-12/Veterans RAND 12 health survey outcomes at 6, 12, and 24 months were compared at follow-up intervals and matched with nonoperated participants using propensity score matching. Results: Three hundred seventy-two of 1359 participants (27.4 percent) underwent one or more reconstructive operation within 24 months of injury. Factors that increased the likelihood of surgery included number of operations during index hospitalization (p < 0.001), hand (p = 0.001) and perineal involvement (p = 0.042), and range-of-motion limitation at discharge (p < 0.001). Compared to the physical component scores of peers who were not operated on, physical component scores increased for participants undergoing scar operations; however, these gains were only significant for those undergoing surgery more than 6 months after injury (p < 0.05). Matched physical component scores showed nonsignificant differences following contracture operations. Mental component scores were unchanged or lower following scar and contracture surgery. Conclusions: Participants requiring more operations during index admission were more likely to undergo reconstructive surgery. There were improvements in Short Form-12/Veterans RAND 12 scores for those undergoing scar operations more than 6 months after injury, although contracture operations were not associated with significant differences in Short Form-12/Veterans RAND 12 scores. Clifford C Sheckter, Gretchen J Carrougher, Kara McMullen, Alyssa Bamer, Jonathan Friedstat, Tam N Pham, Nicole S GibranNorthwest Regional Burn Model System, Boston-Harvard Burn Injury Model SystemYescheberle
2020Inhalation injury is associated with long-term employment outcomes in the burn population: Findings from a cross-sectional examination of the Burn Model System National Database.JournalPLOS ONE159https://journals.plos.org/plosone/articleIntroduction: Inhalation injuries carry significant acute care burden including prolonged ventilator days and length of stay. However, few studies have examined post-acute outcomes of inhalation injury survivors. This study compares the long-term outcomes of burn survivors with and without inhalation injury. Methods: Data collected by the Burn Model System National Database from 1993 to 2019 were analyzed. Demographic and clinical characteristics for adult burn survivors with and without inhalation injury were examined. Outcomes included employment status, Short Form-12/Veterans Rand-12 Physical Composite Score (SF-12/VR-12 PCS), Short Form-12/Veterans Rand-12 Mental Composite Score (SF-12/VR-12 MCS), and Satisfaction With Life Scale (SWLS) at 24 months post-injury. Regression models were used to assess the impacts of sociodemographic and clinical covariates on long-term outcome measures. All models controlled for demographic and clinical characteristics. Results: Data from 1,871 individuals were analyzed (208 with inhalation injury; 1,663 without inhalation injury). The inhalation injury population had a median age of 40.1 years, 68.8% were male, and 69% were White, non-Hispanic. Individuals that sustained an inhalation injury had larger burn size, more operations, and longer lengths of hospital stay (p<0.001). Individuals with inhalation injury were less likely to be employed at 24 months post-injury compared to survivors without inhalation injury (OR = 0.63, p = 0.028). There were no significant differences in PCS, MCS, or SWLS scores between groups in adjusted regression analyses. Conclusions: Burn survivors with inhalation injury were significantly less likely to be employed at 24 months post-injury compared to survivors without inhalation injury. However, other health-related quality of life outcomes were similar between groups. This study suggests distinct long-term outcomes in adult burn survivors with inhalation injury which may inform future resource allocation and treatment paradigms. Full article available at link.  Olivia R. Stockly, Audrey E. Wolfe, Gretchen J. Carrougher, Barclay T. Stewart, Nicole S. Gibran, Steven E. Wolf, Kara McMullen, Alyssa M. Bamer, Karen Kowalske, William G. Cioffi, Ross Zafonte, Jeffrey C. Schneider, Colleen M. Ryan Boston-Harvard Burn Injury Model SystemYescheberle
2020Paucity of clinical practice guidelines for rehabilitation of burn survivors.JournalAmerican Journal of Physical Medicine & RehabilitationEpubhttps://pubmed.ncbi.nlm.nih.gov/32282360/Clinical practice guidelines (CPGs) provide an efficient route from research to practice because they follow a prescribed, vetted process for evidence collection. CPGs offer underserved fields, such as burn rehabilitation, an accessible approach to reliable treatment. We performed a literature search using terms: "Burns AND Clinical Practice Guidelines AND Rehabilitation." Three reviewers determined whether guideline development followed an established vetting process. "Rehabilitation" required evidence of treatment to improve, maintain, or restore human function and provide treatment to facilitate recovery. Only 160 articles were obtained and, after adding the term "functional outcome," 62 remained for full-text review of which 21 were eligible. When articles were scored for inclusion of both rehabilitation AND function or functional outcome AND guideline vetting, 7 articles remained. One was community-based. Nine articles had no recorded vetting process but addressed rehabilitation as an outcome. There is a paucity of CPGs relevant to clinical rehabilitation for burn survivors, likely a result of very few published intervention trials, rare randomized controlled trials addressing rehabilitation, absence of data to establish an evidence base for practice recommendations, an inadequate number of community-based intervention trials, and little patient input. It is likely that rehabilitation of burn survivors will improve if more people gain skills in meeting the needs of people with burn injury. An increase in trained professionals may lead to an increase in intervention trials and research to establish evidence for CPGs. People engaged in burn research have an opportunity to devise a systematic, generally agreed upon approach toward evaluating burn patients and treatment outcomes that will permit data sharing across the world and assess patients throughout the acute and chronic phases of burn injury. Lynn H Gerber, Rati Deshpande, Shruthi Prabhakar, Cindy Cai, Steven Garfinkel, J Mary Louise Pomeroy, Peter Esselman, Jeffrey SchneiderNorthwest Regional Burn Model System, Boston-Harvard Burn Injury Model SystemYescheberle
2020COVID-19 pandemic and the burn survivor community: A call for action.JournalBurnsEpubhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7180154/A number of persons with present or past burn injuries will contract COVID-19. Dealing equitably with disability is an important ethical foundation of “crisis standards of care”. Breaking down barriers for burn survivors by empowering them with their providers of care as partners in a process known as “Coproduction” can provide a platform for advocating powerfully for disability rights. The American Burn Association has begun this process in a statement on their website developed in collaboration with the Phoenix Society of Burn Survivors. In their statement on interpreting burn triage during the COVID-19 pandemic, they emphasize that burn size, although an important determinant of mortality should not be a consideration in triage related to quality of life determinations. Finally, preparation for the post-COVID surge in reconstructive, rehabilitation and psychosocial needs of burn survivors must be underway. Colleen M. Ryan, Frederick J. Stoddard, Lewis E. Kazis, Jeffrey C. SchneiderBoston-Harvard Burn Injury Model SystemYescheberle
2020An Examination of Follow-up Services Received by Vulnerable Burn Populations: A Burn Model System National Database Study.JournalJournal of Burn Care and Research412377-383https://www.ncbi.nlm.nih.gov/pubmed/31710682While disparities in healthcare outcomes and services for vulnerable populations have been documented, the extent to which vulnerable burn populations demonstrate disparities in long-term care is relatively underexplored. This study's goal was to assess for differences in long-term occupational or physical therapy (OT/PT) and psychological service use after burn injury in vulnerable populations. Data from the Burn Model System National Database (2006-2015) were analyzed. The vulnerable group included participants in one or more of these categories: 65 years of age or older, nonwhite, no insurance or Medicaid insurance, preinjury receipt of psychological therapy or counseling, preinjury alcohol and/or drug misuse, or with a preexisting disability. Primary outcomes investigated were receipt of OT/PT and psychological services. Secondary outcomes included nine OT/PT subcategories. Outcomes were examined at 6, 12, and 24 months postinjury. One thousand one hundred thirty-six burn survivors (692 vulnerable; 444 nonvulnerable) were included. The vulnerable group was mostly female, unemployed at time of injury, and with smaller burns. Both groups received similar OT/PT and psychological services at all time points. Adjusted regression analyses found that while the groups received similar amounts services, some vulnerable subgroups received significantly more services. Participants 65 years of age or older, who received psychological therapy or counseling prior to injury, and with a preexisting disability received more OT/PT and psychological or peer support services at follow-up. Overall, vulnerable and nonvulnerable groups received comparable OT/PT and psychological services. The importance of long-term care among vulnerable subgroups of the burn population is highlighted by this study. Future work is needed to determine adequate levels of follow-up services. Vivian Shie, BS, Brennan Yee, Bac, Laura C. Simko, BS, Audrey E. Wolfe, MPH, Colleen M. Ryan, MD, Jeffrey C. Schneider, MD, Radha Holavanahalli, PhD, David Herndon, MD, Marta Rosenberg, PhD, Laura Rosenberg, PhD, Walter Meyer, MD, Nicole Gibran, MD, Shelley Wiechman, PhD, Kara McMullen, MPHBoston-Harvard Burn Injury Model System, North Texas Burn Rehabilitation Model System, Northwest Regional Burn Model System, Pediatric Burn Injury Rehabilitation Model SystemYescheberle
2020Exploring the Burn Model System National Database: Burn injuries, substance misuse, and the CAGE questionnaire.JournalBurnsEpubhttps://www.ncbi.nlm.nih.gov/pubmed/31901407Burn survivors who misuse alcohol and/other substances have been associated with poorer long-term outcomes and clinical complications following injury. The self-reported CAGE questionnaire (Cut down, Annoyed, Guilty, and Eye-opener) is an outcomes assessment tool used to screen for potential substance misuse. Understanding the persistence and emergence of potential substance misuse through examination of CAGE scores may provide important information about this population. Using data collected from the Burn Model System National Database, demographic and clinical characteristics of individuals who reported positive CAGE scores (total score of ≥2) and those who reported negative CAGE scores (total score of 0 or 1) for either alcohol or other drugs were compared. Gabrielle G.Grant, Audrey E.Wolfe, Catherine R.Thorpe, Nicole S.Gibran, Gretchen J.Carrougher, Shelley A. Wiechman, Radha Holavanahalli, Frederick J. Stoddard, Robert L.Sheridan, Lewis E. Kazis, Jeffrey C.Schneider, Colleen M. RyanBoston-Harvard Burn Injury Model System, North Texas Burn Rehabilitation Model System, Northwest Regional Burn Model SystemYescheberle
2020Recognizing the long-term sequelae of burns as a chronic medical condition.JournalBurns462493-496https://www.ncbi.nlm.nih.gov/pubmed/31711801As medicine continues to advance, many individuals are living longer with injuries previously considered life threatening. These individuals often face numerous long-term physical and psychological sequelae associated with their injury that persist through the course of their lives. Recently, other injury populations have begun to think of their condition as "chronic". Using data collected from the Burn Model System National Database, a framework for the reconsideration of burn injury as a chronic condition is proposed. B.M. Kelter, R. Holavanahalli, O.E. Suman, C.M. Ryan, J.C. SchneiderBoston-Harvard Burn Injury Model System, North Texas Burn Rehabilitation Model System, Northwest Regional Burn Model SystemYescheberle
2019Social participation of burn survivors and the general population in work and employment: A Life Impact Burn Recovery Evaluation (LIBRE) profile study.JournalJournal of Burn Care and Research405669-677https://www.ncbi.nlm.nih.gov/pubmed/31069384INTRODUCTION: Work integration and retention after burn injury is a key outcome. Little is known about how burn survivors reintegrate into the workplace. This article compares scores on the Life Impact Burn Recovery Evaluation (LIBRE) Profile, a burn-specific measure of social participation, between burn survivors and general population samples, focusing on the Work and Employment domain. METHODS: Convenience samples of burn survivors and the U.S. population were obtained. Differences in demographic and clinical characteristics and LIBRE Profile scores were assessed. To examine work and employment, we compared family and friends, social activities, and social interactions scores among working vs nonworking burn survivors. RESULTS: Six hundred and one burn survivors (320 employed) and 2000 U.S. residents (1101 employed) were surveyed. The mean age (P = .06), distributions of sex (P = .35), and Hispanic ethnicity (P = .07) did not differ significantly. Distributions of race (P < .01) and education (P = .01) differed significantly. The burn survivor sample had higher scores, demonstrating higher participation, for work and employment (mean = 49.5, SD = 9.42) than the general sample (mean = 46.94, SD = 8.94; P < .0001), which persisted after adjusting for demographic characteristics. Scores on the three domains administered to all respondents were higher (P < .001) for working than nonworking burn survivors. CONCLUSION: Distributions indicated higher social participation in the burn survivor sample than the general sample. Possible explanations include sample bias; resilience, posttraumatic growth, or response-shift of survivors; and limitations of using items in the general sample. Working burn survivors scored higher than those not working. Future work can explore factors that mediate higher scores and develop interventions. Saret, CJ, Ni, P, Marino, M, Dore, E, Ryan, CM, Schneider, JC, Kazis, LEBoston-Harvard Burn Injury Model SystemYescheberle
2019Burn survivors injured as children exhibit resilience in long-term community integration outcomes: A Life Impact Burn Recovery Evaluation (LIBRE) studyJournalBurns4551031-1040https://www.ncbi.nlm.nih.gov/pubmed/30850227INTRODUCTION: There is limited understanding of how burn injuries at different ages are associated with normal growth and development as well as the burn recovery process. This study provides new useful insights by comparing social participation outcomes among burn survivors injured in childhood compared with injuries sustained in middle age, and older adulthood. METHODS: Items from the development of the LIBRE profile were administered to 601 adult burn survivors with ≥5% TBSA burned or burns to critical areas (hands, feet, face, or genitals). Each item was answered on a 5-point Likert scale with higher scores denoting better outcomes. Mean scores for the 6 LIBRE profile scales (sexual relationships, family and friends, social interactions, social activities, work and employment, and romantic relationships) were compared between those burned as children (<18years) and those burned as adults (≥18years). Regression analyses were used to assess differences between groups with adjustment for demographic and clinical characteristics. RESULTS: Of the 597 burn survivors having complete data on age at injury, 165 (27.6%) sustained burn injuries as a child. Those burned as children were more frequently female than those burned as adults (57% vs 47%) and were also more frequently white non-Hispanic (89% vs 77%). Marital status and education level were similar in the two groups. Those who were burned as children had slightly higher scores on the social activities, work and employment and romantic relationships scales. However, these differences did not persist in adjusted regression analyses. CONCLUSIONS: Burn survivors who sustained injuries as a child fared at least as well as those burned as adults in a broad range of long-term social participation outcomes. The impact on long-term social participation outcomes of burn survivors was not significantly different between individuals with burns sustained during important developmental stages at young ages and those injured later in life. Cartwright, S, Saret, C, Shapiro, GD, Ni, P, Sheridan, RL, Lee, AF, Marino, M, Acton, A, Kazis, LE, Schneider, JC, Ryan, CMBoston-Harvard Burn Injury Model SystemYescheberle
2019The impact of electrical injury on long-term outcomes: A burn model system national database studyJournalBurnsepubINTRODUCTION: Electrical injuries exhibit significant acute and long-term sequelae. Amputation and neurological deficits are common in electrical injury survivors. There is a paucity of information on the long-term outcomes of this population. Therefore, this study examines the long-term outcomes of electrical injuries by comparing them to fire/flame injuries. METHODS: Data from the Burn Model System National Database collected between 1996 and 2015 was examined. Demographic and clinical characteristics for adult burn survivors with electrical and fire/flame injuries were compared. Satisfaction With Life Scale (SWLS), Short Form-12 Physical Composite Score (SF-12 PCS), Short Form-12 Mental Composite Score (SF-12 MCS), and employment status were examined at 24 months post-injury. Linear and logistic regression models were used to assess differences in outcome measures between groups, controlling for demographic and clinical variables. RESULTS: A total of 1147 adult burn survivors (111 with electrical injuries; 1036 with fire/flame injuries) were included in this study. Persons with electrical injuries were more likely to be male and injured at work (p < 0.001). SF-12 PCS scores were significantly worse for survivors with electrical injuries at 24 months post-injury than survivors with fire/flame injuries (p < 0.01). Those with electrical injuries were nearly half as likely to be employed at 24 months post-injury than those with fire/flame injuries (p = 0.002). There were no significant differences in SWLS and SF-12 MCS between groups. CONCLUSIONS: Adult survivors with electrical injuries reported worse physical health and were less likely to be employed at 24 months post-injury compared to survivors with fire/flame injuries. A more detailed understanding of return to work barriers and work accommodations is merited for the electrical injury population. Furthermore, the results of this study should inform future resource allocation for the physical health and employment needs of this population. Stockly, OR, Wolfe, AW , Espinoza, LF , Simko, LC , Kowalske, K , Carrougher, GJ , Gibran, N , Bamer, AM , Meyer, W , Rosenberg, M , Rosenberg, L , Kazis, LE , Ryan, CM , Schneider, JCBoston-Harvard Burn Injury Model System, North Texas Burn Rehabilitation Model System, Northwest Regional Burn Model System, Pediatric Burn Injury Rehabilitation Model SystemYescheberle
2019Post-Acute Care Setting is Associated with Employment After Burn InjuryJournalArchives of Physical Medicine and RehabilitationepubOBJECTIVE: To examine differences in long-term employment outcomes in the postacute care setting. DESIGN: Retrospective review of the prospectively collected Burn Model System National Database. SETTING AND PARTICIPANTS: A total of 695 adult survivors of burn injury enrolled between May 1994 and June 2016 who required postacute care at a Burn Model System center following acute care discharge were included. Participants were divided into 2 groups based on acute care discharge disposition. Those who received postacute care at an inpatient rehabilitation facility (IRF) following acute care were included in the IRF group (N=447), and those who were treated at a skilled nursing facility, long-term care hospital, or other extended-care facility following acute care were included in the Other Rehab group (N=248). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Employment status at 12 months postinjury. Propensity score matching and logistic regression were utilized to determine the effect of postacute care setting on employment status. RESULTS: Individuals in the IRF group had larger burns and were more likely to have an inhalation injury and to undergo amputation. At 12 months postinjury, the IRF group had over 9 times increased odds of being employed compared to the Other Rehab group, using propensity score matching (P=.046). CONCLUSIONS: While admitting patients with more severe injuries, IRFs provided a long-term benefit for survivors of burn injury in terms of regaining employment. Given the current lack of evidence-based guidelines on postacute care decisions, the results of this study shed light on the potential benefits of the intensive services provided at IRFs in this population. Espinoza, LF, Simko, LC, Goldstein, R, McMullen, KA, Slocum, C, Silver, JK, Herndon, DN, Suman, OE, Meyer, WJ, Gibran, NS, Kowalske, K, Zafonte, R, Ryan, CM, Schneider, JCBoston-Harvard Burn Injury Model System, Northwest Regional Burn Model System, North Texas Burn Rehabilitation Model System, UCHSC Burn Model System Data Coordination Center (BMS/DCC)Yescheberle
2016Explosion Injuries from E-CigarettesJournalThe New England Journal of Medicine3751400-1402https://www.usfa.fema.gov/downloads/pdf/publications/electronic_cigarettes.pdf Brownson, E. G, Thompson, CM, Goldsberry, S, Chong, H. J, Friedrich, J. B, Pham, T. N., Gibran, N.SNorthwest Regional Burn Model SystemYesmbelay
2019Measuring the Impact of Burn Injury on the Parent-Reported Health Outcomes of Children 1- to 5- Years: A Conceptual Framework for Development of the Preschool Life Impact Burn Recovery Evaluation (LIBRE) Profile CAT.JournalJournal of Burn Care and Research pii: irz110https://www.ncbi.nlm.nih.gov/pubmed/31222201Brady KJS, Grant G, Stoddard FJ, Meyer, WJ, Romanowski, KS, Chang, PH, Painting, LE, Fowler, LA, Nelson, JK, Rivas, P, Epperson, K, Sheridan, RL, Murphy, M, O'Donnell, EH, Ceranoglu, TA, Sheldrick, RC, Ni, P, Slavin, MD, Warner, P, Palmieri, TL, Schneider, JC, Kazis, LE, Ryan, CMBoston-Harvard Burn Injury Model System, Pediatric Burn Injury Rehabilitation Model SystemNombelay
2019Longitudinal Clinical Trial Recruitment and Retention Challenges in the Burn Population: Lessons Learned from a Trial Examining a Novel Intervention for Chronic Neuropathic SymptomsJournalJournal of Burn Care and Researchirz084https://www.ncbi.nlm.nih.gov/pubmed/31102438Ohrtman, EA, Zaninotto, AL, Carvalho, S, Shie, VL, Leite, J, Ianni, CR, Kazis, LE, Zafonte, R, Ryan, CM, Schneider, JC, Fregni, FBoston-Harvard Burn Injury Model SystemNombelay
2019Challenges to the standardization of trauma data collection in burn, tbi, sci, and other trauma populations: A call for common data elements for acute and longitudinal trauma databasesJournalArchives of Physical Medicine and Rehabilitation1005891-898https://www.ncbi.nlm.nih.gov/pubmed/31030731Simko, LC, Chen, L, Amtmann, D, Gibran, N, Herndon, D, Kowalske, K, Miller, AC, Bulger, E, Friedman, R, Wolf, A, Chung, KK, Mosier, M, Jeng, J, Giacino, J, Zafonte, R, Kazis, LE, Schneider, JC, Ryan, CMBoston-Harvard Burn Injury Model System, Pediatric Burn Injury Rehabilitation Model System, Northwest Regional Burn Model System, Spaulding-Harvard Traumatic Brain Injury Model System, Spaulding New England Regional Spinal Cord Injury Center, North Texas Burn Rehabilitation Model SystemYesmbelay
2019Investigation into Possible Association of Oxandrolone and Heterotopic Ossification Following Burn InjuryJournalJournal of Burn Care and Research404398-405https://www.ncbi.nlm.nih.gov/pubmed/31053861Thorpe, CR, Ucer Ozgurel, S, Simko, LC, Goldstein, R, Grant, GG, Pagani, C, Hwang, C, Vasquez, K, Sorkin, M, Vaishampayan, A, Goverman, J, Sheridan, RL, Friedstat, J, Schulz, JT, Schneider, JC, Levi, B, Ryan, CMBoston-Harvard Burn Injury Model SystemYesmbelay
2019A scoping review of burn rehabilitation publications incorporating functional outcomesJournalBurns4551005-1013https://www.sciencedirect.com/science/article/abs/pii/S0305417918309021Gerber, LH, Bush, H, Holavanahalli, R, Esselman, P, Schneider, J, Heinemann, A, Garfinkel, S, Cai, CNorth Texas Burn Rehabilitation Model System, Boston-Harvard Burn Injury Model System, Northwest Regional Burn Model SystemYesmbelay
2018Reliability & validity of the LIBRE Profile.JournalBurns4471750-1758https://www.ncbi.nlm.nih.gov/pubmed/30075970Dore, EC, Marino, M, Ni, P, Lomelin-Gascon, J, Sonis, L, Amaya, F, Ryan, CM, Schneider, JC, Jette, AM, Kazis, LEBoston-Harvard Burn Injury Model SystemYesmbelay
2018The Development and Validity of the Adult Burn Outcome Questionnaire Short Form.JournalJournal of Burn Care and Research395771-779https://www.ncbi.nlm.nih.gov/pubmed/29931275Chen, L, Lee, AF, Shapiro, GD, Goverman, J, Faoro, N, Schneider, JC, Kazis, LE, Ryan, CMBoston-Harvard Burn Injury Model SystemYesmbelay
2018Social Interactions and Social Activities After Burn Injury: A Life Impact Burn Recovery Evaluation (LIBRE) StudyJournalJournal of Burn Care and Research3961022-1028https://www.ncbi.nlm.nih.gov/pubmed/30016442Ohrtman, EA, Shapiro, GD, Simko, LC, Dore, E, Slavin, MD, Saret, C, Amaya, F, Lomelin-Gascon, J, Ni, P, Acton, A, Marino, M, Kazis, LE, Ryan, CM, Schneider, JCBoston-Harvard Burn Injury Model SystemYesmbelay
2017The National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System: Twenty Years of Contributions to Clinical Service and ResearchJournalJournal of Burn Care and Research381e240-e253https://www.ncbi.nlm.nih.gov/pubmed/27294859Goverman, J, Mathews, K, Holavanahalli RK, Vardanian, A, Herndon, DN, Meyer, WJ, Kowalske, K, Fauerbach, J, Gibran, NS, Carrougher, GJ, Amtmann, D, Schneider, JC, Ryan, CMBoston-Harvard Burn Injury Model System, Pediatric Burn Injury Rehabilitation Model System, Northwest Regional Burn Model System, North Texas Burn Rehabilitation Model SystemYesmbelay
2017Adult Contractures in Burn Injury: A Burn Model System National Database StudyJournalJournal of Burn Care and Research381e328-e336https://www.ncbi.nlm.nih.gov/pubmed/27380122Goverman, J, Mathews, K, Goldstein, R, Holavanahalli, R, Kowalske, K, Esselman, P, Gibran, N, Suman, O, Herndon, D, Ryan, CM, Schneider, JCBoston-Harvard Burn Injury Model System, Northwest Regional Burn Model System, North Texas Burn Rehabilitation Model System, Pediatric Burn Injury Rehabilitation Model SystemNombelay
2019The Presence of Scarring and Associated Morbidity in the Burn System National Database.JournalAnnals of Plastic Surgery823 Suppl 2S162-S168https://www.ncbi.nlm.nih.gov/pubmed/30724824Goverman, J, He, W, Martello, G, Whalen, A, Bittner, E, Schulz, J, Gibran, N, Herndon, D, Suman, O, Kowalske, K, Meyer, WJ, Ryan, C, Schneider, JNorthwest Regional Burn Model System, Boston-Harvard Burn Injury Model System, North Texas Burn Rehabilitation Model System, Pediatric Burn Injury Rehabilitation Model SystemYesmbelay
2018Trends 10 years after burn injury: A Burn Model System National Database studyJournalBurns4481882-1886https://www.ncbi.nlm.nih.gov/pubmed/30385060Chin, TL, Carrougher, GJ, Amtmann, D, McMullen, K, Herndon, DN, Holavanahalli, R, Meyer, W, Ryan, CM, Wong, JN, Gibran, NSNorthwest Regional Burn Model System, Pediatric Burn Injury Rehabilitation Model System, North Texas Burn Rehabilitation Model System, Boston-Harvard Burn Injury Model SystemYesmbelay
2018Feasibility of a Kinect1-based rehabilitation strategy after burn injuryJournalBurns4482080-2086https://www.ncbi.nlm.nih.gov/pubmed/30241787Pham, TN, Wong, JN, Terken, T, Gibran, NS, Carrougher, GJ, Bunnell, ANorthwest Regional Burn Model SystemYesmbelay
2019Impact of Burn-Related Amputations on Return to Work: Findings From the Burn Injury Model System National DatabaseJournalJournal of Burn Care and Research40121-28https://www.ncbi.nlm.nih.gov/pubmed/30376104Carrougher, GJ, McMullen, K, Mandell, SP, Amtmann, D, Kowalske, KJ, Schneider, JC, Gibran, NS, Herndon, DNNorthwest Regional Burn Model System, Pediatric Burn Injury Rehabilitation Model System, Boston-Harvard Burn Injury Model System, North Texas Burn Rehabilitation Model SystemYesmbelay
2018Hospital-acquired complications alter quality of life in adult burn survivors: Report from a burn model systemJournalBurns45142-47https://www.ncbi.nlm.nih.gov/pubmed/30477817Deeter, L, Seaton, M, Carrougher, GJ, McMullen, K, Mandell, SP, Amtmann, D, Gibran, NSNorthwest Regional Burn Model SystemYesmbelay
2016Long-Term Outcomes in Patients Surviving Large Burns: The Musculoskeletal SystemJournalJournal of Burn Care and Research374243-54https://www.ncbi.nlm.nih.gov/pubmed/26056761Holavanahalli, RK, Helm, PA, Kowalske, KJNorth Texas Burn Rehabilitation Model SystemNombelay
2018Burn Nurse Competencies: Developing Consensus Using E-Delphi MethodologyJournalJournal of Burn Care and Research395751-759https://www.ncbi.nlm.nih.gov/pubmed/29931347Carrougher, GJ, Hollowed, KA, Sproul, JL, Wiggins, BJ, Mann-Salinas, ENorthwest Regional Burn Model SystemYesmbelay
2018The Burn Model Systems outcome measures: a content analysis using the International Classification of Functioning, Disability, and Health.JournalDisability and Rehabilitation39252584-2593https://www.ncbi.nlm.nih.gov/pubmed/27758149Osborne, CL, Peterson, C, Graham, JE, Meyer, WJ, Simeonsson, RJ, Suman, OE, Ottenbacher, KJPediatric Burn Injury Rehabilitation Model SystemNombelay
2018Fatigue Following Burn Injury: A Burn Model System National Database StudyJournalJournal of Burn Care and Research393450-456https://www.ncbi.nlm.nih.gov/pubmed/28877130Simko, LC, Espinoza, LF, McMullen, K, Herndon, DN, Suman, O, Fauerback, JA, Wiechman, S, Kazis, LE, Ryan, CM, Schneider, JC, Kowalske, KBoston-Harvard Burn Injury Model System, North Texas Burn Rehabilitation Model SystemNombelay
2019Measuring the impact of burn injury on the parent-reported health outcomes of children 1- to 5- years: A conceptual framework for development of the Preschool Life Impact Burn Recovery Evaluation (LIBRE) Profile CAT.JournalJournal of Burn Care and Research41184-94https://pubmed.ncbi.nlm.nih.gov/31222201/Due to the rapid developmental growth in preschool-aged children, more precise measurement of the effects of burns on child health outcomes is needed. Expanding upon the Shriners Hospitals for Children/American Burn Association Burn Outcome Questionnaire 0-4 (BOQ0-4), we developed a conceptual framework describing domains important in assessing recovery from burn injury among preschool-aged children (1-5 years). We developed a working conceptual framework based on the BOQ0-4, the National Research Council and Institute of Medicine's Model of Child Health, and the World Health Organization's International Classification of Functioning, Disability, and Health for Children and Youth. We iteratively refined our framework based on a literature review, focus groups, interviews, and expert consensus meetings. Data were qualitatively analyzed using methods informed by grounded theory. We reviewed 95 pediatric assessments, conducted two clinician focus groups and six parent interviews, and consulted with 23 clinician experts. Three child health outcome domains emerged from our analysis: symptoms, functioning, and family. The symptoms domain describes children's physiological perceptions of pain, skin-related discomfort, and fatigue. The functioning domain describes children's: physical functioning (gross and fine motor function), psychological functioning (internalizing, externalizing, and dysregulation behavior; trauma; toileting; resilience), communication and language development (receiving and producing meaning), and social functioning (connecting with family/peers, friendships, play). The family domain describes family psychological and routine functioning outcomes. Brady, Keri J. S., Grant, Gabrielle, Stoddard, Frederick J., Meyer, Walter J., Romanowski, Kathleen S., Chang, Philip H., Painting, Lynda E., Fowler, Laura A., Nelson, Judith K., Rivas, Perla, Epperson, Kathryn, Sheridan, Robert L., Murphy, Michael, O’Donnell, Ellen H., Ceranoglu, T. Atilla, Sheldrick, R. Christopher, Ni, Pengsheng, Slavin, Mary D., Warner, Petra, Palmieri, Tina L., Schneider, Jeffrey C., Kazis, Lewis E., Ryan, Colleen M.Boston-Harvard Burn Injury Model System, Pediatric Burn Injury Rehabilitation Model SystemYescheberle
2016Long-term outcomes in patients surviving large burns: The musculoskeletal systemJournalJ74105Journal of Burn Care And Research (formerly Journal of Burn Care & Rehabilitation)374243-254https://pubmed.ncbi.nlm.nih.gov/26056761/The authors have previously described long-term outcomes related to the skin in patients surviving large burns. The objective of this study was to describe the long-term musculoskeletal complications following major burn injury. This is a cross-sectional descriptive study that includes a one-time evaluation of 98 burn survivors (mean age = 47 years; mean TBSA = 57%; and mean time from injury = 17 years), who consented to participate in the study. A comprehensive history and physical examination was conducted by a senior and experienced Physical Medicine and Rehabilitation physician. In addition to completing a Medical Problem Checklist, subjects also completed the Burn-Specific Health Scale (Abbreviated 80 item), a self-report measure used to review the level of functional adaptation. Joint pain, joint stiffness, problems walking or running, fatigue, and weak arms and hands are conditions that continue to be reported at an average of 17 years from the time of burn injury. Seventy-three percent (68 of 93) of the study sample were found to have a limitation of motion and areas most affected were the neck (47%), hands (45%), and axilla (38%). The global (Burn-Specific Health Scale-total) score for the overall sample was 0.78. Subjects with limitation of motion had significant difficulty in areas of mobility, self-care, hand function, and role activities. This study underscores the importance of long-term follow-up care and therapeutic interventions for survivors of major burn injury, as they continue to have significant and persistent burn-related impairments even several years following injury. Holavanahalli, Radha K., Helm, Phala A., Kowalske, Karen J.North Texas Burn Rehabilitation Model SystemYesarajbhandari
2015Predictors of discharge disposition in older adults with burns: A study of the burn model systemsJournalJ72793Journal of Burn Care And Research (formerly Journal of Burn Care & Rehabilitation)366607-612Study identified predictors for discharge to independent versus non-independent living status in older patients hospitalized for burns. Patient, injury, and treatment outcomes data were collected from 591 patients aged ≥55 years who were treated and discharged alive from three burn centers participating in the Burn Model Systems project from 1993 to 2011. The primary outcome of interest was final hospital discharge disposition. Mean burn size was 14.8 percent and mean age was 66.7 years. Ninety-three patients (15.7 percent) had an inpatient rehabilitation stay before discharge. Significant factors predictive of inpatient rehabilitation included a larger burn size, mechanical ventilation, older age, range of motion deficits at acute care discharge, and study site. These factors were included in a propensity model. Four hundred seventy-one patients (80 percent) were discharged to independent living status. Matched propensity analysis revealed that older age was significantly associated with a higher likelihood of discharge to non-independent living. Comorbidity and history of alcohol abuse were also predictive patient factors. Furthermore, clinical practice variations among the 3 study sites also constituted a significant factor in discharge disposition. The authors believe that these variations among burn centers need to be studied further to better understand discharge disposition status in older patients with burns.Pham, Tam N., Carrougher, Gretchen J., Martinez, Erin, Lezotte, Dennis, Rietschel, Carly, Holavanahalli, Radha, Kowalske, Karen, Esselman, Peter C.Northwest Regional Burn Model System, UCHSC Burn Model System Data Coordination Center (BMS/DCC)Yesdevopsadmin
2016Satisfaction with life after burn: A burn model system national database studyJournalJ73946Burns4251067-1073Study examined self-reported Satisfaction With Life Scale (SWLS) scores in a longitudinal, multicenter cohort of survivors of major burns and identified risk factors associated with SWLS scores are identified. The SWLS is a validated 5-item instrument with items rated on a 1-7 Likert scale. Data from the Burn Model Systems database for burn survivors older than 9 years of age, from 1994 to 2014, were analyzed. Demographic and medical data were collected on each subject. The SWLS was completed at time of discharge (1,129 patients), 6 months after burn (1,231 patients), 12 months after burn (1,123 patients), and 24 months after burn (959 patients). The differences in scores over time were determined and scores for burn survivors were also compared to a non-burn, healthy population. Step-wise regression analysis was performed to determine predictors of SWLS scores at different time intervals. Mean total SWLS scores for burn survivors were unchanged and significantly below that of a non-burn population at all examined time points after burn. Although the mean SWLS score was unchanged over time, a large number of subjects demonstrated improvement or decrement of at least one SWLS category. Gender, burn size, length of stay (LOS), and school status were associated with SWLS scores at 6 months; scores at 12 months were associated with LOS, school status, and amputation; scores at 24 months were associated with LOS, school status, and drug abuse. Results showed that satisfaction with life after burn was consistently lower than that of non-burn norms. Furthermore, mean SWLS scores did not improve over the two-year follow-up period. This study demonstrates the need for continued efforts to improve patient-centered long term satisfaction with life after burn.Goverman, J., Mathews, K., Nadler, D., Henderson, E., McMullen, K., Herndon, D., Meyer III, W., Fauerbach, J. A., Wiechman, S., Carrougher, G., Ryan, C. M., Schneider, J. C.Boston-Harvard Burn Injury Model System, Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2015Risk factors for the development of heterotopic ossification in seriously burned adults: A national institute on disability, independent living and rehabilitation research burn model system database analysisJournalJ72821Journal of Trauma and Acute Care Surgery795870-876Study identified and analyzed clinical factors that predict heterotopic ossification (HO), the ectopic formation of lamellar bone, in adults with burn injuries. Data were collected from six high-volume burn centers in the Burn Injury Model Systems (BMS) database. The BMS, funded by the National Institute on Disability, Independent Living and Rehabilitation Research, is a program established to research the delivery, demonstration, and evaluation of medical, rehabilitation, and other services designed to meet the needs of individuals with severe burn injuries. Of 2,979 patients in the database with information that addressed risk factors for development of HO, 98 (3.5 percent) developed HO. Of these 98 patients, 97 had arm burns, and 96 had arm grafts. When controlling for age and sex in a multivariate model, patients with greater than 30 percent total body surface area (TBSA) burned had 11.5 times higher odds of developing HO, and those with arm burns that required skin grafting had 96.4 times higher odds of developing HO. For each additional time a patient went to the operating room, odds of HO increased by 30 percent, and each additional ventilator day increased odds by 3.5 percent. Joint contracture, inhalation injury, and bone exposure did not significantly increase odds of HO. Results indicate that risk factors for HO development include greater than 30 percent TBSA burned, arm burns, arm grafts, ventilator days, and number of trips to the operating room. Future studies can use these results to identify highest-risk patients to guide deployment of prophylactic and experimental treatments.Levi, Benjamin, Jayakumar, Prakash, Giladi, Avi, Jupiter, Jesse B., Ring, David C., Kowalske, Karen, Gibran, Nicole S., Herndon, David, Schneider, Jeffrey C., Ryan, Colleen M.Boston-Harvard Burn Injury Model System, Northwest Regional Burn Model SystemYesdevopsadmin
2015An expanded delivery model for outpatient burn rehabilitationJournalJ70738Journal of Burn Care And Research (formerly Journal of Burn Care & Rehabilitation)36114-22Study evaluated the efficacy of utilizing an expanded care coordinator (ECC) to supplement existing outpatient burn rehabilitation services. In this between-group, single-blind, randomized controlled trial, the 41 patients in the control group received standard outpatient care and the 40 experimental group patients received additional services provided by the ECC, including telephone calls at set intervals. The ECC was trained in motivational interviewing, crisis intervention, and solution-focused counseling. He assisted patients before and after each clinic visit, coordinated outpatient services in their geographic area, and helped develop problem-solving approaches to accomplish individualized goals. Outcome measures included patient goals identified utilizing the Goal Attainment Scale, the Burn-Specific Health Scale-Brief, the Short Form 12, a patient satisfaction survey, and a return to work survey. The patient and injury characteristics were similar between the study groups. The average length of hospitalization was 36 days. No differences in outcomes between the groups were found. All participants appreciated the individualized goal setting process that was used as an outcome measure and this may have accounted for the similar outcomes in both the groups. Although most patients with burn injuries may not need an intervention that is this intensive, a subset of patients at higher risk or with more severe injuries may benefit from more intensive and personalized services. Future research should examine the benefits of individual goal setting processes for all the patients and also attempt to identify those patients most at risk for poorer outcomes and therefore, likely to benefit of more intensive personalized services.Wiechman, Shelley A., Carrougher, Gretchen J., Esselman, Peter C., Klein, Matthew B., Martinez, Erin M., Engrav, Loren H., Gibran, Nicole S.North Texas Burn Rehabilitation Model System, Northwest Regional Burn Model SystemYesdevopsadmin
2014Treatment of heterotopic ossification through remote ATP hydrolysisJournalJ73533Science Translational Medicine6255255ra132Heterotopic ossification (HO) is the pathologic development of ectopic bone in soft tissues because of a local or systemic inflammatory insult, such as burn injury or trauma. In HO, mesenchymal stem cells (MSCs) are inappropriately activated to undergo osteogenic differentiation. Through the correlation of in vitro assays and in vivo studies (dorsal scald burn with Achilles tenotomy), the authors have shown that burn injury enhances the osteogenic potential of MSCs and causes ectopic endochondral heterotopic bone formation and functional contractures through bone morphogenetic protein–mediated canonical SMAD signaling. They also demonstrated a prevention strategy for HO through adenosine triphosphate (ATP) hydrolysis at the burn site using apyrase. Burn site apyrase treatment decreased ATP, increased adenosine 3′, 5′-monophosphate, and decreased phosphorylation of SMAD1/5/8 in MSCs in vitro. This ATP hydrolysis also decreased HO formation and mitigated functional impairment in vivo. Similarly, selective inhibition of SMAD1/5/8 phosphorylation with LDN-193189 decreased HO formation and increased range of motion at the injury site in our burn model in vivo. The results suggest that burn injury–exacerbated HO formation can be treated through therapeutics that target burn site ATP hydrolysis and modulation of SMAD1/5/8 phosphorylation.Peterson, Jonathan R., De La Rosa, Sara, Eboda, Oluwatobi, Cilwa, Katherine E., Agarwal, Shailesh, Buchman, Steven R., Cederna, Paul S., Xi, Chuanwu, Morris, Michael D., Herndon, David N., Xiao, Wenzhong, Tompkins, Ronald G., Krebsbach, Paul H., Wang, Stewart C., Levi, BenjaminPediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2017Patient-reported outcome measures: A stethoscope for the patient historyJournalJ75555Annals of SurgeyThis article calls for physicians to implement patient-reported outcome measures (PROMs) into their practice and for researchers to study their potential value in the clinical setting. PROMs are powerful tools that can bridge the need for data-driven patient information while also strengthening the physician-patient connection. When maximized in clinical settings, PROMs can be leveraged to inform clinical decision making, to improve quality of care, and to foster communication between patients and providers. PROMs are a tool for patient-provider communication and have the potential to be as valuable to the clinical encounter as a stethoscope is to the physical examination.Griggs, Cornelia L., Schneider, Jeffrey C., Kazis, Lewis E., Ryan, Colleen M.Boston-Harvard Burn Injury Model SystemYesdevopsadmin
2015Quality of life of young adult survivors of pediatric burns using world health organization disability assessment scale II and burn specific health scale-brief: A comparisonJournalJ72438Journal of Burn Care And Research (formerly Journal of Burn Care & Rehabilitation)365521-533Study examined long-term psychological distress and quality of life (QOL) in young adult survivors of pediatric burns using the World Health Organization Disability Assessment Scale II (WHODAS) and the Burn Specific Health Scale-Brief (BSHS-B). The WHODAS measures health and disability and the BSHS-B measures psychosocial and physical difficulties. Fifty burn survivors, 2.5 to 12.5 years postburn, completed the WHODAS and BSHS-B. Scores were calculated for each instrument, and then grouped by years postburn, total body surface area (TBSA) burned, sex, burn age, and survey age to compare the effects of each. Next, the instruments were compared with each other. The WHODAS disability score mean was 14.4. BSHS-B domain scores ranged from 3 to 3.7. In general, as TBSA burned increased, QOL decreased. Female burn survivors, survivors burned prior to school entry, and adolescents who had yet to transition into adulthood reported better QOL than their counterparts. In all domains except Participation, the WHODAS consistently identified more individuals with lower QOL than the BSHS-B. Young adult burn survivors’ QOL features more disability than their nonburned counterparts, but score in the upper 25 percent for QOL on the BSHS-B. This analysis revealed the need for long-term psychosocial intervention for survivors with larger TBSA, males, those burned after school entry, and those transitioning into adulthood. Both instruments are useful tools for assessing burn survivors’ QOL and both should be given as they discern different individuals. However, the WHODAS is more sensitive than the BSHS-B in identifying QOL issues.Murphy, Mary E., Holzer III, Charles E., Richardson, Lisa M., Epperson, Kathryn, Ojeda, Sylvia, Martinez, Erin M., Suman, Oscar E., Herndon, David N., Meyer III, Walter J.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2015The effect of lower body burns on physical functionJournalJ74396Burns4181653-1659Study assessed how lower-body burn locations affected strength and cardiopulmonary function. Children who participated in an exercise study between 2003 and 2013, were 7-18 years of age, and burned ≥30 percent of their total body surface area were included. Analysis of variance was used to model the relationship of lower-body strength (peak torque per body weight or PTW) and cardiopulmonary function (VO2peak) due to burns which traverse the subject's lower-body joints. Forty-seven patients who had PTW measurements were analyzed. However, only 36 of those patients had VO2peak measurements and could be included in the subsequent analysis. There was a significant relationship between PTW and burns at the hip and toe joints, showing a decrease in peak torque of 26 Newton meters per kilogram (N m/kg) and 33 N m/kg, respectively. Burns at the hip joint corresponded to a significant decrease in VO2peak by 4.9 milliliters per kilogram per minute in peak cardiopulmonary function. Results suggest that physical function and performance are detrimentally affected by burns that traverse specific lower-body joints. The most significant relationship on exercise performance was that of hip-joint burns as it affected both strength and cardiopulmonary measurements. Ultimately, burns at hip and toe joints need to be considered when interpreting exercise test results involving the lower body.Benjamin, Nicole C., Andersen, Clark R., Herndon, David N., Suman, Oscar E.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2015Validation of the community integration questionnaire in the adult burn injury populationJournalJ71557Quality of Life ResearchStudy assessed the psychometric properties of the full-version Community Integration Questionnaire (CIQ-15) in the adult burn population. Data were obtained from a multicenter longitudinal data set of 492 burn survivors. The questionnaire items were evaluated for clinical and substantive relevance; validation procedures were conducted on different samples of the population; construct validity was assessed using exploratory factor analysis; internal consistency reliability was examined using Cronbach’s alpha statistics; and item response theory was applied to the final models. The CIQ-15 was reduced by two questions to form the CIQ-13, with a two-factor structure, interpreted as self/family care and social integration. Item response theory testing suggests that Factor 2 captures a wider range of community integration levels. Cronbach’s alpha was 0.80 for Factor 1, 0.77 for Factor 2, and 0.79 for the test as a whole. The results demonstrate the validity and reliability of the CIQ-13 in addressing issues of self/family care and social integration in the adult burn survivor population.Gerrard, Paul, Kazis, Lewis E., Ryan, Colleen M., Shie, Vivian L., Holavanahalli, Radha, Lee, Austin, Jette, Alan, Fauerbach, James A., Esselman, Peter, Herndon, David, Schneider, Jeffrey C.Boston-Harvard Burn Injury Model SystemYesdevopsadmin
2014Predictors of insulin resistance in pediatric burn injury survivors 24 to 36 months postburnJournalJ69633Journal of Burn Care And Research (formerly Journal of Burn Care & Rehabilitation)355409-415Study identified factors associated with long-term insulin resistance in pediatric burn injury survivors. The study sample consisted of 61 pediatric burn injury survivors 24 to 36 months after the burn injury, who underwent an oral glucose tolerance test. To assess insulin resistance, the authors calculated the area under the curve for glucose and insulin. The diagnostic criteria of the American Diabetes Association were used to define individuals with impaired glucose metabolism. Additional data collected include body composition, anthropometric measurements, burn characteristics, and demographic information. The data were analyzed using multivariate linear regression analysis. Approximately 12 percent of the patients met the criteria for impaired glucose metabolism. After adjusting for possible confounders, burn size, age, and body fat percentage were associated with the area under the curve for glucose (P < .05 for all). Time postburn and lean mass were inversely associated with the area under the curve for glucose (P < .05 for both). Similarly, older age predicted higher insulin area under the curve. The results indicate that a significant proportion of pediatric injury survivors suffer from glucose abnormalities 24 to 36 months postburn. Burn size, time postburn, age, lean mass, and adiposity are significant predictors of insulin resistance in pediatric burn injury survivors. Clinical evaluation and screening for abnormal glucose metabolism should be emphasized in patients with large burns, older age, and survivors with high body fat.Chondronikola, Maria, Meyer, Walter J., Sidossis, Labros S., Ojeda, Sylvia, Huddleston, Joanna, Stevens, Pamela , Borsheim, Elisabet, Suman, Oscar E., Finnerty, Celeste C., Herndon, David N.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2016Reversal of growth arrest with the combined administration of oxandrolone and propranolol in severely burned childrenJournalJ78254Annals of Surgery2643421-428Study investigated whether the combined administration of oxandrolone and propranolol attenuates growth arrest and improves the rate of growth, compared to the administration of oxandrolone or propranolol alone, in severely burned children. In this prospective, randomized study of 612 burned children (males between the ages of 0.5 and 14 years and females between the ages of 0.5 to 12 years), subjects were assigned to one of four treatment groups. The children received one of the following treatments during their acute stay and for 1 year post discharge: (1) control treatment, (2) oxandrolone alone, (3) propranolol alone, or (4) combined administration of oxandrolone and propranolol. Data were recorded at discharge, 6 months, and 1 and 2 years post injury. The duration of growth arrest was defined as the days from the date of burn to the date at which each subject was determined to have passed their admission height by at least 0.25 centimeters and where the height increase was persistent and progressive. Growth rate was measured in centimeters grown per year. The results indicated that combined use of oxandrolone and propranolol shortened the period of growth arrest by 84 days and increased growth rate by 1.7 centimeters per year, compared to controls. It is concluded that combined administration of oxandrolone and propranolol attenuates burn-induced growth arrest in pediatric burn patients.Herndon, David N., Voight, Charles D., Capek, Karel D., Wurzer, Paul, Guillory, Ashley, Kline, Andrea, Andersen, Clark R., Klein, Gordon L., Tompkins, Ronald G., Suman, Oscar E., Finnerty, Celeste C., Meyer, Walter, Sousse, Linda E.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2016Transpulmonary thermodilution versus transthoracic echocardiography for cardiac measurements in severely burned childrenJournalJ78250Shock463249-253Study compared cardiac output (CO) measurements performed in severely burned children using the transpulmonary thermodilution (TPTD) with the PiCCO (Pulse index Continuous Cardiac Output) system or transthoracic echocardiography (TTE). Fifty-four severely burned children were studied. Outcomes were compared using t-tests, multiple linear regression, and a Bland-Altman plot. An analysis of 105 data pairs revealed that PiCCO yielded higher CO measurements than TTE (190 percent versus 150 percent of predicted values). PiCCO- and TTE-derived CO measurements correlated moderately well (0.54). A Bland-Altman plot showed a mean bias of 1.53 liters per minute with a 95-percent prediction interval of 4.31 liters per minute. TTE-derived estimates of CO may underestimate severity of the hyperdynamic state in severely burned children. The authors recommend using the PiCCO system for objective cardiovascular monitoring and to guide goal-directed fluid resuscitation in this population.Wurzer, Paul, Branski, Ludwik K., Jeschke, Marc G., Ali, Arham, Kinsky, Michael P., Bohanon, Frederick J., Hundeshagen, Gabriel, Norbury, William B., Williams, Felicia N., Kamolz, Lars-P., Finnerty, Celeste C., Herndon, David N.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2016Pathophysiology, research challenges, and clinical management of smoke inhalation injuryJournalJ78253Lancet388100521437-1446Article reviews the current understanding of the pathophysiology of smoke inhalation injury, the best evidence-based treatments, and challenges and future directions in diagnostics and management. Smoke inhalation injury is a serious medical problem that increases morbidity and mortality after severe burns. Despite recent advances in critical care and the management of burn patients, smoke inhalation injury continues to increase significantly the morbidity and mortality in burn patients. This is related, it least in part, to the difficulty in reliably grading the severity of inhalation injury and the paucity of evidence-based, generally accepted therapeutic interventions. Clinical trials should be undertaken to address these issues. Basic and preclinical translational studies should focus on determining molecular and cellular mechanisms that underlie both airway and lung parenchymal injury as well as the development of novel treatment approaches including the application of regenerative medicine and bioengineering. The authors recommend that an expert consensus conference be organized in the near future to establish a comprehensive protocol for a large prospective multicenter, ideally multinational, clinical trial. In that trial, the noted gaps in clinical care and pathophysiologic understanding could be definitively addressed to reduce the morbidity and increase the salvage of patients with inhalation injury.Enkhbaatar, Perenlei, Pruitt Jr., Basil A., Mlcak, Ronald, Wolf, Steven E., Sakurai, Hiroyuki, Herndon, David N.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2017Psychometric properties of the modified 5-D itch scale in a burn model system sample of people with burn injuryJournalJ74382Journal of Burn Care And Research (formerly Journal of Burn Care & Rehabilitation)381e402-e408Study evaluated the psychometric properties of the 4-dimension (4-D) itch scale, a modified version of the 5-dimension itch scale, in a sample of individuals with severe burn injury and/or burn injuries to hands, face, and/or feet. Four of the five domains of the 5-dimension itch scale (4-D) were administered to 173 individuals who reported itching in the Burn Injury Model System Centers Program longitudinal study at either 5 or 10 years after injury. Analyses of the scale included evaluation of dimensionality, internal consistency, associations with other symptoms or quality of life measures, and an examination of floor and ceiling effects. Fit values from a one-factor confirmatory factor analysis were acceptable, supporting unidimensionality. Cronbach's α was 0.82, indicating good internal consistency. One item had a corrected item-total score correlation of less than 0.40. Associations between the 4-D and other measures were in the expected direction and magnitude. A negligible number of participants (no more than two) selected the lowest category for all items (minimal floor effect) or the highest category for all items (minimal ceiling effect). The 4-D had acceptable psychometric properties in adult burn injury survivors; however, the scale could be improved by removing the item with a low correlation with the total score.Amtmann, Dagmar, McMullen, Kara, Kim, Jiseon, Bocell, Fraser D., Chung, Hyewon, Bamer, Alyssa, Carrougher, Gretchen J., Gerrard, Paul, Schneider, Jeffrey C., Holavanahalli, Radha K.Yesdevopsadmin
2016The burn outcome questionnaires: Patient and family reported outcome metrics for children of all agesJournalJ73945Burns8Article discusses the psychometric properties and clinical utility of the Burn Outcome Questionnaires (BOQs). The BOQs are currently the most well-studied and clinically developed patient-reported outcome measures for use in children with burn injuries. There are currently four separate BOQ instruments: (1) the BOQ0–5, administered to the parents of the burn survivors, ages 0 up to 5 years of age; (2) the BOQ5–18, also administered to the parents of the burn survivors ages 5–18 years; (3) the BOQ11–18, administered to teen burn survivors, ages 11–18; and (4) the Young Adult Burn Outcome Questionnaire, administered to burn survivors ages 19–30.Ryan, Colleen M., Cartwright, Sara, Schneider, Jeffrey C., Tompkins, Ronald G., Kazis, Lewis E.Boston-Harvard Burn Injury Model SystemYesdevopsadmin
2017Urban telemedicine: The applicability of teleburns in the rehabilitative phaseJournalJ76173Journal of Burn Care And Research (formerly Journal of Burn Care & Rehabilitation)38e235-e239Study evaluated the utility of telemedicine during the rehabilitative phase of burn care. Telemedicine is defined as the use of information technology to deliver health care at a distance. A retrospective review was performed on patients enrolled in a program that utilized telemedicine between a burn center and rehabilitation hospital in an urban setting. Data collected included total number of encounters, visits, type of visit, physician time, and readmissions. Transportation costs were based on local ambulance rates between the two facilities. The impact of telemedicine was evaluated with respect to the time saved for the physician, burn center, and burn clinic, as well as rehabilitative days saved. A patient satisfaction survey was also administered. A total of 29 patients participated in 73 virtual visits through the telemedicine project. Virtual visits included new consults, preoperative evaluations, and postoperative follow-ups. A total of 146 ambulance transports were averted during the study period, totaling $101,110. Virtual visits saved 6.8 outpatient burn clinic days, or 73 clinic appointments of 30-minutes duration. The ability to perform more outpatient surgery resulted in 80 inpatient bed days saved at the burn hospital. The rehabilitation hospital saved an average of 2 to 3 patient days secondary to unnecessary travel. Satisfaction surveys demonstrated patient satisfaction with the encounters, primarily related to time saved. The decrease in travel time for the patient from the rehabilitation hospital to outpatient burn clinic improved adherence to the rehabilitation care plan and resulted in increased throughput at the rehabilitation facility. This study showed how videoconferencing between a burn center and rehabilitation hospital streamlined patient care and reduced healthcare costs, while maintaining quality of care and patient satisfaction.Liu, Yuk M., Vardanian, Andrew, Bozkurt, Taylan, Schneider, Jeffrey C., Hefner, Jaye, Schulz, John T., Fagan, Shawn P., Goverman, JeremyBoston-Harvard Burn Injury Model SystemYesdevopsadmin
2015Predictive value of IL-8 for sepsis and severe infections after burn injury: A clinical studyJournalJ73532Shock433222-227Study investigated whether expression of interleukin 8 (IL-8), a major mediator for inflammatory responses, can be used to predict post-burn sepsis, infections, and mortality. Plasma cytokines, acute-phase proteins, constitutive proteins, and hormones were analyzed during the first 60 days after injury from 468 pediatric burn patients. Demographics and clinical outcome variables (length of stay, infection, sepsis, multiple organ failure [MOF], and mortality) were recorded. A cutoff level for IL-8 was determined using receiver operating characteristic analysis. Receiver operating characteristic analysis identified a cutoff level of 234 picograms per milliliter for IL-8 for survival. Patients were grouped according to their average IL-8 levels relative to this cutoff and stratified into high (133 patients) and low (335 patients) groups. In the low group, regression analysis revealed a significant predictive value of IL-8 to percent of total body surface area burned and incidence of MOF. In the high group, IL-8 levels were able to predict sepsis. In the high group, elevated IL-8 was associated with increased inflammatory and acute-phase responses compared with the low group. High levels of IL-8 correlated with increased MOF, sepsis, and mortality. These data suggest that serum levels of IL-8 may be a valid biomarker for monitoring sepsis, infections, and mortality in burn patients.Kraft, Robert, Herndon, David N., Finnerty, Celeste C., Cox, Robert A., Song, Juquan, Jeschke, Marc G.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2017Rehabilitation research priorities: The next 10 yearsJournalJ75954Journal of Burn Care And Research (formerly Journal of Burn Care & Rehabilitation)383e635-e637Article highlights a core set of foundational themes that are needed to develop the next decade of rehabilitation research priorities to optimize burn recovery. These themes include: integrating burn survivors into rehabilitation research, measuring the right things, utilizing technology, learning from other fields of medicine, translating bench research to rehabilitation, harnessing big data, capitalizing on past successes, embracing social media, and expanding partnerships. It is the challenge of the burn care community to utilize these foundational themes to champion the field of burn rehabilitation research.Schneider, Jeffrey C.Boston-Harvard Burn Injury Model SystemYesdevopsadmin
2015The role of exercise in the rehabilitation of patients with severe burnsJournalJ73522Exercise and Sport Sciences Reviews43134-40Article reviews the evidence for the utility of rehabilitative exercise training (RET) in restoring physiological function in burn survivors. Severe burn trauma results in persistent skeletal muscle catabolism and prolonged immobilization. The authors hypothesize that structured RET is a safe and effective strategy to restore lean body mass and physical function in burn victims. Empirical evidence clearly demonstrates that RET improves measures of physiological function such as aerobic capacity and strength in patients recovering from severe burns. For this reason, the authors conclude that progressive RET should be a component of the outpatient care of burn survivors.Porter, Craig, Hardee, Justin P., Herndon, David N., Suman, Oscar E.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2017Oxandrolone coadministration does not alter plasma propranolol concentrations in severely burned pediatric patientsJournalJ78244Journal of Burn Care And Research (formerly Journal of Burn Care & Rehabilitation)384243-250Study investigated whether the coadministration of oxandrolone and propranolol alters plasma propranolol concentrations. Propranolol, is a beta blocker used to reduce resting heart rate and cardiac work caused by elevated circulating catecholamines. Oxandrolone, a testosterone mimetic, promotes protein synthesis and anabolism to counter muscle wasting; testosterone administration is known to alter beta-adrenergic receptor-mediated signaling. Coadministration of these drugs is expected to synergistically improve patient outcomes. Ninety-two pediatric patients with burns covering at least 30 percent of the total body surface area were randomized to receive propranolol or oxandrolone plus propranolol. Plasma propranolol concentrations were determined following two dosing strategies: Q6 (liquid formulation) and Q24 (extended-release capsule). Samples were drawn before drug administration and at regular intervals throughout the next two dosing periods. Heart rate and blood pressure were recorded throughout the study. Propranolol half-life was 3.3 hours for the Q6 drug dosing frequency and 11.2 hours for the Q24 strategy. The percentage of predicted heart rate declined by 2.8 percent for each doubling of the propranolol concentration in the Q6 dosing schedule. The percentage of predicted heart rate declined by 2.5 percent for each doubling of propranolol concentration on the Q24 dosing schedule. Maximum and minimum propranolol plasma concentrations were similar with either dosing regimen. The results indicate that the addition of oxandrolone did not affect any of the measured parameters; oxandrolone coadministration did not alter propranolol’s plasma concentration, half-life, or effect on heart rate.Guillory, Ashley N., Herndon, David N., Silva, Michael B., Andersen, Clark R., Suman, Oscar E., Finnerty, Celest C.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2015What score on the Vancouver scar scale constitutes a hypertrophic scar? Results from a survey of North American burn-care providersJournalJ74395Burns4171442-1448Study investigated whether the Vancouver Scar Scale (VSS) can be used to define hypertrophic scarring (HTS) in an objective, reliable manner. An online survey sent to 1,000 burn care providers asked respondents what VSS score indicates HTS and asked them to score scar photos using the VSS. Receiver operating characteristic curves were used to evaluate VSS sub-scores and their combinations in diagnosis of HTS. Among the 130 responses received, there was no consensus as to what VSS score indicates a diagnosis of HTS. VSS height score (0–3) performed best for diagnosis of HTS; using a cut-off of ≥1, height score was 99.5 percent sensitive and 85.9 percent specific for HTS. The results indicate that burn clinicians do not routinely use the VSS and perceptions vary widely regarding what constitutes HTS. When a dichotomous variable is needed, the VSS height score with a cut-off of ≥1 may be optimal. The findings underscore the need for an objective tool to reproducibly characterize HTS across burn centers.Thompson, Callie M., Sood, Ravi F., Honari, Shari, Carrougher, Gretchen J., Gibran, Nicole S.Northwest Regional Burn Model SystemYesdevopsadmin
2016Propranolol reduces cardiac index but does not adversely affect peripheral perfusion in severely burned childrenJournalJ78251Shock465486-491Study examined the effect of propranolol on hemodynamic parameters assessed using the PiCCO (Pulse index Continuous Cardiac Output) system in burned children. The study analyzed hemodynamic data from 121 patients who were randomized to receive either propranolol or placebo (control), which was initiated as a prospective randomized controlled trial. Endpoints were cardiac index (CI), percent predicted heart rate (%HR), mean arterial pressure (MAP), percent predicted stroke volume (%SV), rate pressure product (RPP), cardiac work (CW), systemic vascular resistance index (SVRI), extravascular lung water index (EVLWI), arterial blood gases, events of lactic acidosis, and mortality. Mixed multiple linear regressions were applied, and a 95-percent level of confidence was assumed. Groups were comparable in demographics, EVLWI, SVRI, %SV, arterial blood gases, Denver 2 post injury organ failure score, incidence of lactic acidosis, or mortality. The percent predicted HR, MAP, CI, CW, and RPP were significantly reduced in the propranolol-treated group. Results indicate that propranolol significantly reduces cardiogenic stress by reducing CI and MAP in children with severe burn injury. Although, peripheral oxygen delivery, events of lactic acidosis, and organ dysfunction was not higher in propranolol treated patients.Wurzer, Paul, Branski, Ludwik K., Clayton, Robert P., Hundeshagen, Gabriel, Forbes, Abigail A., Voigt, Charles D., Andersen, Clark R., Kamolz, Lars-P., Woodson, Lee C., Suman, Oscar E., Finnerty, Celeste C., Herndon, David N.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2017The Burn Model Systems outcome measures: A content analysis using the International Classification of Functioning, Disability, and Health.JournalJ77157Disability and Rehabilitation39252584-2593https://pubmed.ncbi.nlm.nih.gov/27758149/BACKGROUND: The National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) Burn Injury Model Systems (BMS) is a nationwide database that uses patient-reported outcome measures to collect data. Though the outcome measures demonstrate good psychometric properties, the question remains whether or not these measures collect data that encompass the entire experience of burn patients over time. METHODS: Each meaningful concept included in the BMS assessments was linked to the International Classification of Functioning, Disability and Health (ICF) in order to classify and describe the content of each measure. The linking was completed by two experienced coders. The perspective of each assessment was also determined. RESULTS: The body function component was most frequently addressed overall followed by the activities and participation component. The component body structures and environmental factors are not extensively covered in the BMS assessments. ICF chapter and category distribution varied greatly between assessments. The assessments were of the health status perspective. CONCLUSION: This study suggests a need to revisit the item composition of the BMS assessments to more evenly distribute ICF topics and subtopics that are pertinent to burn injury which will ensure a broader but more precise understanding of burn injury recovery. Implications for Rehabilitation A better understanding of the data collected through the Burn Model Systems (BMS) project may contribute to improve data collection tools and ultimately lead to clinical practice innovations and improvements. Clinicians interested in using BMS data for research purposes can better understand what topics are included and excluded in the collection and what perspectives are addressed. This study highlights the need for burn clinicians around the world to lend their expertise to the WHO for the development of a much needed burn injury International Classification of Functioning, Disability and Health Core Set. Osborne, Candice L., Petersson, Christina, Graham, James E., Meyer III, Walter J., Simeonsson, Rune J., Suman, Oscar E., Ottenbacher, Kenneth J.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2014Uncoupled skeletal muscle mitochondria contribute to hypermetabolism in severely burned adultsJournalJ73521American Journal of Physiology. Endocrinology and Metabolism3075E462-E467Study investigated the impact of severe burn injury on skeletal muscle mitochondrial function and coupling control in adult humans. Mitochondria are the cellular organelles responsible for almost all oxygen consumption in vivo. It was hypothesized that severe burn injury alters skeletal muscle mitochondrial function, favoring mitochondrial thermogenesis. This hypothesis offers a novel mechanistic explanation for the hypermetabolic response to severe thermal trauma. Leak, coupled, and uncoupled mitochondrial respiration was determined in permeabilized myofiber bundles obtained from quadriceps muscle biopsies collected on two separate occasions from 6 severely burned adults and 12 healthy adults (controls). Indirect calorimetry was used to estimate metabolic rate in burn patients. Results indicated that metabolic rate was significantly greater than predicted values for burn patients at both time points. Skeletal muscle oxidative capacity, citrate synthase activity, a marker of mitochondrial abundance, and mitochondrial sensitivity to oligomycin were all lower in burn patients vs. controls at both time points. A greater proportion of maximal mitochondrial respiration was linked to thermogenesis in burn patients compared with controls. Increased metabolic rate in severely burned adults is accompanied by derangements in skeletal muscle mitochondrial function. Skeletal muscle mitochondria from burn victims are more uncoupled, indicating greater heat production within skeletal muscle. The findings suggest that skeletal muscle mitochondrial dysfunction contributes to increased metabolic rate in burn victims.Porter, Craig, Herndon, David N., Borsheim, Elisabet, Chao, Tony, Reidy, Paul T., Borack, Michael S., Rasmussen, Blake B., Chondronikola, Maria, Saraf, Manish K., Sidossis, Labros S.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2016Predicting heterotopic ossification early after burn injuries: A risk scoring systemJournalJ74778Annals of SurgeryThis study developed a scoring system that stratifies burn patients at the time of hospital admission according to risk of developing heterotopic ossification (HO), the development of abnormal bone in the soft tissue. HO in burns is an uncommon but severely debilitating problem with a poorly understood mechanism and no fully effective prophylactic measures. Data were obtained from the Burn Model System National Database for 3,693 subjects with burn dates between 1994 and 2010. The primary outcome was diagnosis of HO at hospital discharge. Logistic regression analysis was used to determine significant demographic and medical predictors of HO. A risk scoring system was created in which point values were assigned to predictive factors and final risk score is correlated with the percent risk of developing HO. The model was internally and externally validated. The mean age of the subjects was 42.5  years, the mean total body surface area (TBSA) burned was 18.5  percent, and 74.9 percent were men. TBSA and the need for grafting of the arm, head/neck, and trunk were significant predictors of HO development. A 13-point risk scoring system was developed using these significant predictors. The model c-statistic is 0.92. The risk scoring system demonstrated evidence of internal and external validity. An online calculator was developed to facilitate translation of knowledge to practice and research. This HO risk scoring system identifies high-risk burn patients suitable for diagnostic testing and interventional HO prophylaxis trials.Schneider, Jeffrey C., Simko, Laura C., Goldstein, Richard, Shie, Vivian L., Chernack, Betty, Levi, Benjamin, Jayakumar, Prakash, Kowalske, Karen J., Herndon, David N., Gibran, Nicole S., Ryan, Colleen M.Boston-Harvard Burn Injury Model SystemYesdevopsadmin
2014Rehabilitation outcomes among burn injury patients with a second admission to an inpatient rehabilitation facilityJournalJ71556PM & R611999-1007Study compared the rehabilitation outcomes of burn patients admitted to an inpatient rehabilitation facility (IRF) who were discharged to acute care and then readmitted to an IRF (repeaters) with those of burn patients admitted to an IRF only 1 time (nonrepeaters). A secondary analysis was performed of data from the Uniform Data System for Medical Rehabilitation, a national data repository, for burn injury patients aged 18 years or more who were admitted to IRFs between 2002 and 2011. Functional status was assessed using the Functional Independence Measure (FIM) instrument. Rehabilitation outcome variables examined included admission FIM total, rehabilitation length of stay, discharge FIM total, FIM change, FIM efficiency (total FIM points gained per day), and discharge disposition. Outcomes of the 188 repeaters’ second stay were compared to the 6,855 nonrepeaters’ first and only stay, using linear regression and logistic regression to determine whether repeater status was associated with rehabilitation outcomes. Analysis revealed that repeater status was inversely associated with discharge FIM total and FIM change in linear regression models. No other significant differences were found, and those differences in discharge FIM total and FIM change were small. The findings indicate that differences found in rehabilitation outcomes between the repeater and nonrepeater groups were small and may not reflect clinically meaningful differences. Burn injury patients who required a second IRF admission had rehabilitation outcomes similar to those of burn injury patients who did not require a second IRF admission, emphasizing the value of inpatient rehabilitation for burn injury IRF readmissions.DiVita, Margaret A., Mix, Jacqueline M., Goldstein, Richard, Gerrard, Paul, Niewczyk, Paulette, Ryan, Colleen M., Kowalske, Karen, Zafonte, Ross, Schneider, Jeffrey C.Boston-Harvard Burn Injury Model SystemYesdevopsadmin
2017The national institute on disability, independent living, and rehabilitation research burn model system: Twenty years of contributions to clinical service and researchJournalJ75436Journal of Burn Care And Research (formerly Journal of Burn Care & Rehabilitation)381e240-e253This article examines the output from each Burn Model System (BMS) component over the past 20 years. The National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) established the BMS in 1993 to improve the lives of burn survivors. The BMS program includes: (1) a multicenter longitudinal database describing the functional and psychosocial recovery of burn survivors, (2) site-specific burn-related research, and (3) a knowledge dissemination component directed toward patients and providers. The database structure, content, and access procedures are described. Publications using the database are identified and categorized to illustrate the content area of the work. Unused areas of the database are identified for future study. Publications related to site-specific projects are cataloged and the most frequently cited articles are summarized to illustrate the scope of these projects. The effectiveness of dissemination activities was measured by quantifying website hits and information downloads. There were 25 NIDILRR-supported publications that utilized the database. These articles covered topics related to psychological outcomes, functional outcomes, community reintegration, and burn demographics. There were 172 site-specific publications; highly cited articles demonstrate a wide scope of study. For information dissemination, visits to the BMS website quadrupled between 2013 and 2014, with 124,063 downloads of educational material in 2014. The NIDILRR BMS program has played a major role in defining the course of burn recovery, and making that information accessible to the general public. The accumulating information in the database serves as a rich resource to the burn community for future study.Goverman, Jeremy, Mathews, Katie, Holavanahalli, Radha K., Vardanian, Andrew, Herndon, David N., Meyer, Walter J., Kowalske, Karen, Fauerbach, Jim, Gibran, Nicole S., Carrougher, Gretchen J., Amtmann, Dagmar, Schneider, Jeffrey C., Ryan, Colleen M.Boston-Harvard Burn Injury Model SystemYesdevopsadmin
2014Visionary leadership in burn rehabilitation over 50 years: Major accomplishments, but mission unfulfilledJournalJ73517PM & R69769-773Article reviews the history of burn care and rehabilitation from the perspective of leaders in the field of physical medicine and rehabilitation (PM&R). Although burn rehabilitation is a requirement of residency training in PM&R and burn topics are included on the national board examination, PM&R residents are not choosing to specialize in burn rehabilitation. The role of the physiatrist is just as essential for burn survivors as it is for those with brain or spinal cord injuries. The authors suggest that leaders in the field need to take a more active role in recruiting and nurturing young physiatrists. The pursuit of clinical and research excellence in burn rehabilitation requires the same energy, tenacity, and visionary leadership demonstrated by leaders in the field of PM&R since the inception of the specialty.Kowalske, Karen, Helm, PhalaNorth Texas Burn Rehabilitation Model SystemYesdevopsadmin
2015Propranolol attenuates hemorrhage and accelerates wound healing in severely burned adultsJournalJ73525Critical Care191Study investigated whether wound healing and perioperative hemodynamics are affected by propranolol administration in severely burned adults. Sixty-nine adult patients with burns covering at least 30 percent of their total body surface area received standard burn care, 35 patients with and 34 without (controls) propranolol. Propranolol was administered within 48 hours of burns and given throughout hospital discharge to decrease heart rate by approximately 20 percent from admission levels. Wound healing was determined by comparing the time between grafting procedures. Blood loss was determined by comparing pre- and post-operative hematocrit while factoring in operative graft area. Data were collected between first admission and first discharge. Demographics, burn size, and mortality were comparable in the control and propranolol groups. Patients in the propranolol group received an average propranolol dose of 3.3 mg/kg/day. Daily average heart rate over the first 30 days was significantly lower in the propranolol group. The average number of days between skin grafting procedures was also lower in propranolol patients (10 days) than in control patients (17 days), indicating faster donor site healing time in the propranolol group. Packed red blood cell infusion was similar between groups (control 5.3 units versus propranolol 4.4 units). Propranolol was associated with 5- to 7-percent improvement in perioperative hematocrit during grafting procedures of 4,000 to 16,000 centimeters squared compared to controls. Results indicate that administration of propranolol during the acute hospitalization period diminished blood loss during skin grafting procedures and improved wound healing in severely burned adults.Ali, Arham, Herndon, David N., Mamachen, Ashish, Hasan, Samir, Andersen, Clark R., Grogans, Ro-Jon, Brewer, Jordan L., Lee, Jong O., Heffernan, Jamie, Suman, Oscar E., Finnerty, Celeste C.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2014Survivors versus nonsurvivors postburn: Differences in inflammatory and hypermetabolic trajectoriesJournalJ73530Annals of Surgery2594814-823Study explored whether trajectories of common biomedical markers of metabolism and inflammation can be utilized to determine survival in pediatric burn patients. A total of 230 severely burned children with burns exceeding 30 percent of their total body surface, requiring at least 1 surgical procedure were enrolled in this study; 79 died within 300 days of the burn injury. Demographics, clinical outcomes, and inflammatory and acute-phase responses (serum cytokines, hormones, and proteins) were determined at admission and at 11 time points for up to 180 days post burn. Statistical analysis was performed using a 1-way analysis of variance, the Student t test, chi-squared test, and Mann-Whitney test where appropriate. Survivors and non-survivors exhibited profound differences in critical markers of inflammation and metabolism at each time point. Non-survivors had significantly higher serum levels of interleukin (IL)-6, IL-8, granulocyte colony-stimulating factor, monocyte chemoattractant protein-1, C-reactive protein, glucose, insulin, blood urea nitrogen, creatinine, and bilirubin. Furthermore, non-survivors exhibited a vastly increased hypermetabolic response that was associated with increases in organ dysfunction and sepsis when compared with survivors. The results indicate that non-survivors have different trajectories in inflammatory, metabolic, and acute phase responses that differentiate them from survivors and may allow predictive models to improve and personalize burn outcomes.Jeschke, Marc G., Gauglitz, Gerd G., Finnerty, Celeste C., Kraft, Robert, Mlcak, Ronald P., Herndon, David N.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2017Two-year gender differences in satisfaction with appearnace after burn injury and prediction of five-year depression: A latent growth curve approachJournalJ77236Archives of Physical Medicine and Rehabilitation98112274-2279Study used latent growth curve and longitudinal structural equation modeling to examine the 2-year trajectory of satisfaction with appearance in adults with burn injury, and that trajectory’s effect on depression 5 years after burn injury. Data on the Satisfaction With Appearance Scale and Patient Health Questionnaire-9 (depression) were collected at discharge from burn injury hospitalization and at 6 months, 1 year, 2 years, and 5 years after discharge. The sample consisted of 720 adults who were hospitalized for a burn injury, enrolled in the Burn Model Systems database, and completed measures at least once throughout the 5-year study duration. Women with burn injury reported higher levels of dissatisfaction with their appearance in comparison to their male counterparts over the 2 years after discharge. Individuals with a larger total body surface area (TBSA) affected by a burn also reported greater body dissatisfaction across the post-discharge 2-year period. Results did not support significant gender or TBSA differences in the rate of change of body dissatisfaction trajectories across these 2 years. Individuals with greater body dissatisfaction at 6 months postdischarge tended to have higher depressive symptoms at 5 years. Six month postdischarge, body dissatisfaction scores also mediated the effects of gender and TBSA on depressive symptoms 5 years later. It is recommended that individuals with heightened body image dissatisfaction after a burn, particularly women and those with larger TBSA, participate in evidence-based psychosocial interventions to improve long-term adjustment.Al Ghriwati, Nour, Sutter, Megan, Pierce, Bradford S., Perrin, Paul B., Wiechman, Shelley A., Schneider, Jeffrey C.Boston-Harvard Burn Injury Model SystemYesdevopsadmin
2016Pediatric contractures in burn injury: A burn model system national database studyJournalJ74971Journal of Burn Care And Research (formerly Journal of Burn Care & Rehabilitation)381e192-e199Study examines the incidence and severity of contractures in a large, multicenter, pediatric burn population and determined the associated risk factors for the development of contractures. Data from the National Institute on Disability and Rehabilitation Research Burn Model System database, for pediatric (younger than 18 years) burn survivors from 1994 to 2003, were analyzed. Demographic and medical data were collected on each subject. The primary outcome measures included the presence of contractures, number of contractures per patient, and severity of contractures at each of nine locations (shoulder, elbow, hip, knee, ankle, wrist, neck, lumbar, and thoracic) at time of hospital discharge. Regression analysis was performed to determine predictors of the presence, severity, and numbers of contractures. Of the 1,031 study patients, 237 (23 percent) developed at least 1 contracture at hospital discharge. Among those with at least one contracture, the mean was 3 contractures per person. The shoulder was the most frequently contracted joint (27.9 percent), followed by the elbow (17.6 percent), wrist (14.2 percent), knee (13.3 percent), and ankle (11.9 percent). Most contractures were mild (38.5 percent) or moderate (36.3 percent) in severity. The statistically significant predictors of contracture development were age and intensive care unit (ICU) length of stay. The statistically significant predictors of severity of contracture were age, ICU length of stay, presence of amputation, and black race. Predictors of the number of contractures included total age, length of stay, length of ICU stay, presence of amputation, total body surface area (TBSA) burned, and TBSA grafted.Goverman, Jeremy, Mathews, Katie, Goldstein, Richard, Holavanahalli, Radha, Kowalske, Karen, Esselman, Peter, Gibran, Nicole, Suman, Oscar, Herndon, David, Ryan, Colleen M., Schneider, Jeffrey C.Boston-Harvard Burn Injury Model SystemYesdevopsadmin
2015Quantifying risk factors for long-term sleep problems after burn injury in young adultsJournalJ73947Journal of Burn Care And Research (formerly Journal of Burn Care & Rehabilitation)This 5-year prospective multicenter study included 152 adults with burn injuries, ages 19 to 30 years, who completed the Young Adult Burn Outcome Questionnaire (YABOQ) up to 36 months after injury. The YABOQ measures 15 patient-reported outcomes including physical, psychological, and social statuses and symptoms such as itch and pain. Scores of these YABOQ outcome domains were standardized to a mean of 50 and a standard deviation of 10 based on an age-matched non-burned reference group of young adults. Sleep quality was assessed using the item "How satisfied are you now with your sleep," rated by a 5-point Likert scale. Patients responding with very and somewhat dissatisfied were classified as having sleep dissatisfaction and the remaining as less or not dissatisfied. The associations between sleep dissatisfaction and YABOQ outcome domains were analyzed longitudinally using mixed-effect generalized linear models, adjusted for burn size, age, gender, and race. Generalized estimating equations were used to take into account correlated error resulting from repeated surveys on each patient over time. Among the burn survivors, sleep dissatisfaction was twice as prevalent (76 of 152; 50 percent) when compared with the non-burned reference group (29 of 112; 26 percent). The likelihood of a burn survivor being dissatisfied with sleep was reduced over time after the burn injury. Sleep dissatisfaction following burns was significantly associated, in a dose-dependent manner, with increasing burn size. Better sleep was associated with better outcomes in all domains except Fine Motor Function; this association was significantly more apparent in the longer termLee, Austin F., Ryan, Collen M., Schneider, Jeffrey C., Kazis, Lewis E., Li, Nien C., Rose, Mary'Liang, Matthew H., Wang, Chao, Palmieri, Tina, Meyer III, Walter J., Pidcock, Frank S., Reilly, Debra, Sheridan, Robert L., Tompkins, Ronald G.Boston-Harvard Burn Injury Model SystemYesdevopsadmin
2016The metabolic stress response to burn trauma: Current understanding and therapiesJournalJ78249Lancet388100521417-1426This is the first installment of a three-part series exploring the stress response to severe burn trauma. This article reviews the current literature pertaining to the pathophysiological stress response to burn trauma, and the leading therapies to mitigate this response. Focus will be placed on recent advances that have come to light in the last decade, as well as important knowledge gaps that need to be pursued in order to develop novel therapeutic strategies which improve outcomes in burn survivors. In particular, discussion focuses on three major metabolic consequences of severe burn trauma: hypermetabolism, muscle wasting, and stress induced diabetes.Porter, Craig, Tompkins, Ronald G., Finnerty, Celeste C., Sidossis, Labros S., Suman, Oscar E., Herndon, David N.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2015Variation in inpatient rehabilitation utilization after hospitalization for burn injury in the United StatesJournalJ72794Journal of Burn Care And Research (formerly Journal of Burn Care & Rehabilitation)366613-618Study analyzed the variation in rehabilitation utilization by state of hospitalization for patients hospitalized with burn injury. This retrospective cohort study used nationally collected data over a 10-year period (2001 to 2010), from the Healthcare Cost and Utilization Project State Inpatient Databases. A total of 57,968 patients hospitalized for burn injury were identified by ICD-9-CM codes and examined to see specifically if they were discharged immediately to inpatient rehabilitation after hospitalization (primary outcome). Both unadjusted and adjusted likelihoods were calculated for each state taking into account the effects of age, insurance status, hospitalization at a burn center, and extent of burn injury by total body surface area (TBSA). The relative risk of discharge to inpatient rehabilitation varied by as much as 6-fold among different states. Higher TBSA, having health insurance, higher age, and burn center hospitalization all increased the likelihood of discharge to inpatient rehabilitation following acute care hospitalization. There was significant variation between states in inpatient rehabilitation utilization after adjusting for variables known to affect each outcome. The authors recommend that future efforts focus on identifying the cause of this state-to-state variation, its relationship to patient outcome, and standardizing treatment across the United States.Greene, Nathaniel H., Pham, Tam N., Esselman, Peter C., Rivara, Frederick P.Northwest Regional Burn Model SystemYesdevopsadmin
2015Predictors of muscle protein synthesis after severe pediatric burnsJournalJ73520Journal of Trauma and Acute Care Surgery784816-822Study examined the skeletal muscle protein synthesis (MPS) rate of burned children over a period of 24 months after injury and identified predictors that influence this response. Eighty-seven children with 40 percent or greater total body surface area (TBSA) burned participated in stable isotope infusion studies at 1, 2, and approximately 4 weeks after burn and at 6, 12, and 24 months after injury to determine skeletal muscle protein fractional synthesis rate (FSR). Generalized estimating equations with log link normal distribution were applied to account for clustering of patients and control for patient characteristics. Patients had large and deep burns. Muscle protein FSR was elevated throughout the first 12 months after burn compared with established values from healthy young adults. Muscle protein FSR was lower in boys, in children older than 3 years, and when burns were greater than 80 percent TBSA. The results of this study indicate that MPS is elevated for at least 1 year after injury, suggesting that greater muscle protein turnover is a component of the long-term pathophysiologic response to burn trauma. MPS is highly affected by sex, age, and burn size in severely burned children. These findings may explain the divergence in net protein balance and lean body mass in different populations of burn patients.Diaz, Eva C., Herndon, David N., Lee, Jinhyung, Porter, Craig, Cotter, Matthew, Suman, Oscar E., Sidossis, Labros S., Borsheim, ElisabetPediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2015Skeletal muscle protein breakdown remains elevated in pediatric burn survivors up to one-year post-injuryJournalJ75731Shock445397-401Study investigated the fractional synthesis rate (FSR) and fractional breakdown rate (FBR) in the skeletal muscle of 42 severely burned pediatric patients for up to 1 year after injury. Skeletal muscle protein kinetics were measured in the postprandial state following bolus injections of phenylalanine stable isotopes. Plasma and muscle phenylalanine enrichments were quantified using gas chromatography-mass spectrometry. Results indicated that the FSR in burn patients was 2- to 3-times higher than values from healthy men previously reported in the literature. The FBR was 4- to 6-times higher than healthy values. Therefore, net protein balance was lower in burn patients compared to healthy men from 2 weeks to 12 months post injury. These findings show that skeletal muscle protein turnover stays elevated for up to 1 year after burn, an effect attributable to simultaneous increases in FBR and FSR. Muscle FBR exceeds FSR during this time, producing a persistent net negative protein balance, even in the postprandial state, which likely contributes to the prolonged cachexia seen in burned victims.Chao, Tony, Herndon, David N., Porter, Craig, Chondronikola, Maria, Chaidemenou, Anastasia, Abdelrahman, Doaa R., Bohanon, Frederick J., Andersen, Clark, Sidossis, Labros S.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2016Long-term effects of physical exercise during rehabilitation in patients with severe burnsJournalJ75734Surgery1603781-788Study compared long-term functional outcome between severely burned children who either participated or did not participate in a 12-week exercise program. A total of 125 severely burned children (mean age 12 years) who received no long-term anabolic drugs chose between a voluntary exercise program (EX-group) and no exercise (NoEX-group) after discharge from the acute burn unit. Demographics between the EX-group (82 children) and NoEX-group (43 children) were comparable. Peak torque per lean leg mass (PTLLM), peak torque per body weight (PTBW), maximal oxygen consumption (VO2max), and peak heart rate (PHR) were assessed. In addition, body mass index (BMI) percentile and lean body mass index (LBMI) were recorded. Both groups were compared for up to 2 years postburn using mixed multiple analysis of variance. The results showed that muscle strength (PTBW) and cardiopulmonary fitness (VO2max and PHR) increased significantly due to hospital-based exercise. In the EX-group, PTLLM also increased significantly with exercise. Between discharge and 12-24 months, BMI percentile increased significantly in the EX-Group but did not change in the NoEX-group. There were no significant differences between groups in BMI percentile, LBMI, PTLLM, and VO2max at 24 months postburn. The findings suggest that exercise significantly improves the physical performance of severely burned children. The benefits are limited to early time points, however, and greatly narrow with further recovery time. Continued participation in exercise activities or a maintenance exercise program is recommended for exercise-induced adaptations to continue.Wurzer, Paul, Voight, Charles D., Clayton, Robert P., Andersen, Clark R., Mlcak, Ronald P., Kamolz, Lars-P., Herndon, David N., Suman, Oscar E.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2016Adult contractures in burn injury: A burn model system national database studyJournalJ74972Journal of Burn Care And Research (formerly Journal of Burn Care & Rehabilitation)381e328-e336Study examined the incidence and severity of contractures in a large, multicenter, burn population and determined the associated risk factors for the development of contractures. Data from the National Institute on Disability and Rehabilitation Research Burn Model System database, for adult burn survivors from 1994 to 2003, were analyzed. Demographic and medical data were collected on each subject. The primary outcome measures included the presence of contractures, number of contractures per patient, and severity of contractures at each of nine locations (shoulder, elbow, hip, knee, ankle, wrist, neck, lumbar spine, and thoracic spine) at time of hospital discharge. Regression analysis was performed to determine predictors of the presence, severity, and numbers of contractures. Of the 1,865 study patients, 620 (33 percent) developed at least 1 contracture at hospital discharge. Among those with at least one contracture, the mean was 3 contractures per person. The shoulder was the most frequently contracted joint (23.0 percent), followed by the elbow (19.9 percent), wrist (17.3 percent), ankle (13.6 percent), and knee (13.4 percent). Most contractures were mild (47.2 percent) or moderate (32.9 percent) in severity. Statistically significant predictors of contracture development were male sex, black race, Hispanic ethnicity, medical problems, neuropathy, total body surface area (TBSA) grafted, and TBSA burned. Predictors of the severity of contracture included male sex, black race, medical problems, neuropathy, TBSA grafted, and TBSA burned. Predictors of the number of contractures included male sex, medical problems, flash burn, neuropathy, TBSA burned, and TBSA grafted.Goverman, Jeremy, Mathews, Katie, Goldstein, Richard, Holavanahalli, Radha, Kowalske, Karen, Esselman, Peter, Gibran, Nicole, Suman, Oscar, Herndon, David, Ryan, Colleen M., Schneider, Jeffrey C.Boston-Harvard Burn Injury Model SystemYesdevopsadmin
2015Clinical and psychiatric characteristics of self-inflicted burn patients in the United States: Comparison with a nonintentional burn groupJournalJ71703Journal of Burn Care And Research (formerly Journal of Burn Care & Rehabilitation)363381-386Study examined whether self-inflicted burn patients differ from nonintentional, nonwork-related burn patients in terms of psychiatric and personality characteristics. Sociodemographic and injury-related factors were also compared. Fifteen patients with self-inflicted and 178 patients with nonintentional burn injuries were drawn from a larger study examining physical and psychosocial outcomes following major burn. Psychiatric/personality factors included self-reported psychiatric treatment history, alcohol/drug use, pre-burn mental health, and neuroticism. Sociodemographic factors and injury-related factors were obtained through medical records. Comparisons between the self-inflicted and the nonintentional groups were made using Fisher’s exact tests for categorical variables and Wilcoxon rank-sum tests for continuous variables. The self-inflicted group was 11.5 times more likely to report prior psychiatric treatment compared to the nonintentional burn group and 4.3 times more likely to have previously abused alcohol. Compared to nonintentional burn patients, self-inflicted burn patients reported worse pre-burn mental health. There were no differences on burn size or sociodemographic characteristics. Relative to survivors of nonintentional burns, self-inflicted burn patients in the United States demonstrate high psychiatric comorbidity. Standards of care must be developed to optimize treatment procedures and recovery outcomes in this subgroup.Rietschel, Carly H., Reese, Jennifer B., Hahn, Anne P., Fauerbach, James A.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2015High tidal volume decreases adult respiratory distress syndrome, atelectasis, and ventilator days compared with low tidal volume in pediatric burned patients with inhalation injuryJournalJ73535Journal of the American College of Surgeons2204570-578Study examined the effects of low and high tidal volume ventilation on the number of ventilator days, ventilation pressures, and incidence of atelectasis, pneumonia, and acute respiratory distress syndrome (ARDS) in pediatric burned patients with inhalation injury. Inhalation injury was diagnosed by bronchoscopy in 932 pediatric burned patients who were admitted to the Shriners Hospital for Children-Galveston from 1986 to 2014. Patients were divided into 3 groups: 241 patients who did not receive any type of ventilation, 190 patients who received high tidal volume (HTV) ventilation of 15 milliliters per kilogram (mL/kg) of body mass, and 501 patients who received low tidal volume (LTV) ventilation of 9 mL/kg. Results showed that HTV was associated with significantly decreased ventilator days and maximum positive end expiratory pressure and significantly increased maximum peak inspiratory pressure and plateau pressure compared with those in patients with LTV. The incidence of atelectasis and ARDS was significantly decreased with HTV compared with LTV. However, the incidence of pneumothorax was significantly increased in the HTV group compared with the LTV group. Findings suggest that HTV significantly decreases ventilator days and the incidence of both atelectasis and ARDS compared with LTV in pediatric burned patients with inhalation injury. Future studies should explore the differences in lung compliance and resistance, as well as work of breathing and blood flow, between high and low tidal volume use.Sousse, Linda E., Herndon, David N., Andersen, Clark R., Ali, Arham, Benjamin, Nicole C., Granchi, Thomas, Suman, Oscar E., Mlcak, Ronald P.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2014Influence of inhalation injury on energy expenditure in severely burned childrenJournalJ73526Burns4081487-1491Study examined the effect of inhalation injury on burn-induced resting energy expenditure (REE) measurements in children with severe burns. REE, as measured by indirect calorimetry, was used to determine the metabolism levels of patients and to guide their nutrition. Eighty-six children (1–18 years) with 40 percent or more of their total body surface area burned were divided into two groups based on their diagnosis: no inhalation injury and inhalation injury. Inhalation injury was diagnosed based on bronchoscopic evaluation. For both groups REE, percent predicted REE, and oxygen consumption were measured at admission, at burn day 10, and when patients were 95 percent healed. At admission, PaO2:FiO2 ratios (an index of respiratory distress) were significantly higher in patients with no inhalation injury than in patient with inhalation injury. No differences were detected in REE or percent of the predicted basal metabolic rate between groups. Additionally, oxygen consumption did not significantly differ between groups. Findings suggest that inhalation injury does not augment the burn-induced hypermetabolic stress response in children, as reflected by REE and oxygen consumption.Przkora, Rene, Fram, Ricki Y., Herndon, David N., Suman, Oscar E., Mlcak, Ronald P.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2017Measuring the social impact of burns on survivorsJournalJ75447Journal of Burn Care And Research (formerly Journal of Burn Care & Rehabilitation)381e377-e383Article describes the development of a pool of items addressing the social impact of burn injuries in adults to create a self-reported computerized adaptive test based on item response theory. The authors conducted a comprehensive literature review to identify preexisting items in other self-reported measures and used data from focus groups to create new items. The authors classified items using a guiding conceptual framework on social participation. The authors conducted cognitive interviews with burn survivors to assess clarity and interpretation of each item; an initial pool of 276 items was reduced to 192 items after cognitive evaluation by experts and burn survivors. The 192 items represent 7 domains and reflect the unique experience of burn survivors within these important areas of social participation: work, recreation and leisure, relating to strangers, romantic, sexual, family, and informal relationships. Additional item content that crossed domains included using self-comfort and others’ comfort with clothing, telling one’s story, and sense of purpose. The item pool that emerged from this work will lead to developing the Life Impact Burn Recovery Evaluation profile, a self-reported outcome measure.Marino, Molly, Soley-Bori, Marina, Jette, Alan M., Slavin, Mary D., Ryan, Colleen M., Schneider, Jeffrey C., Acton, Amy, Amaya, Flor, Rossi, Melinda, Soria-Saucedo, Rene, Resnik, Linda, Kazis, Lewis E.Boston-Harvard Burn Injury Model SystemYesdevopsadmin
2017Fatigue following burn injury: A Burn Model System National Database study.JournalJ76837Journal of Burn Care And Research (formerly Journal of Burn Care & Rehabilitation)393450-456https://pubmed.ncbi.nlm.nih.gov/28877130/Fatigue is a commonly reported but not well-documented symptom following burn injury. This study's objective was to determine the frequency and severity of fatigue over time and to identify predictors of fatigue in the adult burn population. Data from the Burn Model System National Database (April 1997 to January 2006) were analyzed. Individuals over 18 years of age who were alive at discharge were included. The vitality subscale of the Short-Form 36 Item Health Survey was examined at preinjury and discharge and at 6, 12, and 24 months postinjury. Mean and number of low vitality scores were calculated at each time interval. Descriptive statistics were generated for demographic and medical data. Cross-sectional regression models analyzed predictors of vitality at 6, 12, and 24 months postinjury. The study included 945 subjects. The population was 72.5% male and had a mean age of 40.6 years and mean burn size of 17.4%. Fatigue symptoms were present in a majority of the population (74.6%) and were most commonly reported at discharge. Although fewer burn survivors reported fatigue symptoms at each subsequent follow-up (P < .001), approximately one-half (49%) of the population continued to report fatigue symptoms at 24 months postinjury. Larger burn size was the only variable that was significant or approaching significance at all follow-up time points (P < .0167). Fatigue symptoms are common after burns and many burn survivors continue to report symptoms at 2 years postinjury. Burn survivors did not return to preinjury fatigue levels, highlighting the importance of understanding and monitoring fatigue. Simko, Laura C., Espinoza, Leda F., McMullen, Kara, Herndon, David N., Suman, Oscar, Fauerbach, James A., Kowalske, Karen, Wiechman, Shelley, Kazis, Lewis E., Ryan, Colleen M., Schneider, Jeffrey C.Boston-Harvard Burn Injury Model System, North Texas Burn Rehabilitation Model SystemYesdevopsadmin
2017Burn injuries and their impact on cognitive-communication skills in the inpatient rehabilitation settingJournalJ74664Journal of Burn Care And Research (formerly Journal of Burn Care & Rehabilitation)381e359-e369Study examined the prevalence and impact of cognitive-communication disorders among 144 adults with burn injuries admitted to an inpatient rehabilitation facility. Descriptive statistics were used to identify the prevalence of cognitive-communication deficits on admission and discharge. Two main outcomes were analyzed: (1) cognitive-communication ratings on discharge from inpatient rehabilitation as measured by the memory and problem-solving domains of the Functional Independence Measure (FIM) and (2) composite score of the Functional Communication Measure (FCM). Medical, demographic, and rehabilitation predictors of the main outcomes were assessed using regression analyses. Results indicated that on admission to inpatient rehabilitation, 79 percent of the 144 patients presented with cognitive-communication impairments, and of them, 27 percent presented with persistent deficits on discharge. Admission FIM memory score, marital status, and age were significant predictors of the discharge FIM memory score. Admission FIM problem-solving score, age, marital status, and prehospital living with another were significant predictors of the discharge FIM problem-solving score. Admission FCM score and age were significant predictors of the discharge FCM cognitive score. The findings suggest that people with burn injuries are at risk for cognitive-communication impairments, which may persist after inpatient rehabilitation. FIM data obtained on admission can be used as a screening tool to identify these at-risk patients.Hendricks, Carla T., Camara, Kristin, Boole, Kathryn V., Napoli, Maureen F., Goldstein, Richard, Ryan, Colleen M., Schneider, Jeffrey C.Boston-Harvard Burn Injury Model SystemYesdevopsadmin
2016Differential acute and chronic effects of burn trauma on murine skeletal muscle bioenergeticsJournalJ74398Burns421112-122Study determined the temporal relationship between burn trauma and mitochondrial function in murine skeletal muscle local to and distal from burn wounds. Male mice (8-10 weeks old) were burned by submersion of the dorsum in water to create a full thickness burn on approximately 30 percent of the body. Skeletal muscle was harvested spinotrapezius underneath burn wounds (local) and the quadriceps (distal) of sham and burn treated mice at 3 hours, 24 hours, 4 days, and 10 days post-injury. Mitochondrial respiration was determined in permeabilized myofiber bundles by high-resolution respirometry. Caspase 9 and caspase 3 protein concentration were determined by western blot. In muscle local to burn wounds, respiration coupled to ATP production was significantly diminished at 3 hours and 24 hours post-injury, as was mitochondrial coupling control. There was a 5- and 8-fold increase in respiration in response to cytochrome at 3 hours and 24 hours post burn, respectively, indicating damage to the outer mitochondrial membranes. Moreover, we also observed greater active caspase 9 and caspase 3 in muscle local to burn wounds, indicating the induction of apoptosis. Distal muscle mitochondrial function was unaltered by burn trauma until 10d post burn, where both respiratory capacity and coupling control were significantly lower than sham. These data highlight a differential response in muscle mitochondrial function to burn trauma, where the timing, degree and mode of dysfunction are dependent on whether the muscle is local or distal to the burn wound.Porter, Craig, Herndon, David N., Bhattarai, Nisha, Ogunbileje, John O., Szczesny, Bartosz, Szabo, Csaba, Toliver-Kinsky, Tracy, Sidossis, Labos S.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2014Hypoglycemia is associated with increased postburn morbidity and mortality in pediatric patientsJournalJ73529Critical Care Medicine4251221-1231Study examined the prevalence of hypoglycemia after burn injury and investigated whether hypoglycemia is associated with increased post-burn morbidity and mortality. The analysis included 760 pediatric burn patients, who were stratified according the number of hypoglycemic episodes (blood glucose less than 60 milligrams per deciliter) they experienced while in the intensive care unit. Clinical outcomes and metabolic and inflammatory biomarkers were analyzed during the first 60 days after admission. Patients with one or more hypoglycemic events were matched with patients not experiencing any event using propensity score matching, and outcomes and biomarker expression were compared between groups. Results showed that 84 patients had one episode of hypoglycemia, 108 patients had two or more episodes of hypoglycemia, and 568 patients never experienced hypoglycemia. Patients with one or more hypoglycemic episodes had longer hospitalization, as well as more frequent infections, sepsis, multiple organ failure, and death. The 166 propensity score-matched patients with one or more hypoglycemic events had greater inflammatory and metabolic responses, prevalence of sepsis, multiple organ failure, and mortality than burn patients without hypoglycemic. The findings suggest that hypoglycemic episodes correlate with injury severity and inhalation injury. When adjusted for injury severity, hypoglycemia is associated with significantly higher post-burn morbidity and mortality.Jeschke, Marc G., Pinto, Ruxandra, Herndon, David N., Finnerty, Celeste C., Kraft, RobertPediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2016Long-term administration of oxandrolone improves lung function in pediatric burned patientsJournalJ75762Journal of Burn Care And Research (formerly Journal of Burn Care & Rehabilitation)375273-277Study investigated whether the administration of oxandrolone, a synthetic testosterone derivative, will improve pulmonary function in burned pediatric subjects. Lung volumes and spirometry were assessed in 54 burned subjects during scheduled outpatient clinic visits 6 months post burn. The subjects were previously randomized to either the control arm or the oxandrolone arm (0.1 mg/kg twice/day for 12 months) of a larger clinical trial. Maximum voluntary ventilation (MVV), the ratio between forced expiratory volume and forced vital capacity, and diffusion capacity were measured 6 months following burn injury, and results were compared between burned subjects with and without oxandrolone administration. Maximum expired ventilation (VEmax) was also measured in a subset of burned subjects who underwent a maximal exercise treadmill test. Results showed that subjects treated with oxandrolone had a significantly higher MVV. During maximal exercise, subjects treated with oxandrolone had a significantly higher VEmax compared with untreated subjects. These findings indicate that the administration of oxandrolone was associated with improved lung function in pediatric burned patientsSousse, Linda E., Herndon, David N., Mlcak, Ronald P., Lee, Jong O., Andersen, Clark R., Zovath, Andrew J., Finnerty, Celeste C., Suman, Oscar E.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2017Accuracy of currently used paper burn diagram vs a three-dimensional computerized modelJournalJ75437Journal of Burn Care And Research (formerly Journal of Burn Care & Rehabilitation)381e254-e260Study compared burn size estimations obtained with three-dimensional (3D) computer-aided software to those obtained with standard-of-care methods. Burn units have historically used paper diagrams to estimate percent burn; however, unintentional errors can occur. The use of a computer program that incorporates wound mapping from photographs onto a 3D human diagram could decrease subjectivity in preparing burn diagrams and subsequent calculations of total body surface area (TBSA) burned. Nineteen burned patients with an estimated TBSA burned of at least 20 percent were analyzed. Digital photographs were collected before the patient’s first surgery. Using BurnCase 3D, a burn mapping software, the user traced partial- and full-thickness burns from photographs. The program then superimposed tracings onto a 3D model and calculated percent burned. The results were compared with the Lund and Browder diagrams completed after the first operation. A two-tailed t-test was used to calculate statistical differences. For partial-thickness burns, burn sizes calculated using Lund and Browder diagrams were significantly larger than those calculated using BurnCase 3D (15 percent difference). The opposite was found for full-thickness burns, with burn sizes being smaller when calculated using Lund and Browder diagrams (11 percent difference). Substantial differences were found in percent burn estimations derived from BurnCase 3D and paper diagrams. In the studied cohort, paper diagrams were associated with overestimation of partial-thickness burn size and underestimation of full-thickness burn size. Additional studies comparing BurnCase 3D with other commonly used methods are warranted.Benjamin, Nicole C., Lee, Jong O., Norbury, William B., Branski, Ludwik K., Wurzer, Paul, Jiminez, Carlos J., Benjamin, Debra A., Herndon, David N,Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2014Chronic pain following physical and emotional trauma: The station nightclub fireJournalJ71555Frontiers in Neurology586Study identified factors associated with chronic pain among survivors of The Station nightclub fire, including those with and without burn injury. The primary outcome measure was the presence and severity of pain. Univariate and stepwise multiple regression analyses were used to examine relationships among variables. Variables considered included age, gender, marital status, burn injury, total body surface area, skin graft, premorbid employment, time off work, return to same employment, depression assessed with the Beck depression inventory (BDI), and post-traumatic stress measured with the Impact of Event Scale-Revised. All persons in attendance at The Station nightclub in West Warwick, Rhode Island on February 20, 2003 were eligible for inclusion in the study. The recruitment process identified 144 eligible participants, who were asked to complete a survey consisting of 130 questions pertaining to demographic, medical, psychological, social, and occupational status. Of the 104 fire survivors who completed the survey, 27 percent reported pain at least 28 months after the event. Multiple factors associated with pain were assessed in the univariate analysis but only age, graft, and BDI score were significantly associated with pain in the multiple regression model. The results indicated that a significant number of fire survivors with and without burn injuries experienced chronic pain. Depth of burn and depression were significantly associated with pain outcome. These findings suggest that pain management should address both physical and emotional risk factors in this population.Egyhazi, Rachel, Fregni, Felipe, Bravo, Gabriela L., Trinh, Nhi-Ha T., Ryan, Colleen M., Schneider, Jeffrey C.Boston-Harvard Burn Injury Model SystemYesdevopsadmin
2016Heightened TWEAK-NF-kB signaling and inflammation-associated fibrosis in paralyzed muscles of men with chronic spinal cord injuryJournalJ78268American Journal of Physiology. Endocrinology and Metabolism3109E754-E761Study assessed the effects of gene expression or intracellular signaling in paralyzed muscles of men with long-standing spinal cord injury (SCI). Specifically, it examined the expression of genes (TNFαR, TNFα, IL-6R, IL-6, TWEAK, TWEAK R, atrogin-1, and MuRF1) and abundance of intracellular signaling proteins (TWEAK, TWEAK R, NF-κB, and p-p65/p-50/105) that are known to mediate inflammation and atrophy in skeletal muscle. For further insight into the distribution and variability of muscle fiber size, researchers also analyzed the frequency distribution of SCI fiber size. Resting vastus lateralis (VL) muscle biopsy samples were taken from 11 men with long-standing SCI and compared with VL samples from 11 able-bodied men of similar age. ккIn addition, based on the effects of muscle inflammation on promotion of skeletal muscle fibrosis, they assessed the degree of fibrosis between myofibers and fascicles in both groups. Results demonstrated that chronic SCI muscle has heightened TNFαR and TWEAK R gene expression and NF-κB signaling (higher TWEAK R and phospho-NF-κB p65) and fibrosis, along with substantial myofiber size heterogeneity, compared with able-bodied individuals. These data suggest that the TWEAK/TWEAK R/NF-κB signaling pathway may be an important mediator of chronic inflammation and fibrotic adaptation in SCI muscle.Yarar-Fisher, Ceren, Bickel, C. Scott, Kelly, Neil A., Stec, Michael J., Windham, Samuel T., McLain, Amie B., Oster, Robert A., Bamman, Marcas M.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2015Effects of pharmacological interventions on muscle protein synthesis and breakdown in recovery from burnsJournalJ73523Bruns414649-657Article reviews the data pertaining to the effects of pharmacological interventions on muscle protein synthesis, breakdown, and net balance (synthesis minus breakdown) in severely burned patients. A review of the literature related to skeletal muscle protein metabolism following burn injury was conducted. Emphasis was on studies utilizing stable isotope tracer kinetics to assess the impact of pharmacological interventions on muscle protein metabolism in severely burned patients. Data support the efficacy of testosterone, oxandrolone, human recombinant growth hormone, insulin, metformin, and propranolol in improving skeletal muscle protein net balance in patients with severe burns. The mechanisms underlying the improvement of protein net balance differ between types and dosages of drugs, but their main effect is on protein synthesis. Finally, the majority of studies have been conducted during the acute hypermetabolic phase of the injury. Except for oxandrolone, the effects of drugs on muscle protein kinetics following discharge from the hospital are largely unknown.Diaz, Eva C., Herndon, David N., Porter, Craig, Sidossis, Labros S., Suman, Oscar E., Borsheim, ElisabetPediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2016Infection in burnsJournalJ75735Surgical Infections172250-255This review article discusses the epidemiology of burn infections, defines degrees of severity of infection, outlines the major organisms associated with burn wounds, and describes the specific organs and tissues susceptible to infection. The authors also discuss strategies for surveillance, sampling, and infection control in the burn intensive care unit. Developments in critical care and surgical approaches to treating burn wounds, together with newer antimicrobial treatments, have significantly reduced the morbidity and mortality rates associated with this injury. However, several resistant organisms have emerged as the maleficent cause of invasive infection in burn patients, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, Pseudomonas, Acinetobacter, non-albicans Candida spp., and Aspergillus. Advances in antimicrobial therapies and the release of new classes of antibiotics have certainly added to the armamentarium of therapeutic resources for the clinician. Nevertheless, strict infection control measures, constant wound surveillance with regular sampling of tissues for quantitative culture, and early excision and wound closure remain the principal adjuncts to control of invasive infections in burn patients.Norbury, William, Herndon, David N., Tanksley, Jessica, Jeschke, Marc G., Finnerty, Celeste C.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2016Measuring depression in adults with burn injury: A systematic reviewJournalJ74775Journal of Burn Care And Research (formerly Journal of Burn Care & Rehabilitation)375e415-e426This systematic review of the literature was conducted to identify evidence to support the use of measures of depression for adults with burn injuries. The goal was to determine the most reliable, valid, and efficient means of identifying adults with symptoms of depression including major depressive disorder. Established guidelines for conducting systematic reviews were modified by excluding measures that focused on distress or anxiety or only used depression as a predictor of interest. Studies that did not report psychometric data in their results were also excluded. A total of 213 articles that broadly addressed the topic of depression in burn injuries were identified; of those, 56 that met the majority of the inclusion criteria and used depression as either the primary or the secondary outcome were reviewed. Nine studies that included report of some psychometric properties were reviewed. There have been no measures specifically developed to measure depression in those with burn injuries, and it is unclear if they are actually needed. Greater understanding of depression after burn injury can be gained by evaluating the existing general measures of depression and how they are used in the field of burn injury rehabilitation. The ultimate goal is to develop a set of recommendations for the standardization of how depressive symptomatology is assessed in this population.Wiechman, Shelley, Kalpakjian, Claire Z., Johnson, Kurt L.Northwest Regional Burn Model SystemYesdevopsadmin
2016Effects of whole-body vibration exercise on bone mineral content and density in thermally injured childrenJournalJ74399Burns423605-613Study assessed the effects of exercise combined with whole-body vibration (WBV) on bone mass, lean mass (LM), and muscle strength in children recovering from burns. Nineteen children with ≥30 percent total body surface area (TBSA) burns were randomly assigned to a 6-week exercise regimen either alone (EX) or in combination with a 6-week WBV training regimen (EX+WBV). WBV was performed concurrent to the exercise regimen for 5 days a week on a vibrating platform. Dual-energy X-ray absorptiometry quantified bone mineral content (BMC), bone mineral density (BMD), and LM; knee extension strength was assessed using isokinetic dynamometry before and after training. Both groups were similar in age, height, weight, TBSA burned, and length of hospitalization. Whole-body LM increased in the EX group and trended toward an increase in the EX+WBV group. On the other hand, there were decreases in leg BMC for both groups, and in leg BMD for only the EX group. Truncal BMC decreased in only the EX group, while BMD decreased in both groups. Leg strength increased over time in the EX group and the EX+WBV group. Results suggest that exercise in combination with WBV may help attenuate regional bone loss in children recovering from burns. Studies are needed to determine the optimal magnitude, frequency, and duration of the vibration protocol, with attention to minimizing any potential interference with wound healing and graft closure.Edionwe, Joel, Hess, Cameron, Fernandez-Rio, Javier, Herndon, David N., Andersen, Clark R., Klein, Gordon L., Suman, Oscar E., Amonette, William E.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2014Bacterial respiratory tract infections are promoted by systemic hyperglycemia after severe burn injury in pediatric patientsJournalJ73527Burns403428-4235Study investigated whether systemic glucose levels over 150 milligrams per deciliter (mg/dl) in severely burned pediatric patients lead to an overwhelming growth of bacteria in the bronchopulmonary system, subsequently resulting in an increased risk of pulmonary infections. One-hundred six severely burned pediatric patients were enrolled in the study. Patients were divided in two groups: (1) high group, defined by daily average glucose levels greater than 150 mg/dl for more than 75 percent of the length of stay (LOS); and (2) low group, with daily average glucose levels less than 150 mg/dl for more than 75 percent of the LOS. Incidences of pneumonia, atelectasis, and acute respiratory distress syndrome (ARDS) were assessed. Incidence of infections, sepsis, and respiratory parameters were recorded. Blood was analyzed for glucose and insulin levels. Statistical analysis was performed using Student’s t-test and chi-square test. The 2 patient groups were similar in demographics and injury characteristics. Pneumonia in patients on and off mechanical ventilation, as well as ARDS were significantly higher in the high group, while atelectasis was not different. Patients in the high group required significantly longer ventilation compared to low patients. Furthermore, incidence of infection and sepsis were significantly higher in the high group. The results indicate that systemic glucose levels over 150 mg/dl are associated with a higher incidence of pneumonia, confirming the previous studies in critically ill patients.Kraft, Robert, Herndon, David N., Mlcak, Ronald P., Finnerty, Celeste C., Cox, Robert A., Williams, Felicia N., Jeschke, Marc G.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2016Development of a conceptual framework to measure the social impact of burnsJournalJ74981Journal of Burn Care And Research (formerly Journal of Burn Care & Rehabilitation)376e569-e578Article describes the development and validation of a conceptual framework for understanding the social impact of burn injuries in adults, based on the International Classification of Functioning, Disability and Health (ICF). A comprehensive literature review and consultations with clinical experts and burn survivors were performed to identify social life areas impacted by burn injury. Focus groups with burn survivors and clinicians were conducted to inform and validate the framework. Transcripts were coded using grounded theory methodology. The ICF was chosen to ground the content model. The primary construct identified was social participation, which contains two concepts: societal role and personal relationships. The subdomains chosen for item development were work, recreation and leisure, relating with strangers, and romantic, sexual, family, and informal relationships. Qualitative results strongly suggest that the conceptual model fits the constructs for societal role and personal relationships with the respective subdomains. This conceptual framework has guided the implementation of a large-scale calibration study currently underway, which will lead to a computerized adaptive test for monitoring the social impacts of burn injuries during recovery.Marino, Molly, Soley-Bori, Marina, Jette, Alan M., Slavin, Mary D., Ryan, Colleen M., Schneider, Jeffrey C., Resnik, Linda, Acton, Amy, Amaya, Flor, Rossi, Melinda, Soria-Saucedo, Rene, Kazis, Lewis E.Boston-Harvard Burn Injury Model SystemYesdevopsadmin
2016Hypertrophic scarring: The greatest unmet challenge following burn injuryJournalJ78265Lancet388100521427-1436Improvements in acute burn care have enabled patients to survive massive burns that would have once been fatal. Now, up to 70 percent of patients develop hypertrophic scars after burns. Patients with these massive burns have extensive scarring and contractures, itch, and pain. They are dissatisfied with their appearance and experience restricted movement, itch, and loss of function for many years. The greatest unmet challenges in burn rehabilitation relate to decreased quality of life and delayed reintegration into society resulting from post-burn scar. In this, the third article in a series on burn injury in which metabolism and inhalation injury were examined, the authors discuss current strategies for burn wound and scar management, and identify areas where more research is needed to reduce post-burn scarring and improve burn survivors’ rehabilitation and reintegration into society.Finnerty, Celeste C., Jeschke, Marc G., Branski, Ludwik K., Barret, Juan P., Dziewulski, Peter, Herndon, David N.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2016Letter to the editor #2: Description of the burn model system national database sampleJournalJ75742Burns423704-705Article provides a brief overview of the purpose of and information included in the Burn Injury Model System (BMS) National Database. The BMS collects informative data on both adult and pediatric survivors following a major burn. It also collects information on return to work, school, and participation in the community following burn.Amtmann, Dagmar, Gibran, Nicole S., Hernson, David N., Kowalske, Karen J., Schneider, Jeffrey C.Northwest Regional Burn Model SystemYesdevopsadmin
2018Challenges to the standardization of burn data collection: A call for common data elements for burn careJournalJ78571Journal of Burn Care And Research (formerly Journal of Burn Care & Rehabilitation)392201-208Study examined the data dictionaries of six burn databases in the United States to ascertain the extent of common data collected. This was assessed from a quantitative and qualitative perspective. Thirty-two demographic and clinical data elements were examined. The number of databases that collect each data element was calculated. The data values for each data element were compared across the six databases for common terminology. Finally, the data prompts of the data elements were examined for common language and structure. Results indicated that five (16 percent) of the 32 data elements are collected by all six burn databases; additionally, five data elements are present in only one database. Furthermore, there are considerable variations in data values and prompts used among the burn databases. Only one of the 32 data elements (age) contains the same data values across all databases. The burn databases examined show minimal evidence of common data. Findings suggest that there is a need to develop common data elements and standardized coding to enhance interoperability of burn databases.Schneider, Jeffrey C., Chen, Liang, Simko, Laura, Warren, Katherine N., Nguyen, Brian P., Thorpe, Catherine R., Jeng, James C., Hickerson, William L., Kazis, Lewis E., Ryan, Colleen M.Boston-Harvard Burn Injury Model SystemYesdevopsadmin
2017Functional exercise capacity in children with electrical burnsJournalJ75955Journal of Burn Care And Research (formerly Journal of Burn Care & Rehabilitation)383e647-e652Study investigated the effect of electrical burns on metabolic rate, body composition, and aerobic capacity in children with electrical burns. Twenty-four severely burned children were studied: 12 children had a combination of electrical and flame burns and 12 matched controls had only flame burns. Exercise assessments were conducted after discharge from the intensive care unit. Primary outcomes were cardiopulmonary fitness measured as maximal oxygen consumption (VO2), muscle strength, and days of myoglobinemia (serum myoglobin at or above ≥500 mg/dl). Secondary outcomes included height, weight, body mass index, lean body mass index, and length or stay. Demographics of both the groups were comparable. The electrical burn group had more days of myoglobinemia during acute hospitalization than the flame burn group (3.6 days versus 0.3 days). Maximal VO2 was significantly lower in the electrical burn group than in the flame burn group at intensive care unit discharge. The results indicate that electrical burns are associated with myoglobinemia and decreased cardiopulmonary fitness.Foncerrada, Guillermo, Capek, Karel D., Wurzer, Paul, Herndon, David N., Mlcak, Ronald P., Porter, Craig, Suman, Oscar E.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2016Effects of community-based exercise in children with severe burns: A randomized trialJournalJ73524Burns42141-47Study evaluated the efficacy of a 12-week community-based exercise training rehabilitation program (COMBEX) in improving lean mass, muscle strength, and aerobic capacity in children with severe burns. Thirty-four pediatric patients (aged 7–18 years) with burns covering 30 percent or more of their total body surface area (TBSA) were randomized to participate in COMBEX (12 patients) or an outpatient exercise program (EX) performed at the hospital (22 patients). Both programs were started after hospital discharge and consisted of 12 weeks of progressive resistive and aerobic exercise. COMBEX was performed in community fitness centers near the patients’ home. Outcomes were assessed at discharge (pre-exercise) and after the 12-week program. Primary outcomes were lean body mass (dual energy X-ray absorptiometry), muscle strength (isokinetic dynamometry), and peak aerobic capacity (indirect calorimetry). Demographics, length of hospitalization, and TBSA burned were comparable between groups. Both groups exhibited a significant increase in lean muscle mass, muscle strength, and peak aerobic capacity. Furthermore, the magnitude of these increases were not different between groups. Results of this study suggest that both EX and COMBEX are efficacious in improving lean mass, strength, and cardiopulmonary capacity in severely burned children.Pena, Raquel, Ramirez, Leybi L., Crandall, Craig G., Wolf, Steven E., Herndon, David N., Suman, Oscar E.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2014Impact of stress-induced diabetes on outcomes in severely burned childrenJournalJ73531Journal of the American College of Surgeons2184783-796Study examined the impact of insulin control on outcomes in 243 pediatric patients with massive burns covering 30 percent or more of their total body surface area. Participants were randomized into 2 groups: (1) 145 patients receiving sliding scale insulin to lower blood glucose levels to Finnerty, Celeste C., Ali, Arham, McLean, Josef, Benjamin, Nicole, Clayton, Robert P., Andersen, Clark R., Mlcak, Ronald P., Suman, Oscar E., Meyer, Walter, Herndon, David N.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2015Measurement of change in the mechanical properties of burned skin to therapist intervention with a vacuum deviceJournalJ73518Burns414796-802Study evaluated the measurements of a portable materials testing device before and after burn therapist intervention for closed burns. A recording was taken using a hand-held vacuum device to measure deformation of the skin in the same location prior to and following a treatment session with a burn therapist in an outpatient clinic at a tertiary burn center. Twenty-eight subjects with healed burns were evaluated. Statistically significant differences were noted in modulus and elasticity change between sheet and meshed split thickness autografts. Positive change in modulus was correlated with increasing therapy time, specifically for meshed grafts. Positive change in modulus was noted in therapy time greater than 48 minutes. Results demonstrate that quantitative measurement of the outcomes of burn therapies on the mechanical properties of healed burns is possible in an outpatient clinic setting. Improvement in the stiffness of burn scars was observed in treatment sessions that last at least 48 minutes.Gabriel, Vincent, Kowalske, KarenNorth Texas Burn Rehabilitation Model SystemYesdevopsadmin
2015Assessing the ability of comorbidity indexes to capture comorbid disease in the inpatient rehabilitation burn injury populationJournalJ71471American Journal of Physical Medicine and Rehabilitation945373-384Study examined whether existing comorbidity measures capture comorbidities in the burn inpatient rehabilitation population. Data were obtained from the Uniform Data System for Medical Rehabilitation from 2002 to 2011 for adults with burn injury. International Classification of Diseases, 9th Revision (ICD-9) codes were used to assess three comorbidity measures: (1) Charlson Comorbidity Index, (2) Elixhauser Comorbidity Index, and (3) Centers for Medicare and Medicaid Services Comorbidity Tiers. The number of subjects and unique comorbidity codes (frequency greater than 1 percent) captured by each comorbidity measure was calculated. The study included 5,347 patients with a median total body surface area burn decile of 20 to 29 percent, mean age of 51.6 years, and mean number of comorbidities of 7.6. There were 2,809 unique ICD-9 comorbidity codes. The Charlson Comorbidity Index, Elixhauser Comorbidity Index, and Centers for Medicare and Medicaid Services Comorbidity Tiers did not capture 67 percent, 27 percent, and 58 percent of the subjects, respectively. There were 107 unique comorbidities that occurred with a frequency of greater than 1 percent. Of these, 67 percent were not captured in all three comorbidity measures. These findings indicate that commonly used comorbidity indexes do not reflect the extent of comorbid disease in the burn rehabilitation population. Future work is needed to assess the need for comorbidity indexes specific to the inpatient rehabilitation setting.Slocum, Chloe S., Goldstein, Richard , DiVita, Margaret A., Mix, Jacqueline, Niewczyk, Paulette, Gerrard, Paul, Sheridan, Robert, Kowalske, Karen J., Zafonte, Ross, Ryan, Colleen M., Schneider, Jeffrey C.Boston-Harvard Burn Injury Model SystemYesdevopsadmin
2015Comparison of long-term quality of life of pediatric burn survivors with and without inhalation injuryJournalJ73640Burns414721-726Study examined the long-term quality of life (QOL) of pediatric burn survivors with and without inhalation injuries. It was hypothesized that patients with inhalation injury would report more disability and lower QOL. Participants included 51 patients with inhalation injury and 72 without inhalation injury who had burns covering at least 10 percent of total body surface area (TBSA), were age 16 years or older at time of interview, and were greater than 5 years from injury. Subjects completed the World Health Organization Disability Assessment Scale II (WHODAS II), a measure of health and disability, and the Burn Specific Health Scale-Brief (BSHS-B), a measure of QOL. Multiple regression analyses were used to measure the effects of inhalation injury while controlling for age at burn and TBSA. The mean age of burn of participants with inhalation injury was 11.7 years, mean TBSA 55 percent, and mean ventilator days 8.4. The mean age of burn of participants without inhalation injury was 10.3 years, mean TBSA 45 percent, and mean ventilator days 1.3. Inhalation injury did not appear to significantly impact participants’ scores on the majority of the domains. The WHODAS II domain of household activities showed a significant relation with TBSA; increased size of burn was associated with difficulty completing tasks for both groups. The BSHS-B domain of treatment regimen showed a relation with age at burn; increased age was associated difficulty in this area for both groups. Overall, the groups were comparable in their reports of disability and QOL. Inhalation injury did not affect long-term QOL.Rosenberg, Marta, Ramirez, Maribel, Epperson, Kathy, Richardson, Lisa, Holzer III, Charles, Andersen, Clark R., Herndon, David N., Meyer III, Walter, Suman, Oscar E., Mlcak, RonaldPediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2016Hypermetabolism and hypercatabolism of skeletal muscle accompany mitochondrial stress following severe burn traumaJournalJ78266American Journal of Physiology. Endocrinology and Metabolism3112E436-E438Study explored how hypermetabolism contributes to muscle wasting in burn patients. It was hypothesized that oxidative stress, cytosolic protein degradation, and mitochondrial stress as a result of hypermetabolism contribute to postburn muscle cachexia. Fourteen patients with burns covering more than 30 percent of their total body surface area were studied. Thirteen young healthy adults served as controls. Researchers found that burn patients were profoundly hypermetabolic at both the skeletal muscle and systemic levels, indicating increased oxygen consumption by mitochondria. In skeletal muscle of burn patients, concurrent activation of mTORC1 signaling and elevation in the fractional synthetic rate paralleled increased levels of proteasomes and elevated fractional breakdown rate. Burn patients had greater levels of oxidative stress markers as well as higher expression of mitochondrial unfolded protein response (mtUPR)-related genes and proteins, suggesting that burns increased mitochondrial stress and protein damage. Indeed, upregulation of cytoprotective genes suggests hypermetabolism-induced oxidative stress postburn. In parallel to mtUPR activation postburn, mitochondrial-specific proteases and mitochondrial translocases were upregulated, suggesting increased mitochondrial protein degradation and transport of preprotein, respectively. The findings demonstrate that proteolysis occurs in both the cytosolic and mitochondrial compartments of skeletal muscle in severely burned patients. Increased mitochondrial protein turnover may be associated with increased protein damage due to hypermetabolism-induced oxidative stress and activation of mtUPR. The results suggest a novel role for the mitochondria in burn-induced muscle wastingOgunbileje, John O., Porter, Craig, Herndon, David N., Chao, Tony, Abdelrahman, Doaa R., Papadimitriou, Anastasia, Chondronikola, Maria, Zimmers, Teresa A., Reidy, Paul T., Rasmussen, Blake B., Sidossis, Labros S.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2016Is real-time feedback of burn-specific patient-reported outcome measures in clinical settings practical and useful? A pilot study implementing the young adult burn outcome questionnaireJournalJ73367Journal of Burn Care And Research (formerly Journal of Burn Care & Rehabilitation)37164-74Study examined the feasibility of a computerized, burn-specific patient-reported outcome measures, the Young Adult Burn Outcome Questionnaire (YABOQ), with real-time benchmarking feedback in a burn outpatient practice. The YABOQ was redesigned for formatting and presentation purposes, transcribed to a computerized format, and administered to young adult burn survivors via an iPad platform in the office before outpatient visits. A report including recovery curves benchmarked to a non-burned healthy age-matched population and to patients with similar injuries was produced for the domains of physical function and social function limited by appearance. Patients and clinicians completed satisfaction surveys at the conclusion of the visit. Free-text responses, included in the satisfaction surveys, were treated as qualitative data adding contextual information about the assessment of feasibility. Eleven patients and their providers completed the study for 12 clinical visits. All patients found the iPad survey and report easy to use and most reported that it helped them communicate their situation to their doctor/nurse practitioner and understand their course of recovery. Qualitative comments included: “it helped organize my thoughts of recovery,” “it opened lines of communication with the doctor,” and “it showed me how far I have come, and how far I need to go.” Only four of 12 provider surveys agreed that it helped them understand a patient’s condition; however, in two visits, the providers stated that it helped identify a pertinent clinical issue. Findings support the feasibility of using a burn-specific patient reported outcome measure with real-time feedback in an outpatient burn clinic.Ryan, Colleen M., Lee, Austin F., Kaxis, Lewis E., Shapiro, Gabriel D., Schneider, Jeffrey C., Goverman, Jeremy, Fagan, Shawn P., Wang, Chao, Kim, Julia, Sheridan, Robert L., Tompkins, Ronald G.Boston-Harvard Burn Injury Model SystemYesdevopsadmin
2014Occurrence of multiorgan dysfunction in pediatric burn patients: Incidence and clinical outcomeJournalJ73528Annals of Surgery2592381-387Study examined the incidence of single- or multiple-organ failure and its resultant clinical outcomes during acute hospitalization in pediatric burn patients. Patient outcomes are inherently dependent on intact organ function; however, burn injury affects the structure and function of almost every organ, but especially lung, liver, kidney, and heart. Therefore, single-organ failure and/or multiple-organ failure (MOF) are thought to contribute significantly to post-burn morbidity and mortality. The incidence of MOF was monitored in 821 pediatric burn patients during acute hospitalization. Patients were divided into groups based on of the incidence of single-organ-specific failure, MOF, and non-MOF. The DEN-VER2 score was used to assess organ-specific scores for lung, liver, kidney, and heart. The patient’s demographics, injury characteristics, and outcome parameters were recorded. Results indicate that respiratory failure has the highest incidence in the early phase of post-burn injury and decreases starting 5 days after burn injury. Cardiac failure was noted to have the highest incidence throughout hospital stay. Incidence of hepatic failure increases with the hospital length of stay and is associated with a high mortality during the late phase of the acute hospital stay. Renal failure has an unexpectedly low incidence but is associated with a high mortality during the first 3 weeks after burn injury. Three or more organ failure is associated with very high mortality. The findings of this study confirm the expected chronologic incidence of organ-specific failure and yield the long-term mortality from liver and renal failure.Kraft, Robert, Herndon, David N., Finnerty, Celeste C., Shahrokhi, Shahriar, Jeschke, Marc G.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2016Five-year outcomes after long-term oxandrolone administration in severely burned children: A randomized clinical trialJournalJ75763Shock454367-374Study investigated whether administration of oxandrolone for 2 years yields greater effects on bone mineral content (BMC), bone mineral density (BMD), and growth in 119 hospitalized children with severe burn injury (30 percent or more total body surface area burned). Eighty four patients were randomized to the control group, and 35 patients were randomized to receive oxandrolone twice daily for 24 months (long-term oxandrolone group). Height, weight, BMC, and BMD were recorded annually through 5 years postinjury. The long-term administration of oxandrolone for 16 months postburn significantly increased whole-body (WB) BMC and lumbar spine (LS) BMC; these effects were significantly pronounced for a longer time in patients who were in growth spurt years (7-18 years). When adjusted for height, sex, and age, LS-BMD was found to significantly increase with long-term oxandrolone administration. Fewer patients receiving oxandrolone exhibited LS-BMD z scores below -2.0 as compared with controls, indicating a significantly reduced risk for future fracture with oxandrolone administration. Long-term oxandrolone patients had significantly greater height velocity than controls throughout the first 2 years. No adverse side effects were attributed to the long-term administration of oxandrolone. A comparison of the current patients receiving long-term oxandrolone to previously described patients receiving 12 months of oxandrolone revealed that long-term oxandrolone administration imparted significantly greater increases in WB-BMC, WB-BMD, and LS-BMD. Results indicate that administering oxandrolone for up to 2 years following severe burn injury results in greater improvements in BMC, BMD, and height velocity.Reeves, Patrick T., Herndon, David N., Tanksley, Jessica D., Jennings, Kristofer, Klein, Gordon L., Mlcak, Ronald P., Clayton, Robert P., Crites, Nancy N., Hays, Joshua P., Andersen, Clark, Lee, Jong O., Meyer, Walter , Suman, Oscar E., Finnerty, Celeste C.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2016Cardiovascular dysfunction following burn injury: What we have learned from rat and mouse modelsJournalJ75736International Journal of Molecular Sciences171This literature review summarizes the data supporting the prevalent role that β-adrenergic receptors play in mediating post-burn cardiac dysfunction and the idea that pharmacological modulation of this receptor family is a viable therapeutic target for resolving burn-induced cardiac deficits. Severe burn profoundly affects organs both proximal and distal to the actual burn site. Cardiovascular dysfunction is a well-documented phenomenon that increases morbidity and mortality following a massive thermal trauma. Beginning immediately post-burn, during the ebb phase, cardiac function is severely depressed. By 48 hours post-injury, cardiac function rebounds and the post-burn myocardium becomes tachycardic and hyperinflammatory. While current clinical trials are investigating a variety of drugs targeted at reducing aspects of the post-burn hypermetabolic response such as heart rate and cardiac work, there is still a paucity of knowledge regarding the underlying mechanisms that induce cardiac dysfunction in the severely burned. There are many animal models of burn injury, from rodents, to sheep or swine, but the majority of burn related cardiovascular investigations have occurred in rat and mouse models.Guillory, Ashley N., Clayton, Robert P., Herndon, David N., Finnerty, Celeste C.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2014Early rehabilitative exercise training in the recovery from pediatric burnJournalJ69028Medicine and Science in Sports and ExerciseStudy examined the effects of early outpatient exercise on muscle mass, function, and fractional synthetic rate in severely burned children. Forty-seven children with burns covering at least 40 percent of their total body surface area performed 12-weeks standard of care rehabilitation (SOC) or rehabilitative exercise training (RET) immediately following hospital discharge. Dual-energy X-ray absorptiometry was used to assess lean body mass (LBM) at discharge, post-treatment, and 12 months post-burn. Muscle function was evaluated with a Biodex Isokinetic Dynamometer and peak aerobic fitness (VO2peak) was measured using a modified Bruce treadmill protocol post-treatment. Stable isotope infusion studies were performed in a subset of patients (13 SOC and 11 RET) at discharge and post-treatment to determine mixed-muscle fractional synthetic rate. Relative peak torque and VO2peak was greater post-treatment with RET compared to SOC. In addition, RET increased whole-body and leg LBM compared to SOC. Furthermore, the percentage change in whole-body and leg LBM from discharge to 12 months post-burn was greater with RET compared to SOC. Muscle fractional synthetic rate decreased from discharge to post-treatment in both groups; however no differences were observed between treatment groups at each time-point. The results of this study suggest that early outpatient exercise training implemented at hospital discharge represents an effective intervention to improve muscle mass and function following severe burn injury.Hardee, Justin P., Porter, Craig, Sidossis, Labros S., Borsheim, Elisabet, Carson, James A., Herndon, David N., Suman, Oscar E.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2017Impact of cognition on burn inpatient rehabilitation outcomesJournalJ75236PM & R917-JanStudy assessed how cognitive function affects rehabilitation outcomes in the burn injury population. A retrospective analysis was conducted of 5,347 adults admitted to inpatient rehabilitation facilities in the United States with burn injuries between 2002 and 2011. Rehabilitation outcomes examined included: Functional Independence Measure (FIM) total gain, readmission to an acute care setting at any time during inpatient rehabilitation, acute readmissions in the first 3 days of IRF admission, rate of discharge to the community setting, and length of stay (LOS) efficiency. Multivariable regression was used to model rehabilitation outcome measures, using the cognitive domain of the FIM instrument as the independent variable and controlling for demographic, medical, and facility covariates. Cognitive FIM total scores at admission was a significant predictor of FIM total gain, LOS efficiency, and acute readmission at 3 days. Cognitive FIM total scores did not have an impact on acute care readmission rate or discharge to the community setting. Findings suggest that cognitive status may be an important predictor of rehabilitation outcomes in the burn injury population. Future work is needed to further examine the impact of specific cognitive interventions on rehabilitation outcomes in this population.Bajorek, Alexander J., Slocum, Chloe, Goldstein, Richard, Mix, Jacqueline, Niewczyk, Paulette, Ryan, Colleen M., Hendricks, Carla T., Zafonte, Ross, Schneider, Jeffrey C.Boston-Harvard Burn Injury Model SystemYesdevopsadmin
2016Long-term skeletal muscle mitochondrial dysfunction is associated with hypermetabolism in severely burned childrenJournalJ73366Journal of Burn Care And Research (formerly Journal of Burn Care & Rehabilitation)37153-63Study examined skeletal muscle mitochondrial respiratory capacity and function in healthy individuals and in burn victims for up to 2 years postinjury. Muscle biopsies were collected from 16 healthy men and from 69 children with burns encompassing at least 30 percent of their total body surface area. Seventy-nine biopsies were collected from cohorts of burn victims at 2 weeks, 6 months, 12 months, and 24 months postburn. Hypermetabolism was determined by the difference in predicted and measured metabolic rate. Mitochondrial respiration was determined in saponin-permeabilized myofiber bundles. Outcomes were modeled by analysis of variance, with differences in groups assessed by Tukey-adjusted contrasts. Results showed that burn patients were hypermetabolic for up to 2 years postinjury. Coupled mitochondrial respiration was lower at 2 weeks, 6 months, and 12 months postburn compared with healthy controls. Coupled respiration was greater at 6, 12, and 24 months postburn versus 2 weeks postburn. Mitochondrial adenosine diphosphate and oligomycin sensitivity (measures of coupling control) were lower at all time-points postburn vs control, but greater at 6, 12, and 24 months postburn versus 2 weeks postburn. The findings suggest that muscle mitochondrial respiratory capacity remains significantly lower in burn victims for 1-year postinjury. Mitochondrial coupling control is diminished for up to 2 years postinjury in burn victims, resulting in greater mitochondrial thermogenesis. These quantitative and qualitative derangements in skeletal muscle bioenergetics likely contribute to the long-term pathophysiological stress response to burn trauma.Porter, Craig, Herndon, David N., Borsheim, Elisabet, Bhattarai, Nisha, Chao, Tony, Reidy, Paul T., Rasmussen, Blake B., Andersen, Clark R., Suman, Oscar E., Sidossis, Labros S>Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2017An intervention bundle to facilitate return to work for burn-injured workers: Report from a burn model system investigationJournalJ75430Journal of Burn Care And Research (formerly Journal of Burn Care & Rehabilitation)381e70-e78Study evaluated the work-related outcomes of interventions aimed at returning injured workers to employment within 90 days of their insurance claims. The interventions include patient/family education focused on recovery rather than disability, employer contact and education by the vocational rehabilitation (VR) counselor, physician recommendations for work accommodations, provision of employee status letters, and Activity Prescription Forms (APFs). The medical records of 338 adults with occupation-related burn injuries and receiving care at a single regional burn center from June 2010 to July 2015 were reviewed. Data on patient and injury characteristics and outpatient VR services provided were collected. The primary outcome of interest was the rate of patients who return to work (RTW). The VR counselor evaluated all patients. All patients received an employer letter(s) and APF documentation. Workplace accommodations were provided to more than 30 percent of patients. The RTW rate was 93 percent, with an average of 24 days from injury to RTW. In an intervention bundle involving the patient, employer, Workers’ compensation, and the burn clinic staff, injured workers achieved a high rate of RTW. Although the authors could not correlate individual bundle components to outcome, they postulate that the combination of employer/employee/insurer engagement and flexibility contributed to the success of this program.Carrougher, Gretchen J., Brych, Sabina B., Pham, Tam N., Mandell, Samuel P., Gibran, Nicole S.Northwest Regional Burn Model SystemYesdevopsadmin
2014Cognition in patients with burn injury in the inpatient rehabilitation populationJournalJ69150Archives of Physical Medicine and Rehabilitation9571342-1349Study investigated whether patients with burn injury have differences in their cognition compared with other inpatient rehabilitation populations. Data were obtained from the Uniform Data System for Medical Rehabilitation from 2002 through 2011. A total of 5,347 rehabilitation patients with burn injury were compared with 668,816 patients from the following impairment groups: spinal cord injury, amputation, polytrauma and multiple fractures, and hip replacement. Differences between the groups were calculated for the total cognitive Functional Independence Measure (FIM) score and each cognitive subscale item (memory, verbal comprehension, verbal expression, social interaction, and problem solving). Patients with burn injury were compared with the other groups using a bivariate linear regression model. A multivariable linear regression model was used to determine whether differences in cognition existed after adjusting for covariates (e.g., sociodemographic factors, facility factors, medical complications). Adults with burn injuries had an average total cognitive FIM score of 26.8 compared with an average FIM score of 28.7 for the other groups combined. The subscale with the greatest difference between those with burn injury and the other groups was memory (5.1 compared with 5.6). These differences persisted after adjustment for covariates. The results indicate that adults with burn injury have worse cognitive FIM scores than other rehabilitation populations. Future research is needed to determine the impact of this comorbidity on patient outcomes and potential interventions for these deficits.Purohit, Maulik, Goldstein, Richard, Nadler, Deborah, Mathews, Katie, Slocum, Chloe, Gerrard, Paul, DiVita, Margaret A., Ryan, Colleen M., Zafonte, Ross, Kowalske, Karen, Schneider, Jeffrey C.Boston-Harvard Burn Injury Model SystemYesdevopsadmin
2017Human herpes viruses in burn patients: A systematic reviewJournalJ78267Burns43125-33This systematic review examined clinical differences among subtypes of human herpes viruses, including herpes simplex virus (HSV), cytomegalovirus (CMV), and varicella zoster virus (VZV); described established therapy approaches, and assessed evidence of herpes virus-related morbidity and mortality in burn patients. PubMed, Ovid, and Web of Science were searched to identify studies of HSV, CMV, or VZV infections in burn patients. Exclusion criteria included a level of evidence (LoE) of IV or V, nonhuman in vivo studies, and non-English articles. There was no limitation by publication date. Fifty articles were subjected to full-text analysis. Of these, 18 had LoE between I-III and were included in the final review (2 LoE I, 16 LoE II-III). Eight had a prospective study design, 9 had a retrospective study design, and 1 included both. No direct evidence linked CMV and HSV infection with increased morbidity and mortality in burns. Following burn, CMV reactivation was more common than a primary CMV infection. Active HSV infection impaired wound healing but was not directly correlated to mortality. Infections with VZV are rare after burns but when they occur, VZV infections were associated with severe complications including mortality. The therapeutic effect of antiviral agents administered after burns warrants investigation via prospective randomized controlled trials.Wurzer, Paul, Guillory, Ashley, Parvizi, Daryousch, Clayton, Robert P., Branski, Ludwik K., Kamolz, Lars-P., Finnerty, Celeste C., Herndon, David N., Lee, Jong O.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2015Inpatient rehabilitation experience of children with burn injuries: A 10-yr review of the uniform data system for medical rehabilitationJournalJ71955American Journal of Physical Medicine and Rehabilitation946436-443Study examined the characteristics and short-term functional outcomes of the pediatric burn inpatient rehabilitation population using data from the Uniform Data System for Medical Rehabilitation database between 2002 and 2011. Demographic, medical, and functional data were evaluated for children younger than 18 years at time of admission to inpatient rehabilitation with primary diagnosis of burn injury. Function was assessed with the Functional Independence Measure (FIM) or the WeeFIM. Of the 509 children included, 124 were evaluated with FIM and 385 with the WeeFIM. The mean age of the population was 8.6 years and 72 percent were boys. The mean length of stay was 35 days. Functional status improved significantly from admission to discharge; most gains were in the motor subscore. Most patients were discharged home (95 percent). Of those discharged home, most (96 percent) went home with family. The findings suggest that children receiving multidisciplinary inpatient rehabilitation make significant functional improvements in total functional scores and in both motor and cognitive subscores.Luce, John C., Mix, Jacqueline , Mathews, Katie, Goldstein, Richard, Niewczyk, Paulette, DiVita, Margaret A., Gerrard, Paul, Sheridan, Robert L., Ryan, Colleen M., Kowalske, Karen, Zafonte, Ross, Schneider, Jeffrey C.Boston-Harvard Burn Injury Model SystemYesdevopsadmin
2016Morbidity and mortality in severely burned children with clostridium difficile-associated diarrheaJournalJ75733Surgery15961631-1637Study investigated the effect of Clostridium difficile-associated diarrhea (CDAD) on morbidity and mortality in severely burned children and identified CDAD risk factors. After retrospective review of 2,840 records, 288 pediatric burn patients were identified as having diarrhea, defined as stool output of more than 10 milliliters per kilogram per day for 2 or more successive days) and had stool samples immunoassayed for toxins A and B. A case-control analysis was performed by matching cases to controls via logistic regression and propensity scores so that age, admission time, and time of occurrence could be controlled; the outcomes of interest were mortality and hospitalization time. Eighteen patients tested positive for C difficile toxins (median age, 4 years; mean total body surface area burned, 59 percent). In the CDAD group, unadjusted in-hospital mortality was 28 percent. Hospitalization averaged 48 days in the CDAD group and 38 days in the non-CDAD group. Duration of stay per percent of total body surface area burned was greater in the CDAD group (0.82 versus 0.60), as were prolonged bouts of diarrhea complicated by acidosis (13 versus 4 days). Of the 18 possible risk factors evaluated, inhalation injury diagnosed at admission occurred more often in CDAD patients than matched controls (59 versus 31 percent). The findings indicate that CDAD during hospitalization is associated with greater mortality after burns. Inhalation injury increases the likelihood of C difficile infection. Whether C difficile infection is an indication of greater illness among certain burned patients is unknown.Finnerty, Celeste C., Herndon, David N., Lee, Jong O., Rodriguez, Noe A., Al-Haj, Iman H., Wurzer, Paul, Calhoun, Brendan R., Jeschke, Marc G.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2016Feasibility of an exoskeleton-based interactive video game system for upper extremity burn contracturesJournalJ73944PM & R85445-452Study assessed the feasibility of using an exoskeleton-based interactive gaming system to measure continuous joint motion data.in the rehabilitation of upper-extremity burn contractures. Eight subjects with a history of burn injury and upper-extremity contractures were recruited from the outpatient clinic of a regional inpatient rehabilitation facility. Subjects used an exoskeleton-based interactive gaming system to play 4 different video games. Continuous joint motion data were collected at the shoulder and elbow during game play. Outcome measures a visual analog scale for engagement, difficulty, and comfort; and angular range of motion by subject, joint, and game. The study population had a mean age of 43 years and total body surface area burned range of 10 to 90 percent. Subjects reported satisfactory levels of enjoyment, comfort, and difficulty. Continuous joint motion data demonstrated variable characteristics by subject, plane of motion, and game. Results demonstrate the feasibility of using an exoskeleton-based interactive gaming system in the burn population. Future studies are needed that examine the efficacy of tailoring interactive video games to the specific joint impairments of burn survivors.Schneider, Jeffrey C., Ozsecen, Muzaffer Y., Muraoka, Nicholas K., Mancinelli, Chiara, Croce, Ugo D., Ryan, Colleen M., Bonato, PaoloBoston-Harvard Burn Injury Model SystemYesdevopsadmin
2014Burn rehabilitation outcomes: Lessons learned from the uniform data system for medical rehabilitationJournalJ69215Journal of Burn Care And Research (formerly Journal of Burn Care & Rehabilitation)353212-213Article briefly reviews some studies that have used the Uniform Data System for Medical Rehabilitation (UDSMR) to develop a better understanding of burn rehabilitation outcomes. The UDSMR maintains the largest inpatient rehabilitation database in the world, which includes information on approximately 80 percent of all inpatient rehabilitation facilities nationally. Despite some limitations, there is much value to the UDSMR data set for burn rehabilitation research.Schneider, Jeffrey C., Mathews, Katie, Ryan, Colleen M.Boston-Harvard Burn Injury Model SystemYesdevopsadmin
2015Does acute stress disorder predict subsequent posttraumatic stress disorder in pediatric burn survivors?JournalJ73534Journal of Clinical Psychiatry76111564-1568Study examined the prevalence of posttraumatic stress disorder (PTSD) in pediatric burn survivors who had been treated for acute stress disorder symptoms during their initial hospitalization and compared them to patients who had been asymptomatic for acute stress disorder. Participants were primarily matched on total body surface area burned and gender, and as close as possible on age at time of burn and number of years postburn. Pediatric burn survivors completed a semi-structured clinical interview, the Missouri Assessment of Genetics Interview for Children-PTSD section, which is based on criteria from the DSM-IV for evaluating lifetime PTSD. Of the 183 participants in the study, 85 matched pairs with and without acute stress disorder were identified. The prevalence of PTSD at the time of follow-up was 8.24 percent (7 of 85) for the acute stress disorder group and 4.71 percent (4 of 85) for the comparison group. No significant differences were found between the groups. A logistic regression analysis was conducted to determine if prior acute stress disorder diagnosis, burn size, gender, ethnicity, age at time of study participation, and number of years postburn predicted subsequent PTSD. None of the variables were significant predictors.Rosenberg, Laura, Rosenberg, Marta, Robert, Rhonda, Richardson, Lisa, Sharp, Sherri, Holzer, Charles E., Thomas, Christopher, Meyer III, Walter J.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2015Immediate and long-term psychological problems for survivors of severe pediatric electrical injuryJournalJ75732Burns4181823-1830Study compared the emotional and cognitive difficulties experienced during the initial acute hospitalization and the last follow-up visit between children with electrical injuries (EI) and children without electrical injuries (non-EI). It was hypothesized that children with electrical burns would have different psychological outcomes. Medical records of 67 patients with EI and a matched group of 67 survivors of other burns (controls) were reviewed. For the EI group, the mean age at injury was 12.6 years, the mean age at follow up was 15.5 years, and mean total body surface area (TBSA) burned was 32 percent. For the non-EI group, the mean age at injury was 12.4 years, the mean age at follow up was 14.5 years, and mean TBSA was 32 percent. During the acute hospitalization, a significant difference was found between the groups in the area of neuropathic pain. Individuals with EI were more likely to have acute stress disorder/post-traumatic stress disorder as well as amnesia of the accident than the controls; however, this did not reach statistical significance. No differences were found between the groups in other psychological areas. Follow-up information from the last documented psychology/psychiatric visit revealed an equal number of patients experienced anxiety disorders, depression, grief, behavioral problems, and cognitive difficulties. The results indicated that while some differences were evident between the groups immediately after injury, long-term outcomes were similar.Rosenberg, Marta, Mehta, Neha, Rosenberg, Laura, Ramirez, Maribel, Meyer III, Walter J., Herndon, David N,, Andersen, Clark R., Thomas, ChristopherPediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2017A preliminary study on qEEG in burn patients with chronic pruritusJournalJ77657Annals of Rehabilitation Medicine414693-700Study compared the electroencephalography (EEG) activity in burn patients experiencing chronic itching (pruritus) and their paired healthy subjects to investigate the cortical reorganizational changes associated with pruritus. This study employed the use of quantitative EEG (qEEG) to analyze the changes in brainwave power in eight subjects: 4 patients with pruritus after burn injury and 4 gender- and age-matched healthy subjects. During the EEG recordings, subjects were asked to close their eyes, but remain awake, while sitting still in a chair, staying relaxed in a quiet room for 5 minutes. An EEG recording was then run under the same conditions, but with eyes open for 5 minutes. EEG recordings were analyzed for absolute alpha, low beta, high beta, and theta power for both groups. A decreased alpha activity was observed in the occipital channels (0.82 versus 1.4) and a decreased low beta activity in the frontal area (0.22 versus 0.4) in eyes closed conditions. An overall decreased theta trend was observed in both the eyes open and eyes closed conditions in burn patients, compared to healthy individuals. The results provide preliminary evidence that chronic pruritus in burn subjects is associated with brain reorganizational changes at the cortical level, characterized by an EEG pattern.Miraval, Fiorella K., Shie, Vivan L., Morales-Quezada, Leon, Santiago, Carolina, Fernandes-Marcondes, Bianca, Nadler, Deborah, Ryan, Colleen M., Schneider, Jeffrey C., Fregni, FelipeBoston-Harvard Burn Injury Model SystemYesdevopsadmin
2016Long-term outcomes in patients surviving large burns: The musculoskeletal systemJournalJ74105Journal of Burn Care And Research (formerly Journal of Burn Care & Rehabilitation)374243-254Study documents the long-term musculoskeletal complications following major burn injury. This is a cross-sectional descriptive study that includes a one-time evaluation of 98 burn survivors (mean age = 47 years; mean total body surface area burned = 57 percent; and mean time from injury = 17 years.) A comprehensive history and physical examination was conducted by a senior and experienced Physical Medicine and Rehabilitation physician. In addition to completing a Medical Problem Checklist, subjects also completed the Burn-Specific Health Scale (Abbreviated 80 item), a self-report measure used to review the level of functional adaptation. Joint pain, joint stiffness, problems walking or running, fatigue, and weak arms and hands are conditions that continue to be reported at an average of 17 years from the time of burn injury. Seventy-three percent of the subjects were found to have a limitation of motion and areas most affected were the neck (47 percent), hands (45 percent), and axilla (38 percent). The global (Burn-Specific Health Scale-total) score for the overall sample was 0.78. Subjects with limitation of motion had significant difficulty in areas of mobility, self-care, hand function, and role activities. This study underscores the importance of long-term follow-up care and therapeutic interventions for survivors of major burn injury, as they continue to have significant and persistent burn-related impairments even several years following injury.Holavanahalli, Radha K., Helm, Phala A., Kowalske, Karen J.North Texas Burn Rehabilitation Model SystemYesahammond
2009Treatments for common psychiatric conditions among adults during acute, rehabilitation, and reintegration phasesJA International Review of Psychiatry216559-569Difede J., Cukor,J., Lee F., Yurt R.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2010The roleof hyperglycemia in burned patients: evidence based studies”JA Shock33113-MayMecott G.A., Al-Mousawi A.M., Gauglitz G.G., Herndon D.N., Jeschke M.G.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2010The 5-D itch scale: A new measure of pruritusJA BRITISH JOURNAL OF DERMATOLOGY1623587-93Elman S., Hynan L., Gabriel V., Mayo M.North Texas Burn Rehabilitation Model SystemYesdevopsadmin
2010Severity of post-burn hand contracture affects self-careJA Am J Phys Med Rehabil89 S36Zhang L., Holavanahalli R., Dolezal C., Kowalske K.North Texas Burn Rehabilitation Model SystemYesdevopsadmin
2010Uniaxial biomechanical properties of unburned human skinJA J Burn Care Res31 S64Gabriel V., Haughawout S.North Texas Burn Rehabilitation Model SystemYesdevopsadmin
2009Quality of life and psychosocial adjustment to burn injuryJA International Review of Psychiatry216539-548Corry N., Pruzinsky T., Rumsey N.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2010Pre-Injury, acute and serial RNA expression patterns from untreated human burn woundsJA J Burn Care R31 S65Gabriel V., McClellan E., Scheuermann R.Yesdevopsadmin
2010In-Hospital and Discharge Pain and Itch as Predictors of Long-Term Sleep Disturbances in Pediatric Burn InjuriesJA JOURNAL OF BURN CARE & RESEARCH31 S59Arceneaux L.L., Epperson K.M., Duvall C.E., Herndon D.N.,, Mason S.T., Holavanahalli R., Wiechman-Askay S., Meyer, W.J. .Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2010Quality of Care and Recovery From Burn Injuries inChildren 5-18 Years of age:The Multi-Center Benchmarking StudyJA JOURNAL OF BURN CARE & RESEARCH31 S90Kazis L.E., Sheridan R. L., Lee A. F. , Liang M.H., Hinson M., Lydon M., Stubbs K., Palmieri T. L., Meyer W. J., Tompkins R. G.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2010Posttraumatic stress disorder and pain impact function and disability following major burn injuryJAJ57970Journal of Burn Care & Research31113-25Background/Objective: To examine the differences in intrathecal baclofen management of individuals with spasticity of cortical vs spinal etiologies. Design: Retrospective chart review of 57 individuals with the diagnoses of severe cortical and spinal spasticity requiring an intrathecal baclofen pump. Methods: Parameters evaluated included daily dosage of medication required, flex vs simple continuous delivery modes, dosing changes, need for other local spasticity treatment, and catheter complications. Results: There were no statistically significant differences between individuals with cortical spasticity and spinal spasticity when comparing daily dosage, number of contacts, and mode of delivery. At 6 months, there was a statistically significant difference in dosing between individuals with multiple sclerosis and those without. Within groups, there was a significant difference in average daily dosing over 3 years. A significant difference was found comparing the use of botulinum toxin type A for upper extremity spasticity within the cortical group. Nine individuals had catheter complications. Conclusions: Cortical and spinal spasticity appear to parallel each other with no significant differences in daily dosing, dosing changes, and mode of delivery of intrathecal baclofen . This did not hold true at all time points for the multiple sclerosis subgroup. The significant difference noted within groups for daily dosing over the first 3 years challenges the notion of stable dosing over time. Focal injections of Botox/phenol in the upper extremities are an important adjunct therapy for patients with cortical spasticity, even after the placement of an intrathecal baclofen pump. Our complication rate was slightly lower than that reported in the literature.Corry N., Klick B., Fauerbach J.A.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2009Psychiatric morbidity and functional impairments in survivors of burns, traumatic injury and ICU stays for other critical illnesses: A review of the literatureJA International Review of Psychiatry216531-538Davydow D., Katon W., Zatzick D.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2009Post-traumatic growth and spirituality in burn injuryJA International Review of Psychiatry216570-579Wiechman S., Magyar-Russell G.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2010Propranolol Does Not Reduce Risk for Acute Stress Disorder in Pediatric Burn TraumaJA JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE681193-197Sharp S., Thomas C., Rosenbert L., Rosenberg M., Meyer W.J.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2010Physical and Psychological Recovery from Burn Injury for children Ages 5 to 18 Years: The Multi-Center Benchmarking StudyJA JOURNAL OF BURN CARE & RESEARCH31 S89Lee A.F., Li N., Kazis L.E., Sheridan R., Lydon M., Hinson M.I., Palmieri T., Meyer W., Tompkins R. Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2010Propranolol does not impair the benefits of exercise-training during pediatric post-burn rehabilitationJA JOURNAL OF BURN CARE & RESEARCH31 S111Al-Mousawi A.M., Pham A., Williams F.N., Jeschke M.G., Herndon D.N., and Suman O.E.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2010Lower extremity post-burn contracture affects functional mobilityJA J Burn Care Res31 S84Kowalske K., Holavanahalli R., Helm P., Dolezal, C.'North Texas Burn Rehabilitation Model SystemYesdevopsadmin
2009Epidemiology of burn injuries II: Psychiatric and Behavioural PerspectivesJA International Review of Psychiatry216512-521McKibben J., Ekselius L.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2010Clinical Research Award. Posttraumatic stress disorder and pain impact functioning and disability following major burn injuryJA JOURNAL OF BURN CARE & RESEARCH31113-25Corry, N., Klick, B., Fauerbach, J.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2010High potency bisphosphonates for burn related heterotopic ossificationJA J Burn Care Res31 S109Gabriel V., Barreto, J.North Texas Burn Rehabilitation Model SystemYesdevopsadmin
2009GUEST EDITORS: Neuropsychiatric Aspects of Traumatic Burn InjuryJA International Review of Psychiatry216501-504Fauerbach J., McCann U.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2009Epidemiology of burn injuries: Highlighting cultural and socio-demographic aspectsJA International Review of Psychiatry216505-511Dissanaike S., Rahimi M.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2009Assessment of Recovery From Burn-Related Neuropathy by Electrodiagnostic TestingJAJ56730JOURNAL OF BURN CARE & RESEARCH304668-674The purpose of this study was to investigate the recovery of burn-related neuropathies by electrodiagnostic testing. Burn patients who presented to an American Burn Association verified burn center were interviewed and examined for clinical evidence of peripheral neuropathies by a physiatrist. Patients whom consented to participate were tested for electrodiagnostic evidence of peripheral neuropathy. Repeated studies were performed to assess for evidence of recovery. A total of 370 patients were screened. Thirty-six (9.73%) patients had clinical evidence of neuropathy. Eighteen male patients with a mean TBSA burn of 42% had nerve conduction studies perfonned. Etiologies of the injuries included eight flame, eight electrical, and three others. Seventy-three nerve conduction studies were performed and 58 of the tests were abnormal. The most commonly affected nerve was the median sensory ( 1 0 ) . For patients with repeated tests, the mean time between tests was 169 days (SD, 140 days). There was a significant difference between the initial and follow-up test (McNemar's change test P = .009). [n subset analysis of motor and sensory abnormalities, there was no significant difference (P .07). The most common neuropathy identified in this cohort was the median sensory. Overall, there was improvement in the nerve conduction abnormalities examined. This study suggests that the prognosis for recovery after burn-related neuropathy is good. (j Burn Care Res 2009;30:668 - 674)Gabriel V., Kowalske K., Holavanahalli R.North Texas Burn Rehabilitation Model SystemNodevopsadmin
2009Approach-avoidance coping conflict in a sample of burn patients at risk for posttraumatic stress disorderJA Depression and Anxiety269838-850Fauerbach, J.Johns Hopkins University Burn Injury Rehabilitation Model SystemNodevopsadmin
2010Adolescent Burn Survivors and their Parents Perceptions of Recovery Outcomes: Do They Agree or Disagree?JA JOURNAL OF BURN CARE & RESEARCH312S90Meyer W.J., Lee A.F., Kazis L.E., Li N.C., Sheridan R.L., Herndon D.N., Hinson M.I., Stubbs T.K., Palmieri T.L., Tompkins R.G..Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2011Skeletal muscle is anabolically unresponsive to an amino acid infusion in pediatric burn patients 6 months postinjuryJAJ62902Annals of Surgery2533592-597Study examined the effect of a steady state amino acid (AA) infusion on leg muscle protein turnover and whole-body muscle and whole-body nonmuscle protein breakdown rates in pediatric burn patients at 6 month postinjury compared with that of healthy subjects. A total of 10 pediatric patients and 5 healthy young males underwent an 8-hour stable isotope infusion study. During the last 3 hours, an AA solution was infused. Femoral arterial and venous blood samples and muscle biopsy samples were collected throughout the study. During AA infusion, the leg muscle protein synthesis rate significantly increased in both groups, however, in the burn group, protein breakdown also increased, although non-significantly. As a result, protein net balance remained negative. In the control group, breakdown nonsignificantly decreased resulting in a significant increase in muscle protein net balance. Whole-body protein breakdown was significantly higher in the burn patients. Findings suggest that, in pediatric burn patients at 6 months postinjury, leg muscle protein net deposition is unresponsive to AA infusion; and whole-body protein breakdown is significantly higher than in healthy subjects.Tuvdendorj D, Chinkes DL, Zhang XJ, Sheffield-Moore M, Herndon DNPediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2011Virtual reality as an adjunctive non-pharmacologic analgesic for acute burn pain during medical proceduresJAJ62892Annals of Behavioral Medicine412183-191Article reviews evidence from clinical and laboratory research studies exploring the use of virtual reality (VR) to control pain in burn patients undergoing painful medical procedures. VR analgesia has been demonstrated in burn patients both during daily wound care and during physical therapy. Burn patients report 35 to 50 percent reductions in procedural pain while in a distracting immersive virtual reality, and functional magnetic resonance imaging brain scans show associated reductions in pain-related brain activity during VR. VR distraction appears to be most effective for patients with the highest pain intensity levels. VR is thought to reduce pain by directing patients' attention into the virtual world, leaving less attention available to process incoming neural signals from pain receptors. The authors briefly describe how VR pain distraction systems have been tailored to the unique needs of burn patients to date, and speculate about how VR systems could be tailored to the needs of other patient populations in the future.Hoffman, HG, Chambers, GT, Meyer III, WJ, Arceneaux, LL, Russell, WJ, Seibel, EJ, Richards, TL, Sharar, SR Patterson, David R..Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2011Association between dietary fat content and outcomes in pediatric burn patientsJAJ62906Journal of Surgical Research1661e83-390Study compared a low fat/high-carbohydrate diet and a high-fat diet on morbidity and mortality outcomes in severely burned children. Nine hundred forty-four children with burns on 40 percent or more of their total body surface area (TBSA) were divided into two groups: 518 patients receiving Vivonex T.E.N. (low-fat/high-carbohydrate diet) and 426 patients receiving milk (high-fat diet). Patient demographics, caloric intake, length of hospital stay, and incidence of sepsis, mortality, hepatic steatosis, and organomegaly at autopsy were determined. Demographics and caloric intake were similar in both groups. Patients receiving Vivonex T.E.N. had shorter intensive care unit (ICU) stays, a shorter ICU stay per percentage TBSA burn, a lower incidence of sepsis, and lived significantly longer until death than those receiving milk. There was no difference in overall mortality between the two groups. Autopsies revealed decreased hepatic steatosis and decreased enlargement of kidney and spleen in patients receiving Vivonex T.E.N. Results suggest the benefit of high carbohydrate/low fat nutrition; however, the findings in these time periods can also be likely due to the multifactorial effects of advances in burn care. The authors believe that these results have some relevance because high fat is associated with poorer outcomes compared with low fat.Lee JO, Gauglitz GG, Herndon DN, Hawkins HK, Halder SC, Jeschke MGPediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2010Intensive insulin therapy improves insulin sensitivity and mitochondrial function in severely burned childrenJAJ62899Critical Care Medicine3861475-1483Study examined the effects of an intensive insulin therapy protocol in an acute pediatric burn unit and the mechanisms underlying its benefits. Twenty children, 4 to 18 years old, with total body surface area burned greater than 40 percent and who arrived within 1 week after injury were included in the data analysis. Patients were randomized to one of two groups: (1) intensive insulin therapy maintained blood glucose levels between 80 and 110 milligrams per deciliter (mg/dL) or (2) conventional insulin therapy maintained blood glucose Fram RY, Cree MG, Wolfe RR, Mlcak RP, Qian T, Chinkes DL, Herndon DNPediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2011Psychiatric diagnoses after hospitalization with work-related burn injuries in Washington stateJAJ61112Journal of Burn Care and Research323369-378Study examined workers who were hospitalized with work-related burn injuries and their psychiatric sequelae in Washington State. Psychiatric sequelae of interest were depression, posttraumatic stress disorder, and other anxiety disorders. Workers' compensation claims for burn patients from Washington State hospitalized from January 2001 through April 2008 were identified. The resulting claims were searched for the presence of certain psychiatric diagnoses or treatment codes, and descriptive analyses were performed. Of the 329 workers hospitalized with work-related burns during the study period, 62 (19 percent) had a psychiatric diagnosis of interest. Claims with psychiatric diagnoses had higher medical costs and more days of time loss than those without these diagnoses. Workers with electrical burns in the construction industry and in construction and extraction occupations had a higher proportion of psychiatric sequelae. Workers who were married also has proportionately more psychiatric diagnoses.Anderson NJ, Bonauto DK, Adams DNorthwest Regional Burn Model SystemYesdevopsadmin
2011Functional and Psychosocial Outcomes of Older Adults After Burn Injury: Results From a Multicenter Database of Severe Burn InjuryJAJ60430Journal of Burn Care and Research32166-78Study examined the long-term functional and psychological outcomes of older adults after burn injury. The authors analyzed the outcomes of 737 patients aged 55 years or older who were enrolled and followed in the National Institute on Disability and Rehabilitation Research burn program. Change in living situation as well as distress, functional impairment, and quality of life were examined at discharge and at 6, 12, and 24 months after hospital discharge. Mixed effects modeling compared differences across age groups and time. Results indicated that patients in all age groups had significant deficits in Short Form-36, Functional Independence Measure, and Brief Symptom Inventory scores at time of discharge. Recovery of physical and psychosocial functioning was greatest from discharge to 6 months in patients aged 55 to 74 years and greatest at 1 year for patients aged 75 years or older. The findings confirm that severe burn injury significantly impacts both functional outcome and psychosocial quality of life in older adults. However, the impact seems to be elated to age as are recovery trajectories.Klein, M, Lezotte, D, Heltshe S, Fauerbach J, Holavanahalli R, Rivara F, Pham T, Engrav, LYesdevopsadmin
2011Comparing parent and child perceptions of stigmatizing behavior experienced by children with burn scarsJAJ62912Body Image8170-73Study compared perceptions of stigmatization experienced by 85 pediatric burn survivors with those of their parents. Among the burn survivors, 38 percent were female, 44 percent had facial scars, and the median number of surgical procedures was two. Survivors and a parent independently completed the Perceived Stigmatization Questionnaire (PSQ), rating the frequency that the child experienced three types of stigmatizing behaviors: absence of friendly behavior, confused and staring behavior, and hostile behavior. The sample was divided into a high (top 25 percent) and low (bottom 75 percent) perceived stigmatization groups. Results indicated that the mean ratings of parents did not significantly differ from that of children reporting low stigmatization. The mean PSQ parent ratings were significantly lower than those of children reporting high stigmatization. Additionally, the level of agreement on PSQ subscale scores within child-parent dyads was significantly lower in children reporting high stigmatization relative to child-parent dyads of children reporting low stigmatization. The findings suggest that children surviving burns may experience stigmatization that is under-perceived by their parents.Lawrence, J.W., Rosenberg, L., Mason, S., & Fauerbach, J.A.Pediatric Burn Injury Rehabilitation Model SystemNodevopsadmin
2011Children with burn injuries-assessment of trauma, neglect, violence and abuseJAJ62893Journal of Injury and Violence Research3298-110Article discusses the epidemiology and risk factors, mechanisms of injury, clinical assessment, and methods of prevention associated with pediatric burn injuries. Burns are the third most frequent cause of childhood injury resulting in death, behind motor vehicle accidents and drowning. Burn injuries account for the greatest length of stay of all hospital admissions for injuries and costs associated with care are substantial. The majority of burn injuries in children are scald injuries resulting from hot liquids, occurring most commonly in children aged 0 to 4 years. Other types of burns include electrical, chemical, and intentional injury. Mechanisms of injury are often unique to children and involve exploratory behavior without the requisite comprehension of the dangers in their environment. Assessment of the burned child includes airway, breathing, and circulation stabilization, followed by assessment of the extent of the burn and head to toe examination. The standard rule of 9s for estimating total body surface area (TBSA) of the burn is inaccurate for the pediatric population and modifications include utilizing the Lund and Browder chart, or the child’s palm to represent 1 percent TBSA. Further monitoring may include cardiac assessment, indwelling catheter insertion, and evaluation of inhalation injury with or without intubation depending on the context of the injury. Risk factors and features of intentional injury should be known and sought and vital clues can be found in the history, physical examination, and common patterns of presentation.Toon MH, Maybauer DM, Arceneaux LL, Fraser JF, Meyer W, Runge A, Maybauer MOPediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2010Glucose control in severely thermally injured pediatric patients: What glucose range should be target?JAJ62908Annals of Surgery2523521-528Study determined which glucose levels are associated with improved morbidity and mortality in thermally injured children. Two-hundred eight pediatric patients with burns over 30 percent of their total body surface area were included in this trial. Several statistical models were used to determine the daily average and 6 AM glucose targets that were associated with improved morbidity and mortality. Patients were then divided into good- and poor-glucose-controlled patients and demographics, clinical outcomes, infection, sepsis, inflammatory, and hypermetabolic responses were determined. Statistical modeling showed that hyperglycemia is a strong predictor of adverse hospital outcome and that daily 6 AM glucose level of 130 milligrams per deciliter (mg/dL) and daily average glucose levels of 140 mg/dL are associated with improved morbidity and mortality postburn. When comparing good- and poor-glucose-control groups, it was determined that patients with glucose levels of 130 mg/dL exert attenuated hypermetabolic and inflammatory responses, as well as significantly lower incidence of infections, sepsis, and mortality compared with patients with poor glucose control. These findings suggest that a blood glucose level of 130 mg/dL should be targeted in severely burned patients.Jeschke M.G., Kraft R., Emdad F., Kulp G.A., Williams F.N., Herndon, D.N.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2010Intensive insulin therapy in severely burned pediatric patients: A prospective randomized trialJAJ62894American Journal of Respiratory and Critical Care Medicine1823351-359Study explored whether intensive insulin therapy is associated with improved post-burn morbidity and mortality. A total of 239 severely burned children with burns over more than 30 percent of their total body surface area were randomized to intensive insulin treatment or control. Demographics, clinical outcomes, sepsis, glucose metabolism, organ function, and inflammatory, acute phase, and hypermetabolic responses were determined. Demographics were similar in both groups. Control patients were targeted to maintain glucose levels 140 to 180 milligrams per deciliter (mg/dl), whereas intensive insulin-treated patients received insulin to maintain glucose levels between 80 and 110 mg/dl. Intensive insulin treatment significantly decreased the incidence of infections and sepsis compared with controls. Furthermore, intensive insulin therapy improved organ function as indicated by improved serum markers, DENVER2 scores, and ultrasound. Intensive insulin therapy alleviated post-burn insulin resistance and the vast catabolic response of the body. Intensive insulin treatment dampened inflammatory and acute-phase responses compared with controls. Mortality was 4 percent in the intensive insulin therapy group and 11 percent in the control group.Jeschke MG, Kulp GA, Kraft R, Finnerty CC, Mlcak R, Lee JO, Herndon DNPediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2011Spatial and temporal localization of the melanocortin I receptor and its ligand a--melanocyte-stimulating hormone during cutaneous wound repairJAJ60771Journal of Histochemistry and Cytochemistry593278-288Study investigated the role of the melanocortin 1 receptor (MC1R) and its ligand a-melanocyte-stimulating hormone (a-MSH) in the regulation of inflammatory and fibroproliferative responses to cutaneous injury. Specifically, the authors report the localization of the MC1R/a-MSH signaling in murine cutaneous wounds, human acute burns, and hypertrophic scars. During murine wound repair, MC1R and a-MSH were detected in inflammatory cells and suprabasal keratinocytes at the leading edge of the migrating epithelial tongue. MC1R and a-MSH protein levels were upregulated in human burn wounds and hypertrophic scars compared to uninjured human skin, where receptor and ligand were absent. In burn wounds and hypertrophic scars, MC1R and a-MSH localized to epidermal keratinocytes and dermal fibroblasts. This spatiotemporal localization of MC1R and a-MSH in cutaneous wounds warrants future investigation into the role of MC1R/a-MSH signaling in the inflammatory and fibroproliferative responses to cutaneous injury.Muffley LA, Zhu KQ, Engrav LH, Gibran NS, Hocking AMNorthwest Regional Burn Model SystemYesdevopsadmin
2011Is there a difference in clinical outcomes, inflammation and hypermetabolism between scald and flame burn? JA Pediatric Crit. Care Med126275-281OBJECTIVE: Severe thermal injury induces inflammatory and hypermetabolic responses that are associated with morbidity and mortality. However, it is not well-documented whether the causes of burns affect inflammation, hypermetabolism, and morbidity. The aim of the present study was to determine whether there is a difference in degree of inflammation, hypermetabolism, endocrine and acute-phase response, and clinical outcome between pediatric patients with scald and flame burns. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Children with burns requiring surgical intervention were enrolled in this cohort study and divided into two groups, scald or flame burn. In a second assignment, we analyzed the study populations in representative subgroups containing individuals with third-degree burns of 40% to 60% total body surface area. We determined clinical outcomes, resting energy expenditures, cytokine profiles, acute-phase proteins, constitutive proteins, and hormone panels. Statistical analysis was evaluated by analysis of variance, Student's t test corrected with the Bonferroni post hoc test, and the propensity score. Statistical significance was set at p < .05. A total of 912 patients were identified. Six hundred seventy-four had a flame burn and 238 had a scald burn. There was a significant difference (p < .05) in burn size (flame, 48% ± 23%; scald, 40% ± 21%), third-degree burn (flame, 39% ± 27%; scald 22% ± 25%), age (flame, 8 ± 5 yrs; scald, 3 ± 3 yrs), and mortality between groups. Propensity analysis confirmed the type of burn as a significant risk factor for morbidity and mortality. Subanalysis conducted in a representative patient group suffering from 40% to 60% burn total body surface area revealed that flame burns lead to significantly increased hypermetabolic, inflammatory, and acute-phase responses when compared to scald burns (p < .05). The frequency of sepsis was 3% in the scald burn group, while it was 14% in the flame group (p < .001). Multiorgan failure occurred in 14% of the scald patients, while it occurred in 17% of flame patients. The mortality in patients suffering from a scald burn was 3% compared to 6% in the flame-burned group (p < .05). CONCLUSION: The type of burn affects hypermetabolism, inflammation, acute-phase responses, and mortality postburn.Kraft R.A., Kulp G.A., Herndon D.N., Emdad, F., Williams F.N., Hawkins H.K., Leonard K.R., Jeschke M.G. Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2010Perceived stigmatization and social comfort: Validating the constructs and their measurement among pediatric burn survivorsJAJ59887Rehabilitation Psychology554360-371Study implemented a four-step process to evaluate the measurement properties of the Perceived Stigmatization Questionnaire (PSQ) and the Social Comfort Questionnaire (SCQ) among long-term pediatric burn survivors. Participants included 369 pediatric and 347 adult burn survivors. First, a series of confirmatory factor analyses compared the hypothesized four-factor model comprising 3 PSQ factors (absence of friendly behavior, confused and staring behavior, and hostile behavior) and one social comfort factor to three other models. Second, the measurement invariance of both instruments was tested in a pediatric sample and compared to an adult sample. Third, possible differences in structural parameters across groups were tested. Fourth, the researchers tested whether the 3 perceived stigmatization factors and the social comfort factor loaded on one second-order factor. Results indicated that the four-factor model was superior to the comparison models. The PSQ and SCQ demonstrated measurement invariance. Factor variance, factor covariance, and the latent means of the PSQ did not vary across groups. The adult group had a significantly lower latent mean on the SCQ than the pediatric group. The three factors of the PSQ and the one-factor SCQ loaded on one second-order factor. The results of this study lend support to both the construct validity of perceived stigmatization and social comfort and the potential value of the PSQ and SCQ for studying the social experience of people with visible differences.Lawrence, J.W., Rosenberg, L., Rimmer, R.B., Thombs, B.D., & Fauerbach, J.A. Yesdevopsadmin
2010a-tocopherol adipose tissue stores are depleted after burn injury in pediatric patientsJAJ62898American Journal of Clinical Nutrition9261378-1384Study tested the hypothesis that thermal injury depletes body stores of vitamin E by measuring concentrations of a-tocopherol concentrations in adipose tissue samples obtained from children with burn injuries. Adipose tissue a-tocopherol concentrations are generally accepted to reflect long-term vitamin E deficiency. Eight pediatric patients were followed up to 1 year after burn injury. Surgically obtained samples were collected at various intervals and stored at -80 degrees centigrade in a biorepository. a- and ?-tocopherols, cholesterol, and triglycerides were measured in the same tissue sample. During the first week after injury, adipose tissue a-tocopherol concentrations were within the expected normal range of 199 nanomoles per gram (nmol/g) of adipose tissue but were substantially lower at weeks 2 and 3 (133 and 109 nmol/g of adipose tissue, respectively). Individual rates of decrease, estimated by linear regression, showed that adipose tissue a-tocopherol decreased by an average of 6.1 nmol/g daily. During the first month after injury, adipose tissue triglyceride concentrations also decreased, whereas no changes in cholesterol concentrations occurred. The results suggest that the burn injury experienced by these pediatric patients altered their metabolism such that vitamin E status diminished during the month after injury. Further studies are needed to evaluate the mechanism and consequences of the observed vitamin E depletion.Traber MG, Leonard SW, Traber DL, Traber LD, Gallagher J, Bobe G, Jeschke MG, Finerty CC, Herndon DNPediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2010Temperature responses in severely burned children during exercise in a hot environmentJAJ59084Journal of Burn Care and Research314624-630Study examined the thermoregulatory response of burned children to exercise in the heat. Ten children with greater than 40 percent total body surface area burns and 10 non-burned children performed a 30-minute session of treadmill exercise at 75 percent of their peak aerobic power in a heated environment. Intestinal temperature, burned and unburned skin temperature, and heart rate were recorded before exercise, every 2 minutes during exercise, and during recovery. Three of the 10 burned children completed the exercise session in the heat; however, all the non-burned children completed the 30-minute session. One burned child reached a core body temperature greater than 39 degrees centigrade at minute 23. Burned children had significantly higher core body temperature through the first 12 minutes of exercise compared with non-burned children. However, nine of the 10 burned children did not become hyperthermic during exercise in the heat. In this study, hyperthermia did not typically occur in burned children, relative to non-burned children. Whether this is due to an intolerance to exercise in the heat or to an inability to generate sufficient heat during exercise needs to be explored further.McEntire, S., Chinkes, D.L., Herndon, D.N., Suman, O.E.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2010Insulin increases resistance to burn wound infection-associated sepsisJAJ62909Critical Care Medicine381202-208Study examined the ability of insulin to improve outcome following a Pseudomonas aeruginosa wound infection in a rodent model of severe burn injury. Burn-injured Sprague Dawley rats were randomized into treatment groups that received either saline or insulin. Burn wounds were topically inoculated with a lethal dose of Pseudomonas aeruginosa 6 days after injury. Survival, systemic dissemination of bacteria, systemic inflammation, and immune activation were examined. Insulin decreased the early inflammatory response to a severe burn injury. Treatment with low doses of insulin following burn injury improved the outcome of rats in response to a lethal burn wound infection. Specifically, survival was improved and systemic dissemination of bacteria from the wound was decreased. Systemic inflammation, indicated by serum interleukin-6 levels, was significantly decreased by insulin treatments after injury. Additionally, insulin treatments were associated with alterations in B and T lymphocyte responses to wound infection. Although the mechanisms by which insulin improves outcome following a lethal burn wound infection are not known, the data suggest that immunologic responses to infection may be altered by postburn insulin treatments.Gauglitz GG, Toliver-Kinsky TE, Williams FN, Song J, Cui W, Herndon DN, Jeschke MG Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2011Measuring coping behavior in patients with major burn injuries: A psychometric evaluation of the BCOPEJAJ61113Journal of Burn Care and Research323392-398Study assessed psychometric properties of the brief COPE (BCOPE) in hospitalized patients with burn injury. The BCOPE is a 28-item measure developed from the full-version COPE inventory (60 items) to provide an efficient means of assessing coping behaviors. A total of 362 participants admitted to the hospital with a major burn injury were evaluated. In addition to the BCOPE survey completed at discharge, and at 6 and 24 months after discharge, participants completed the Davidson Trauma Scale (DTS), the Satisfaction with Appearance Scale (SWAP), and the Short-Form 12 Health Survey (SF-12). Exploratory factorial analysis was conducted to evaluate patterns of coping strategies. To assess construct validity, the BCOPE scale scores were correlated with the distress measures across time points. Exploratory factorial analysis revealed seven factors accounting for 51 percent of total variance. The pattern matrix indicated four items loaded onto factor 1 (active coping) and four onto factor 2 (avoidant coping). The remaining 5 factors (humor, religion, emotional support, venting, and acceptance) were consistent with original scale assignments. Construct validity of BCOPE scales (active and avoidant) was demonstrated by their association with the DTS, SF-12, and SWAP. The results indicate that the BCOPE is valid, reliable, and can be meaningfully interpreted.Amoyal N, Mason ST, Gould NF, Corry N, Mahfouz S, Barkey A, Fauerbach JA Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2011Psychosocial impact of childhood face burns: A multicenter, prospective, longitudinal study of 390 children and adolescentsJAJ62903373387-394Study examined the impact of face burns on the psychosocial adjustment of pediatric burn survivors and their parents during the first two years after injury. Subjects were 390 children less than 18 years old at injury, admitted for burn treatment from September 2001 to December 2004. Psychosocial functioning was assessed using the age-specific Burn Outcomes Questionnaire (BOQ) administered at scheduled time points following discharge up to 24 months thereafter. The BOQ includes an adolescent self-report questionnaire for patients 11 to 18 years of age and two age-specific questionnaires for parents: one version for parents of children under five years old and another for those with children 5 to 18 years old. A psychosocial score was determined from domains of the BOQ, and these scores from children with both face burns and grafts were compared to those of children with non-face burns or with face burns but no face grafts. The parents of both the 0- to-4 year olds and the 5-to-18 year olds who had facial burns and grafts reported decreased BOQ psychosocial scores. When the teenagers (11 to 18 years old) with facial burns and grafts filled out the BOQ themselves, they also reported low psychosocial scores compared to those with no facial burns with grafts. Findings suggest that severe face burn influences psychosocial adjustment in children. Additional psychosocial support is suggested to enhance recovery for patients with severe face burns and their families during the years following injury.Stubbs T.K., James L.E., Daugherty, M.B., Epperson, K., Barajaz, K., Blakeney, P., Meyer, W.J.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2010Impaired glucose tolerance in pediatric burn patients at discharge from the acute hospital stayJAJ59517Journal of Burn Care and Research315728-733Study measured insulin resistance in severely burned children whose wounds were 95 percent healed. Twenty-four children, aged 4 to 17 years, with total burn surface area equal to or greater than 40 percent underwent a 2-hour oral glucose tolerance test before discharge from the acute pediatric burn unit. Plasma glucose and insulin levels as well as the Homeostasis Model Assessment for Insulin Resistance (HOMAIR) were compared with published oral glucose tolerance test data from healthy, non-burned children. There was a significant difference between severely burned children and non-burned, healthy children with respect to the HOMAIR. Severely burned children had a HOMAIR of 3.53 compared with the value in non-burned, healthy children of 1.28. The results of this study warrant future investigations into therapeutic options for the burned child during the rehabilitative phase of their care after injury.Fram RY, Cree MG, Wolfe RR, Barr D, Herndon DNPediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2010Effects of exercise training on resting energy expenditure and lean mass during pediatric burn rehabilitationJAJ58459Journal of Burn Care and Research313400-408Study examined the effects of exercise training on resting energy expenditure (REE) during the rehabilitation of severely burned pediatric patients. Severe burns cause profound hormonal and metabolic disturbances resulting in hypermetabolism, reflected in extreme elevation of REE and extensive skeletal muscle catabolism. Twenty-one patients (aged 7 to 17 years) with 40 percent and greater total body surface area burns participated in the study. Participants were randomized at admission to the burn intensive care unit to either a 12-week, hospital-based exercise program (EX) or a home-based standard of care program (SOC), commencing 6 months after injury. Age, sex, and total body surface area burned were similar. Mean change in REE, normalized to individual lean body mass, was almost negligible between SOC and EX group patients. A significant increase in lean body mass was found for EX patients, which persisted when normalized to height. Peak torque also improved significantly more in EX patients, reflecting improved strength. Exercise training significantly enhanced lean mass and strength, without observed exacerbation of postburn hypermetabolism. Therefore, the use of exercise conditioning as a safe and effective component of pediatric burn rehabilitation is recommended.Al-Mousawi A, Williams FN, Mlcak RP, Jeschke MG, Herndon DN, Suman OEPediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2011Long-term oxandrolone treatment increases muscle protein net deposition via improving amino acid utilization in pediatric patients 6 months after burn injuryJAJ62900Surgery1495645-653Study evaluated whether oxandrolone treatment affects mechanisms of protein turnover in skeletal muscle in response to amino acid (AA) infusion and on whole-body protein breakdown in pediatric burn patients 6 months postinjury. At the time of admission, patients were randomized to control or oxandrolone treatments. Clinically, oxandrolone has been used successfully to treat muscle wasting and conditions of growth disorders. The treatment regimens were continued until 6 months postinjury, at which time 26 patients underwent study with a stable isotope tracer infusion to measure muscle and whole-body protein turnover. Protein kinetics in leg muscle were expressed in nanomoles per minute per 100 milliliters of leg volume. During AA infusion, rates of protein synthesis in leg muscle were increased in both groups (basal versus AA: control, 51 versus 86; oxandrolone, 56 versus 96). In the control group, there was also a simultaneous increase in breakdown (basal versuss AA: 65 versus 89), which resulted in no change in the net balance of leg muscle protein (basal versus AA: -15 versus -2). In the oxandrolone group, protein breakdown did not change (basal versus AA: 80 versus 77), leading to increased net balance (basal versus AA: -24 versus 19). Protein breakdown at the whole-body level was not different between the groups. This study shows that long-term oxandrolone treatment increased net deposition of leg muscle protein during AA infusion by attenuating protein breakdown, but did not affect whole-body protein breakdown.Tuvdendorj D, Chinkes DL, Zhang XJ, Suman OE, Aarsland A, Ferrando A, Kulp GA, Jeschke MG, Wolfe RR, Herndon DN Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2011Functional genomics unique to week 20 post wounding in the deep cone/fat dome of the Duroc/Yorkshire porcine model of fibroproliferative scarringJAJ60772PLoS One64 Study reports the differential transcriptome over time and the functional genomics unique to Week 20 post wounding from the deep cones/fat domes in the Duroc/Yorkshire porcine model of fibroproliferative scarring following shallow and deep partial thickness wounds. A system was assembled that permits the study of genome-wide gene expression in microanatomical locations, in shallow and deep partial-thickness wounds, and pigmented and non-pigmented skin, using the Duroc (pigmented fibroproliferative) and Yorkshire (non-pigmented non-fibroproliferative) porcine model. This system was used to obtain the differential transcriptome at 1, 2, 3, 12 and 20 weeks post wounding. It is not clear when fibroproliferation begins, but it is fully developed in humans and the Duroc breed at 20 weeks. Therefore, the authors obtained the derivative functional genomics unique to 20 weeks post wounding and also obtained long-term, forty-six week follow-up with the model. The differential transcriptome provided new insights into the fibroproliferative process as several genes thought fundamental to fibroproliferation were absent and others differentially expressed were newly implicated. The observation that the scars are still thick at forty-six weeks post wounding further validated the model.Engrav LH, Tuggle CK, Kerr KF, Zhu KQ, Numhom S, Couture OP, Beyer RP, Hocking AM, Carrougher GJ, Ramos MLC, Klein MB, Gibran NSNorthwest Regional Burn Model SystemYesdevopsadmin
2011Burns: Where are we standing with propranolol, oxandrolone, recombinant human growth hormone, and the new incretin analogs?JAJ62905Current Opinion in Clinical Nutrition and Metabolic Care142176-181This review article discusses the more recent advances in therapeutic strategies to attenuate the hypermetabolic response and its associated insulin resistance postburn. The hypermetabolic response in critically ill patients is characterized by hyperdynamic circulatory, physiologic, catabolic, and immune system responses. Failure to satisfy overwhelming energy and protein requirements after, and during critical illness, results in multiorgan dysfunction, increased susceptibility to infection, and death. Attenuation of the hypermetabolic response by various pharmacologic modalities is emerging as an essential component of the management of severe burn patients. At present, beta-adrenergic blockade with propranolol represents probably the most efficacious anticatabolic therapy in the treatment of burns. Other pharmacological strategies include growth hormone, insulin-like growth factor, oxandrolone and intensive insulin therapy. Investigation of alternative strategies, including the use of metformin, glucagon-like-peptide-1 and the PPAR-gamma agonists are under current investigation.Gaulglitz G.G., Williams F.N., Herndon D.N., Jeschke M.G.Pediatric Burn Injury Rehabilitation Model SystemNodevopsadmin
2010What's new in Shock, June 2010?JAJ62897Shock336559-561Article provides an overview of the current month’s edition of SHOCK, which presents a diverse range of outstanding clinical and basic science investigations. Topics include: prediction of morbidity and mortality after trauma, burns, and sepsis through physiological, inflammatory, cellular, and genetic patterns; stem cell cardioprotection; hemorrhage control through nerve stimulation; models of sepsis exploring modulation by toll-like receptor agonists, microvascular fluid leak, immune cell receptor regulation, and gastric mucosal barrier disruption; pancreatic injury following abdominal compartment syndrome; vasopressin and anaphylaxis; and the anti-inflammatory effects of oxygen therapy and thiazolidinediones (rosiglitazone and pioglitazone).Al-Mousawi A, Jeschke MG, Herndon DNPediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2011Select practices in management and rehabilitation of burns: A survey reportJAJ60503Journal of Burn Care and Research322210-223Study examined the organization and current practices in physical rehabilitation across burn centers. An online survey was used to collect information regarding: (1) logistics of the burn center, (2) inpatient and outpatient treatment of patients with burn injury, and (3) specific protocols in the treatment of a few complications secondary to burn injuries. Of the 159 responses received, 115 were received from the United States, 20 from Australia, 16 from Canada, and 7 from New Zealand. The overall sample included responses from 76 physical therapists (PTs) and 78 occupational therapists (OTs). Seventy-three of those surveyed considered themselves primarily a burn therapist. Nurses (86 percent) were reported as primarily responsible for wound care of inpatients, followed by wound care technicians (24 percent). Ninety-seven percent of the therapists reported following their own treatment plans. The trunk and areas of head and neck were treated by both PTs and OTs, whereas the lower extremities continue to be treated predominantly by PTs. Some common practices regarding treatment of a few complications secondary to burn injuries such as splinting to prevent contractures, treatment of exposed or ruptured extensor tendons, exposed Achilles tendons, heterotopic ossification, postoperative ambulation, conditioning, scar massage, and the use of compression garments are described.Holavanahalli, R.K., Helm, P.A., Parry, I.S., Dolezal, C.A., Greenhalgh,D.G.North Texas Burn Rehabilitation Model SystemYesdevopsadmin
2012Role of the PPAR-a agonist feno?brate in severe pediatric burnJA Burns384481-496Fenofibrate is a peroxisome proliferator activated receptor alpha agonist that contains both pro and anti-inflammatory properties, and has been used in the treatment of dyslipidemia and diabetes for decades. Its receptors are expressed in the liver, skeletal muscle, cardiac, enteric, and renal cells, which allow it to provide systemic regulation of lipoprotein metabolism, fatty acid oxidation, and fatty acid transport. Hyperglycemia is a common complication found in the burn population because hepatic glucose production and catecholamine-mediated hepatic glycogenolysis are augmented. Insulin resistance occurs often in these patients and is associated with poor outcomes. In the pediatric burn population, fenofibrate has been found to ameliorate or decrease the number of hypoglycemic episodes when compared to management with insulin alone. Its mechanism of action is thought to involve an improvement in insulin signaling in skeletal muscle, as well as improvements in mitochondrial function, glucose oxidation, and insulin sensitivity. The long term use of fenofibrate in severely burned patients may improve hyperglycemia and insulin resistance, as well as improve wound healing, and reduce apoptosis, and oxidative stress. Elijah IE, Børsheim E, Maybauer DM, Finnerty CC, Herndon DN, Maybauer MO.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2012Thermal Injury Activates the eEF2K-Dependent eEF2 Pathway in Pediatric PatientsJA Journal of Parenteral and Enteral Nutrition365596-602BACKGROUND: Burn induces a hypermetabolic state characterized by alterations in protein metabolism, which is associated with increased morbidity and mortality. Eukaryotic elongation factor 2 (eEF2) plays a crucial role in regulating protein synthesis in many diseases, but whether it participates in burn-induced hypermetabolism is unclear. The aim of this study was to determine the expression of eEF2 and the upstream eEF2-inactivating kinase, eEF2K, in severely burned pediatric patients. METHODS: Eight pediatric patients (> 40% total body surface area) and 3 nonburned pediatric volunteers were enrolled. Muscle and skin biopsies were collected at early (0-10 days postburn [dpb]), middle (11-49 dpb), and late (50-365 dpb) time points. Resting energy expenditure (REE), body composition, and muscle protein fractional synthesis rate (FSR) were measured. Proteins were extracted and analyzed by Western blotting. To further investigate the protein synthesis pathway, microarray data from muscle and skin were examined from 22 nonburned and 20 burned children. RESULTS: Burn patients exhibited a profound hypermetabolic response, as seen by a significant increase in REE (P < .05) and loss of lean body mass without altered muscle FSR, indicating a shift to catabolism after thermal injury. In muscle, the phosphorylation of eEF2K-dependent eEF2 was down regulated early and middle postburn. Similar changes in eEF2K and eEF2 levels occurred in skin at the early time point. Total amounts of eEF2 and eEF2K were not altered. CONCLUSION: Burn induces prolonged activation of eEF2K and eEF2. Alterations in these mediators may contribute to profound hypermetabolism in severely burned patients. Song J, Finnerty CC, Herndon DN, Kraft R, Boehning D, Brooks NC, Tompkins RG, Jeschke MG.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2012Burn size and survival probability in paediatric patients in modern burn care: a prospective observational cohort studyJA Lancet37998201013-1021BACKGROUND: Patient survival after severe burn injury is largely determined by burn size. Modern developments in burn care have greatly improved survival and outcomes. However, no large analysis of outcomes in paediatric burn patients with present treatment regimens exists. This study was designed to identify the burn size associated with significant increases in morbidity and mortality in paediatric patients. METHODS: We undertook a single-centre prospective observational cohort study using clinical data for paediatric patients with burns of at least 30% of their total body surface area (TBSA). Patients were stratified by burn size in 10% increments, ranging from 30% to 100% TBSA, with a secondary assignment made according to the outcome of a receiver operating characteristic (ROC) analysis. Statistical analysis was done with Student's t test, ?(2) test, logistic regression, and ROC analysis, as appropriate, with significance set at pKraft R, Herndon DN, Al-Mousawi AM, Williams FN, Finnerty CC, Jeschke MG.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2012Harborview burns -- 1974 to 2009JAJ64122PLoS ONE77e40086Article reviews changes in burn care at the Harborview Burn Center in Seattle, WA, from 1974 to 2009. It reports results and include observations on changes in numbers of standard and short-stay admissions, age distribution, transport patterns, percent of total body surface area burned, race/ethnicity, payer status, fluid creep, burn surgery, length of stay, mortality, trajectory to death, and unprecedented survival. A total of 14,266 consecutive admissions were analyzed in five-year periods and many parameters compared to the National Burn Repository. Fluid resuscitation was compared in five-year periods from 1974 to 2009. Mortality was modeled with the rBaux model. Changes that are highlighted include: (1) the large increase in numbers of total and short-stay admissions, (2) the decline in numbers of large burn injuries, (3) that unadjusted case fatality declined to the mid-1980s but has changed little during the past two decades, (4) that race/ethnicity and payer status disparity exists, and (5) that the trajectory to death changed with fewer deaths occurring after seven days post-injury. Administration of fluids in excess of the Baxter formula during resuscitation of uncomplicated injuries was evident at least by the early 1990s and has continued to the present; the cause is likely multifactorial but pre-hospital fluids, prophylactic tracheal intubation, and opioids may be involved.Engrav LH, Heimbach DM, Rivara FP, Kerr KF, Osler T, Pham TN, Sharar SR, Esselman PC, Bulger EM, Carrougher GJ, Honari S, Gibran NSNorthwest Regional Burn Model SystemYesdevopsadmin
2013Pruritus in adult burn survivors: Postburn prevalence and risk factors associated with increased intensityJAJ65331Journal of Burn Care and Research34194-101Study investigated self-reported postburn pruritus (itching) in two groups of adult burn survivors. Descriptive statistics, general linear regression, and mixed model repeated measures analyses were used to test statistical significance. Group 1 consisted of 637 participants who were injured from 2006 to 2010 and were followed up prospectively for 2 years from the time of injury. Prevalence and severity of pruritus were compared across multiple subgroups. Prevalence of pruritus at discharge, 6, 12, and 24 months following injury were 93, 86, 83, and 73 percent, respectively. Regression results established that burn size and the percentage of total body surface area grafted were correlated to itch intensity values. Group 2 included 336 participants injured 4 to 10 years before an assessment using the validated 5-D Itch Scale. Many patients (44.4 percent) reported itching in the area of the burn, graft, or donor site. Within this group, 76 percent reported itching for less than 6 hours per day, and 52 and 29 percent considered itch intensity to be mild or moderate, respectively. The impact of postburn pruritus on leisure, vocation, and sleep are described for those long-term survivors suffering from postburn pruritus. New predictors for postburn itch were identified to include younger age, dry skin, and raised/thick scars. The findings confirm that the prevalence of burn pruritus is high, initially affecting more than 90 percent and persisting for more than 40 percent of long-term burn survivors.Carrougher GJ, Martinez EM, McMullen KS, Fauerbach JA, Holavanahalli RK, Herndon DN, Wiechman SA, Engrav LH, Gibran NSNorthwest Regional Burn Model SystemYesdevopsadmin
2006Quality of Life of Young Adults Who Survived Pediatric BurnsJA J. Burn Care & Research276773-778Ninety-five young adult pediatric burn survivors, ages 18 to 28, who were an average of 14 years after massive burn, were questioned about their quality of life. The Quality of Life Questionnaire (QLQ) by Evans and Cope was used to assess their long-term adjustment in diverse environmental settings. Results revealed burn survivors as a group rated their overall quality of life lower than the normal population. They also had differences from the normal population in some subdomains of the QLQ. When analyzed by sex, only one difference was seen with females rating their involvement in sports activities lower than males. Analysis of the effect of age showed that male burn survivors had improvements with their quality of life with age and the further they were after burn. In conclusion, the ability to detect distress among burn survivors will provide targets for related treatment and subsequent assessment of efficacy of intervention.Rosenberg, M., Blakeney, P., Robert, R., Thomas, C., Holzer III, C., Meyer III, W.J. Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2011Changes in cardiac physiology after severe burn injuryJA J Burn Care Res322269-274Cardiac stress, mediated by increased catecholamines, is the hallmark of severe burn injury typified by marked tachycardia, increased myocardial oxygen consumption, and increased cardiac output (CO). It remains one of the main determinants of survival in large burns. Currently, it is unknown for how long cardiac stress persists after a severe injury. Therefore, the aim of this study was to determine the extent and duration of cardiac stress after a severe burn. To determine persistence of cardiac alteration, the authors determined cardiac parameters of all surviving patients with burns = 40% TBSA from 1998 to 2008. One hundred ninety-four patients were included in this study. Heart rate, mean arterial pressure, CO, stroke volume, cardiac index, and ejection fractions were measured at regular intervals from admission up to 2 years after injury. Rate pressure product was calculated as a correlate of myocardial oxygen consumption. All values were compared with normal nonburned children to validate the findings. Statistical analysis was performed using log transformed analysis of variance with Bonferroni correction and Student's t-test, where applicable. Heart rate, CO, cardiac index, and rate pressure product remained significantly increased in burned children for up to 2 years when compared with normal ranges (P < .05), indicating vastly increased cardiac stress. Ejection fraction was within normal limits for 2 years. Cardiac stress persists for at least 2 years postburn, and the authors suggest that attenuation of these detrimental responses may improve long-term morbidity.Williams F.N., Herndon D.N., Suman O.E., Lee, J.O., Norbury W.B., Branski L.K., Mlcak R.P., Jeschke M.G.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2006Thermoregulation during exercise in severely burned childrenJA Pediatr. Rehabil.9157-64INTRODUCTION: Severe burns result in skeletal muscle catabolism and weakness, which is worsened by prolonged physical inactivity. Exercise would be an ideal tool in the rehabilitation of burned children. However, it has been postulated that burned children may have an excessive rise in body temperature during exercise compared to non-burned children, partly due to the reduced area available for heat dissipation, thereby questioning the safety of exercise in burned children. METHODS: Children (n = 15) with >40% total body surface area (TBSA) burns and non-burned children (n = 13) successfully completed this study. All subjects completed 20 minutes of treadmill exercise at approximately 75% of their peak aerobic power. Tympanic temperature (Ttym), burned and unburned skin temperature were recorded pre-exercise, every 2 minutes during exercise and during recovery. RESULTS: Within burned children, significant differences between the temperature of unburned skin and burned skin, during later stages of sub-maximal exercise (minutes 12-20) were present. However, there were no significant differences between burned and non-burned children in Ttym or unburned skin temperature indicating that severely burned children do not demonstrate an impaired thermoregulatory response to 20 minutes of sub-maximal exercise at room temperatures. CONCLUSION: It is concluded that exercise at moderate intensities conducted at room temperature is safe in burned children with McEntire, S.J., Herndon, D.N., Sanford, A.P., Suman, O.E.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2008Gender differences in pediatric burn patients: Does it make a difference? JA Ann. Surg.2481126-136Objective: There is evidence that females have a better outcome in intensive care units (ICUs) when compared with males. The aim of the present study was to compare hospital course and physiologic markers between severely burned pediatric females and males. Summary Background Data: One-hundred eighty-nine children sustaining a 40% total body surface area burn were divided into females (n = 76) and males (n = 113). Methods: Patient demographics, clinical parameters, and mortality were noted. Muscle protein synthesis was determined by stable isotope technique. Resting energy expenditure (REE) was measured by indirect calorimetry and body composition by dual x-ray absorptiometry. Serum hormones, proteins, and cytokines were determined. Cardiac function and liver size were determined by repeated ultrasound measurements. Results: There were no significant differences between females and males for mortality, demographics, burn size, nutritional intake, or concomitant injuries. ICU stay was in females: 29±3 days whereas the stay in males was 38±3 days, P Jeschke, M.G., Mlcak, R.P., Finnerty, C.C., Norbury, W.B., Przkora, R., Kulp, G.A., Gauglitz, G.G., Zhang, X.J., Herndon, D.N. Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2007Pamidronate preserves bone mass for at least 2 years following acute administration for pediatric burn injuryJA Bone412297-302We have previously shown that pamidronate, when given within 10 days of burn injury, preserves lumbar spine bone mineral content from admission to discharge in 6-8 weeks and at 6 months increases both lumbar spine and total body bone mineral content (BMC) over placebo. We followed patients unblinded after 6 months every 3 months up to 2 years post-burn to see if the effects of pamidronate were sustained. Additionally, we assessed bone remodeling at 1 year post-burn by iliac crest bone biopsy. We enrolled 57 subjects who were initially randomized to pamidronate (n=32) and placebo (n=25). After 2 years, 21 subjects (pamidronate=8, placebo=13) remained. Analysis of bone densitometry by dual energy X-ray absorptiometry revealed an effect of both treatment (pPrzkora, R., Herndon, D.N., Sherrard, D.J., Chinkes, D.L., Klein, G.L. Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2006Assessing Potential Suicide Risk of Young Adults Burned as ChildrenJA J. Burn Care & Research276779-785This study examines potential for suicide risk among young adults burned as children and examines characteristics associated with potential risk. Eighty-five young adults were administered the Suicide Probability Scale, which contains four clinical subscales: suicide ideation, hopelessness, negative self-evaluation, and hostility; the 16 Personality Factor Questionnaire; and the Family Environment Scale. Burn survivors reported more feelings of hopelessness in comparison to the reference group. High anxiety was positively associated with hopelessness, suicide ideation, hostility and negative self-evaluation whereas high extroversion was inversely related with hopelessness, negative self-evaluation, and hostility. Multiple regression analyses revealed emotional stability explained 29% of the variance, self-reliance 17% of the variance, and both 38% of the variance in relation to Suicide Probability Scale scores; and increased family conflict 12% of the variance. Results suggest that high anxiety, emotional reactivity, and family conflict correlate with increased potential suicide risk; whereas, extroversion correlates with decreased risk.Rosenberg, L., Robert, R., Thomas, C., Holzer III, C.E., Blakeney, P., Meyer III, W.J.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2010Sexual Attitudes and Behavior of Young Adults Who were Burned as ChildrenJA Burns37 215-221OBJECTIVE: Little is known about sexual attitudes and behaviors of adults burned as children. We hypothesized that survivors with large burn scars would have differences in sexual attitudes and behaviors from their unburned counterparts. METHODS: Ninety-two young adults (50 males and 42 females), ages 21.0 ± 2.7 years old, who were burned 30% total body surface area or more as children 14.2 ± 5.4 years earlier, completed the questionnaire "What Young People Believe and Do" by RC Sorenson, 1972. The questionnaire explores sources of sexual information, attitudes toward different sexual behaviors, and experience with different sexual behaviors. RESULTS: Sixty-five percent of the females and 52% of the males currently had a significant other. Although only 54% women and 60% of men felt they were sexually attractive, 83 and 87%, respectively, endorsed feeling confident about sex. Experience with sexual intercourse was common: 90% of females and 76% of males. Burn severity was not significantly correlated with sexual attitudes and behaviors. CONCLUSION: The majority of 92 young adults burned as children described sexual attitudes and behaviors comparable to the general population and the vast majority had significant sexual experience. Females reported more sexual behavior post-burn than males.Meyer, WJ, Russell, W, Thomas, CR, Robert, RS, Blakeney, B.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2012Long-Term Propranolol Use in Severely Burned Pediatric PatientsJA Annals of Surgery 2563402-411Objective: To determine the safety and efficacy of propranolol given for 1 year on cardiac function, resting energy expenditure, and body composition in a prospective, randomized, single-center, controlled study in pediatric patients with large burns. Background: Severe burns trigger a hypermetabolic response that persists for up to 2 years postburn. Propranolol given for 1 month postburn blunts this response. Whether propranolol administration for 1 year after injury provides a continued benefit is currently unclear. Methods: One-hundred seventy-nine pediatric patients with more than 30% total body surface area burnswere randomized to control (n=89) or 4mg/kg/d propranolol (n = 90) for 12 months postburn. Changes in resting energy expenditure, cardiac function, and body composition were measured acutely at 3, 6, 9, and 12 months postburn. Statistical analyses included techniques that adjusted for non-normality, repeated-measures, and regression analyses. P < 0.05 was considered significant. Results: Long-term propranolol treatment significantly reduced the percentage of the predicted heart rate and percentage of the predicted resting energy expenditure, decreased accumulation of central mass and central fat, prevented bone loss, and improved lean body mass accretion. There were very few adverse effects from the dose of propranolol used. Conclusions: Propranolol treatment for 12 months after thermal injury, ameliorates the hyperdynamic, hypermetabolic, hypercatabolic, and osteopenic responses in pediatric patients. This study is registered at clinicaltrials.gov: NCT00675714.Herndon DN, Rodriguez NA, Diaz EC, Hegde S, Jennings K, Mlcak RP, Suri JS, Lee JO, Williams FN, Meyer W, Suman OE, Barrow RE, Jeschke MG, Finnerty CC.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2010Donor site wound protein synthesis correlates with length of acute hospitalization in severely burned childrenJA Wound Repair Regen18 277-283Autografting of burn wounds results in generation of donor site wounds. Here we measured donor site wound protein fractional synthesis rate (FSR) in a burn pediatric population and showed that FSR increases over time postsurgery and correlates with the length of hospital stay (LOS) normalized for total body surface area (TBSA) burn size. 3.9 +/- 1.1 days after the grafting surgery patients participated in a metabolic study consisting of continuous infusion of l-[ring-(2)H(5)]-phenylalanine and donor site wound punch biopsies. Donor site wound protein FSR was 10.4 +/- 7.5%/day. Wound FSR demonstrated linear correlation with the time postsurgery (pDemidmaa, T., Chinkes, D.L., Zhang, X., Aarsland, A., Herndon, D.N.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2008Insulin resistance postburn: Underlying mechanisms and current therapeutic strategiesJA J Burn Care Res295683-94The profound hypermetabolic response to burn injury is associated with insulin resistance and hyperglycemia, significantly contributing to the incidence of morbidity and mortality in this patient population. These responses are present in all trauma, surgical, or critically ill patients, but the severity, length, and magnitude is unique for burn patients. Although advances in therapeutic strategies to attenuate the postburn hypermetabolic response have significantly improved the clinical outcome of these patients during the past years, therapeutic approaches to overcome stress-induced hyperglycemia have remained challenging. Intensive insulin therapy has been shown to significantly reduce morbidity and mortality in critically ill patients. High incidence of hypoglycemic events and difficult blood glucose titrations have led to investigation of alternative strategies, including the use of metformin, a biguanide, or fenofibrate, a peroxisome proliferator-activated receptor (PPAR)-gamma agonist. Nevertheless, weaknesses and potential side affects of these drugs reinforces the need for better understanding of the molecular mechanisms underlying insulin resistance postburn that may lead to novel therapeutic strategies further improving the prognosis of these patients. This review aims to discuss the mechanisms underlying insulin resistance induced hyperglycemia postburn and outlines current therapeutic strategies that are being used to modulate hyperglycemia after thermal trauma.Gauglitz, G.G., Herndon, D.N., Jeschke, M.G. Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2004Psychological Problems Reported by Young Adults Who Were Burned as Children, Shriners Hospitals for Children, Galveston Burns HospitalJA J. Burn Care & Rehabilitation25 98-106This study assessed long-term psychosocial sequelae of young adult pediatric burn survivors. Subjects were 101 young adults (43 females and 58 males) between the ages of 18 and 28 years who were at least 2 years (average, 14 years) postburn at least 30% TBSA (mean = 54 ± 20%). Educational status was 25% high school dropouts, 28% high school graduation only, 32% some college, and 5% completed college. Seventy-seven percent either worked or attended school; 28% had had a long-term partner. When assessed by Achenbach's Young Adult Self-Report (YASR) scale and compared with its published reference group, the males reported differences only in the somatic complaints, but the females endorsed significantly more externalizing and total problems, specifically withdrawn behaviors, somatic complaints, thought problems, aggressive behavior, and delinquent behavior. Despite these problems suffered by some female pediatric burn survivors, the overall outcome revealed that most pediatric burn survivors are making the transition into adulthood with minimal unexpected difficulty. The past two decades have witnessed a marked increase in the number of individuals who survived severe burns as children and are now becoming adults. Twenty-five years ago only half of the children with greater than 50%Total Body Surface Area (TBSA) burns survived. Now, half of those who have 85% TBSA burns survive; and essentially all those with smaller burns routinely survive. 1 Many of those young survivors face futures as persons with obvious burn scars and significant disfigurement to the face and /or extremities (most burns over 30% cause such scarring). Yet, burn care experts know almost nothing about the impact of the injury and its accompanying disfigurement and/or disability upon the psychosocial functioning and/or quality of life of pediatric burn survivors when they become adults. Most assessments of the psychosocial problems and adjustment of pediatric burn survivors focus on the immediate burn period through the first years post-burn and indicate that the majority of young survivors during these early years have reasonably good psychosocial adjustment, with only about thirty percent having significant psychosocial problems. 2-6 These studies did not target long-term psychosocial adjustment during the survivors' transition from dependent adolescents to independent adults; they are not true longitudinal studies that involve more than one time point of evaluation. Many people, lay and professional, have predicted that such survivors will lead lonely, isolated lives, rejected by peers and/or afraid to enter the mainstream of society. A few studies concerning how pediatric burn survivors function as adults have been published. 7-16 All of these reports have been optimistic and somewhat reassuring to the people who care for children who are burned. Blakeney et al 3,12,17 conducted three studies of older adolescents and young adults and found that, in each sample, 40 to 50% of the individuals presented as well adjusted while 50 to 60% presented with some degree of psychological distress; 25% presented with symptoms severe enough to warrant clinical attention. The most recent study by Sheridan et al 16 used a standardized instrument, the SF-36, to assess the quality of life of 80 adults (ages 24 ± 8 years) who received massive burn injuries of at least 70% TBSA as children (15.7 ± 5.5 years since injury). These individuals are reported to have, in comparison with the age-matched standardization group, similar responses in all domains except in physical disability. This would indicate that, even with physical complaints, the burn survivors are achieving satisfactory lives. However, these studies leave many questions unanswered. The present authors, responsible in large degree for this optimistic view, know from our clinical work as well as research data that doing well and responding within the normal range are not phrases synonymous with entirely happy and adjusting with ease. What are the struggles of these children as they enter adulthood? Are they succeeding to their own satisfaction? Do they need special assistance? Are needed services provided? In publishing these general outcomes are we failing to adequately portray the difficulties and obstacles facing burn survivors as they fight to establish themselves as independent, self-supporting and valuable individuals? The current study of 101 young adults burned as children was designed to address some of these unanswered questions and to identify more specifically the questions to be pursued. Because of our limited opportunity to interact with these young people who are now surpassing the upper age limit to receive care at our pediatric hospital, we attempted to gather as much information as was practical from each of the participants. Such an approach yields much data and will be reported in segments. The current paper, ie, the first segment, provides a comprehensive demographic and sociological picture and an overview of the psychological adjustment as reported by these individuals who suffered major burn injuries as children.Meyer, III, W.J., Blakeney, P., Russell W., Thomas, C., Robert, R., Berniger F., Holzer, III, C.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2011Burns: Where are we standing with propranolol, oxandrolone, recombinant human growth hormone and the new incretin analogs?JA Curr OpinClin Nutr Metab Care14 2176-181https://pubmed.ncbi.nlm.nih.gov/21157309/PURPOSE OF REVIEW: The hypermetabolic response in critically ill patients is characterized by hyperdynamic circulatory, physiologic, catabolic and immune system responses. Failure to satisfy overwhelming energy and protein requirements after, and during critical illness, results in multiorgan dysfunction, increased susceptibility to infection, and death. Attenuation of the hypermetabolic response by various pharmacologic modalities is emerging as an essential component of the management of severe burn patients. This review focuses on the more recent advances in therapeutic strategies to attenuate the hypermetabolic response and its associated insulin resistance postburn. RECENT FINDINGS: At present, beta-adrenergic blockade with propranolol represents probably the most efficacious anticatabolic therapy in the treatment of burns. Other pharmacological strategies include growth hormone, insulin-like growth factor, oxandrolone and intensive insulin therapy. SUMMARY: Novel approaches to the management of critical illness by judicious glucose control and the use of pharmacologic modulators to the hypercatabolic response to critical illness have emerged. Investigation of alternative strategies, including the use of metformin, glucagon-like-peptide-1 and the PPAR-? agonists are under current investigation. Gaulglitz G.G., Williams F.N., Herndon D.N., Jeschke M.G.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2006The influence of age and gender on resting energy expenditure in severely burned childrenJA Ann. Surg.2441121-130Introduction: Recent evidence suggests that female severely burned children have higher endogenous anabolic hormone levels and a shorter ICU stay compared with males. The purpose of this study was to analyze the influence of age and gender on resting energy expenditure (REE) in severely burned children from acute hospitalization through 12 months postburn. Methods: A total of 100 pediatric patients with >40% total body surface area (TBSA) burn were enrolled in a prospective study and followed by indirect calorimetry measurements. The REE was expressed as actual REE kcal/d, percent of predicted REE, and REE/ body mass index (BMI). Statistical analysis was performed by Student t test and one-way ANOVA for repeated measures. Significance was accepted at P < 0.05. Results: The measured REE was significantly higher in males versus females at all time points (P < 0.05). The percent of predicted REE was significantly higher in males versus females during the acute hospitalization, at discharge, 6 and 9 months postburn (P < 0.05). The REE/BMI showed a significant difference between males and females at the acute and discharge time period (P < 0.05). In children 3 to 9.9 years of age, the measured REE and the percent of predicted REE were significantly higher in males versus females during the acute study, at discharge and 6 months postburn (P < 0.05). The measured REE at discharge, 9 and 12 months postburn for children >10 years of age was significantly higher in males compared with females (P < 0.05). Conclusion: Data show that female children exert a decreased hypermetabolic response compared with male children, which may improve burn outcomes in females.Mlcak, R.P., Jeschke, M.G., Barrow, R.E., Herndon, D.N.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2004Effects of long-term oxandrolone administration in severely burned childrenJA Surgery1362219-224BACKGROUND: Severe burns cause exaggerated catabolism of muscle protein and inhibit bone deposition. Weakness and bony growth arrest interfere with rehabilitation. The purpose of this study was to determine whether oxandrolone administration for 1 year after the burn reverses muscle and bone catabolism in hypermetabolic pediatric burn patients. METHODS: Children with burns greater than 40% total body surface area were enrolled into a randomized controlled trial to receive oxandrolone as a long-term anabolic agent. All patients received similar clinical care. Subjects were studied at discharge (95% healed) and at 6, 9, and 12 months after the burn, after treatment with 0.1 mg/kg po bid or placebo. Serum hepatic transaminases were measured. Lean body mass (LBM), bone mineral content (BMC,) and bone mineral density (BMD) were measured by dual energy x-ray absorptiometry. Patients completed a safety questionnaire and were reviewed clinically at intervals. RESULTS: The groups were similar in age, weight, and total body surface area burned. LBM was significantly greater with oxandrolone at 6, 9, and 12 months after the burn (P < .001) and BMC at 12 months (P < .016). Age- and gender-matched BMD z scores were significantly better with oxandrolone (P < .039). Liver transaminases were unaffected. CONCLUSIONS: Long-term administration of oxandrolone safely improves LBM, BMC, and BMD in severely burned children.Murphy, K.D., Thomas, S., Mlcak, R.P., Chinkes, D.L., Klein, G.L., Herndon, D.N.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2005Objective assessment of burn scar vascularity, erythema, pliability, thickness, and planimetryJA Dermatol Surg.31148-58BACKGROUND: There is currently a lack of objective methods to assess scars. OBJECTIVES: The objectives of this study were to (1) determine the pattern of scar formation up to 24 months after a burn, compare clinical and photographic scar assessment, and determine what percentage of scars became hypertrophic after a major trauma and (2) replace each clinical parameter of a clinical scar scale by objective measurements. METHODS: Scars from 62 patients were evaluated from the acute phase up to 24 months after the burn, using photographs and clinical assessment during visits. Photographic planimetry helped estimate the percentage of scars that became hypertrophic. Thereafter, 69 patients had scars evaluated using clinical assessment and several instruments to evaluate pigmentation, erythema, pliability, thickness, and perfusion. The sensitivity and specificity of each instrument were determined regarding their ability to correlate with the parameters of hypertrophic and nonhypertrophic scars. Analysis of variance and Tukey's test were used in statistical analysis, with pOliveira, G.V., Chinkes, D., Mitchell, C., Oliveras, G., Hawkins, H.K., Herndon, D.N.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2009Abnormal insulin sensitivity persists up to three years in pediatric post-burnJA J Clin Endocrinol Metab9451656-1664Context: The acute hypermetabolic response post-burn is associated with insulin resistance and hyperglycemia, significantly contributing to adverse outcome of these patients. Objective: The aim of the study was to examine the persistence of abnormalities of various clinical parameters commonly utilized to assess the degree of insulin resistance in severely burned children for up to 3 yr after the burn injury. Design, Setting and Patients: A total of 194 severely burned pediatric patients, admitted to our institute between 2002 and 2007, were enrolled in this prospective study and compared to a cohort of 95 nonburned, noninjured children. Main Outcome Measures: Urinary cortisol, epinephrine, and norepinephrine, serum cytokines, and resting energy requirements were determined at admission and 1, 2, 6, 9, 12, 18, 24, and 36 months post-burn. A 75-g oral glucose tolerance test was performed at similar time points; serum glucose, insulin, and C-peptide were measured; and insulin sensitivity indices, such as ISI Matsuda, homeostasis model assessment, quantitative insulin sensitivity check index, and ISI Cederholm, were calculated. Statistical analysis was performed by ANOVA with Bonferroni correction with significance accepted at P < 0.05. Results: Urinary cortisol and catecholamines, serum IL-7, IL-10, IL-12, macrophage inflammatory protein-1b, monocyte chemoattractant protein-1, and resting energy requirements were significantly increased for up to 36 months post-burn (P < 0.05). Glucose values were significantly augmented for 6 months post-burn (P < 0.05), associated with significant increases in serum C-peptide and insulin that remained significantly increased for 36 months compared to nonburned children (P < 0.05). Insulin sensitivity indices, ISI Matsuda, ISI quantitative insulin sensitivity check index, and homeostasis model assessment were abnormal throughout the whole study period, indicating peripheral and whole body insulin resistance. The insulinogenic index displayed physiological values, indicating normal pancreatic ß-cell function. Conclusions: A severe burn is associated with stress-induced insulin resistance that persists not only during the acute phase but also for up to 3 yr post-burn.Gauglitz, G.G., Herndon, D.N., Kulp, G.A., Meyer, W.J., Jeschke, M.G.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2006Resting energy expenditure in severaly burned children: Analysis of agreement between indirect calorimetry and prediction equations using the Bland-Altman methodJA Burns32 335-345INTRODUCTION: Knowledge of a child's resting energy expenditure (REE) is essential in optimizing nutritional support for severely burned children. The provision of adequate nutritional support is vital in order to avoid the consequences of malnutrition or overfeeding. Nutritional requirements for severely burned children are often based on equations for estimates of REE. The accuracy of the predictive equations of REE has been questioned and many authors have advocated the measurement of REE. This study tests the hypothesis that estimates of REE vary significantly from measured REE (MREE) in a population of severely burned children, and are not accurate for determining nutritional requirements. METHODS: In 91 severely burned children aged between 3 and 18 years, REE was measured by indirect calorimetry (MREE) at the height of the hypermetabolic response and compared with predicted equations (PREE) from the Food and Agriculture/World Health Organization/United Nations University (FAO/WHO/UNU), Schofield-HW and Harris-Benedict. Agreement between indirect calorimetry and predicted equations was assessed following the Bland-Altman method. RESULTS: In the entire cohort group, predicted REE from all three equations were significantly lower compared to MREE (pSuman, O.E., Mlcak, R.P., Chinkes, D.L., Herndon, D.N.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2008Differences in Behavioral Perceptions between Young Adult Burn Survivors and Cross-InformantsJA J. Burn Care Research29 750-755The purpose of this study is to gain insight into the level of agreement, in terms of personal problems, between burn survivors and an informant with whom they have a close personal relationship. Participants in the study were 72 young adult burn survivors between the ages of 18 and 28 with a mean age of 20.9 +/- 2.6 years. There were 37 males and 35 females in the group. The mean total burn surface area was 55.34 +/- 19.9% with injuries occurring before the age of 18, a minimum of 2 years prior to the study with a mean of 14.3 +/- 4.9 years since burned. To assess this issue the participants completed The Young Adult Self-Report (YASR), and the informants completed The Young Adult Behavior Checklist (YABCL). In relationship to burn survivors, the informant group comprised 67% mothers, 3% fathers, and 30% domestic partners. Paired t-test and Pearson Correlations Coefficients were calculated to compare the differences and variance of the Total Problems Scale, Internalizing Scale and Externalizing Scale for the YABCL and YASR results. The family members of burn survivors reported more problems for their young adult relatives than did the informants of the reference population. In general, the YACBL scores were higher than and highly correlated to the YASR scores. Although there were not ethic differences in the YABCL and the YASR measures, the correlation between the YABCL and the YASR was excellent for Caucasian families but not good for Black and Hispanic families. This study supports concerns about the need for routine follow-up into adulthood for those individuals who were burned as children. This would seem to be especially critical for the female population.Russell, W., Holzer III, C.E., Robert, R.S., Thomas, C.R., Blakeney, P., Meyer III, W.J.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2012Personality Disorders in Young Adult Survivors of Pediatric Burn InjuryJA Journal of Personality Disorders262255-266Objective: Life experience shapes personality and chronic trauma in childhood has been associated with risk for development of subsequent personality disorder. The purpose of this study is to determine the prevalence and character of personality disorders and traits in young adult survivors of severe pediatric burn injury. Method: SCID-II and 16PF were completed by 98 young adult survivors of pediatric burn trauma. Results: 48 (49%) met criteria for one or more personality dis-orders. The most frequent personality disorders were Paranoid (19.4%), Passive Aggressive (18.4%), Antisocial (17.3%), Depressive (11.2%), and Borderline (9.2%). Diagnosis with a personality disorder was associated with comorbid Axis I diagnoses and strongly correlated with personality traits as measured by the 16PF. Conclusions: Pediatric burn trauma is similar to other chronic traumas of childhood in signi?cant correlation with subsequent personality disorder.Christopher R. Thomas, MD, William Russell, MA, Rhonda S. Robert, PhD, Charles E. Holzer, PhD, Patricia Blakeney, PhD, and Walter J. Meyer, MDPediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2007Inhalation injury in severely burned children does not augment the systemic inflammatory responseJA Crit. Care111R22INTRODUCTION: Inhalation injury in combination with a severe thermal injury increases mortality. Alterations in inflammatory mediators, such as cytokines, contribute to the incidence of multi-organ failure and mortality. The aim of the present study was to determine the effect of inhalation injury on cytokine expression in severely burned children. METHODS: Thirty severely burned pediatric patients with inhalation injury and 42 severely burned children without inhalation injury were enrolled in the study. Inhalation injury was diagnosed by bronchoscopy during the first operation. Blood was collected within 24 hours of admission and again at five to seven days following admission. Cytokine expression was profiled using multi-plex antibody-coated beads. Significance was accepted at a p value of less than 0.05. RESULTS: The mean percentages of total body surface area burned were 67% +/- 4% (56% +/- 6%, third-degree burns) in the inhalation injury group and 60% +/- 3% (45% +/- 3%, third-degree burns) in the non-inhalation injury group (p value not significant [NS]). Mean age was 9 +/- 1 years in the inhalation injury group and 8 +/- 1 years in the non-inhalation injury group (p value NS). Time from burn to admission in the inhalation injury group was 2 +/- 1 days compared to 3 +/- 1 days in the non-inhalation injury group (p value NS). Mortalities were 40% in the inhalation injury group and 12% in the non-inhalation injury group (p < 0.05). At the time of admission, serum interleukin (IL)-7 was significantly increased in the non-inhalation injury group, whereas IL-12p70 was significantly increased in the inhalation injury group compared to the non-inhalation injury group (p < 0.05). There were no other significant differences between groups. Five to seven days following admission, all cytokines decreased with no differences between the inhalation injury and non-inhalation injury cohorts. CONCLUSION: In the present study, we show that an inhalation injury causes alterations in IL-7 and IL-12p70. There were no increased levels of pro-inflammatory cytokines, indicating that an inhalation injury in addition to a burn injury does not augment the systemic inflammatory response early after burn.Finnerty, C.C., Herndon, D.N., Jeschke, M.G.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2011Prediction of maximal aerobic capacity in severely burned childrenJA Burns374682-686INTRODUCTION: Maximal oxygen uptake (VO2 peak) is an indicator of cardiorespiratory fitness, but requires expensive equipment and a relatively high technical skill level. PURPOSE: The aim of this study is to provide a formula for estimating VO2 peak in burned children, using information obtained without expensive equipment. METHODS: Children, with = 40% total surface area burned (TBSA), underwent a modified Bruce treadmill test to assess VO(2) peak at 6 months after injury. We recorded gender, age, %TBSA, %3rd degree burn, height, weight, treadmill time, maximal speed, maximal grade, and peak heart rate, and applied McHenry's select algorithm to extract important independent variables and Robust multiple regression to establish prediction equations. RESULTS: 42 children; 7-17 years old were tested. Robust multiple regression model provided the equation: VO2 =10.33-0.62 × age (years)+1.88 × treadmill time (min)+2.3 (gender; females = 0, males = 1). The correlation between measured and estimated VO2 peak was R = 0.80. We then validated the equation with a group of 33 burned children, which yielded a correlation between measured and estimated VO2 peak of R = 0.79. CONCLUSIONS: Using only a treadmill and easily gathered information, VO2 peak can be estimated in children with burns.Porro L., Rivero H.G., Gonzalez D., Tan A., Herndon D.N., Suman O.E. Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2006Body composition changes with time in pediatric burn patientsJA J. Trauma 605968-971Background: Major trauma and burns are associated with whole body catabolism which can persist for 1 or more years after injury. This study investigates body composition in massively burned children for up to 2 years. Methods: Twenty-five pediatric patients with greater than 40% total body surface area burns were studied. At discharge, 6, 12, 18, and 24 months after burn height, weight, body composition, resting energy expenditure (REE), serum growth hormone, insulin-like growth factor-I (IGF-I), IGF binding protein-3 (IGFBP-3), insulin, cortisol, parathyroid hormone, and thyroid hormones were measured. Tukey's test was used for analysis. Significance was accepted at p < 0.05. Results: Lean body mass, fat mass, bone mineral content, height, and weight increased significantly during the second year after burn. Percent predicted REE decreased significantly, whereas IGFBP-3 and parathyroid hormone levels increased significantly over time. Insulin and T3 uptake were significantly higher at discharge. Conclusions: Body composition of severely burned children significantly improved in the second year compared with the first year after injury. This demonstrates a need for long-term rehabilitation in these burn patients.Przkora, R., Barrow, R.E., Jeschke, M.G., Suman, O.E., Celis, M., Sanford, A.P., Chinkes, D.L., Mlcak, R.P., Herndon, D.N. Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2007The Importance of Family Environment for Young Adults Burned During ChildhoodJA Burns33 541-546This study examined the role of family environment for young adult burn survivors making the transition from adolescence to adulthood. Ninety-three young adults who sustained large burns as children were asked to describe their families using the Family Environment Scale (FES). When examining the difference between burn survivors and the normative sample of the FES, burn survivors did not perceive their current family environment different than the normative group. However, burn survivors endorsed more items in the areas of achievement orientation and moral-religious emphasis, and less involvement in intellectual-cultural activities. We also examined the relationship between family characteristics on the FES and psychological adjustment of burn survivors as measured by the Young Adult Self-Report (YASR). Increased conflict on the FES was positively associated with YASR total problem score, internalizing behaviors, and externalizing behaviors. In addition, participation in recreational and social activities and organization both inversely correlated with YASR total problem score. In conclusion, increased family conflict was associated with decreased psychological adjustment of burn survivors as measured by the YASR total problem score.Rosenberg, L., Blakeney, P., Meyer, W. J., Holzer, C., Thomas, C.R.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2005Effects of growth hormone on anthropometric measurements and cardic function in children with thermal injuryJA Burns31160-66Severe burn injuries are associated with growth delays a persistent hypermetabolic response and severe muscle catabolism and wasting. Growth hormone (GH), a potent anabolic agent and salutary modulator of post-traumatic metabolic responses has been shown to decrease muscle wasting, improve net protein synthesis and attenuate growth delays in burned children. In non-burned populations, GH has recently been shown to be of benefit in enhancing cardiac performance and improving cardiac contractility and efficiency. Yet, whether administration of GH will induce similar improvements in cardiac function in severely burned children is presently unknown. We therefore, investigated whether the administration of GH initiated upon hospital discharge (95% healed) and continued for 1-year post-burn would improve resting cardiac function in burned children. Severely burned children were randomized to receive either saline placebo (n = 37) or 0.05 mg/kg per day of GH (n = 39) from discharge until 12-month post-burn. Outcome variables included height, weight, lean body mass, resting energy expenditure, cardiac index, stroke-volume index, heart rate and left ventricular ejection fraction. Results: height, weight, lean body mass and ejection fraction showed a significant increase with GH. Our results indicate that severely burned children treated with long-term GH show a significant improvement in left ventricular ejection fraction.Mlcak, R.P., Suman, O.E., Murphy, K., Herndon, D.N.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2005Metabolic and hormonal changes of severely burned children receiving long-term oxandrolone treatmentJA Ann. Surg.2423384-9 discussion 390-1Objective: When given to children for 1 year after a severe burn, oxandrolone significantly improves lean body mass, bone mineral content, and muscle strength. The beneficial effects of oxandrolone on height and weight were observed 1 year after treatment was discontinued. To study the efficacy of oxandrolone in severely burned children for 12 months after burn and 12 months after the drug was discontinued. Summary Background Data: Oxandrolone attenuates body catabolism during the acute phase after burn. It is unclear whether oxandrolone would have any beneficial effects during long-term treatment or if there were any effects after the drug was stopped. Methods: Sixty-one children with 40% total body surface area burns were enrolled in this study. Patients were randomized into those to receive oxandrolone (n = 30) or placebo (n = 31) for the first 12 months. Treatment was discontinued after 12 months, and the patients were studied without the drug for the following 12 months. At discharge and 6, 12, 18, and 24 months after burn, height, weight, body composition, resting energy expenditure, muscle strength, and serum human growth hormone, insulin-like growth factor-I (IGF-1), IGF binding protein-3, insulin, cortisol, parathyroid hormone, tri-iodothyronine uptake (T3 uptake), and free thyroxine index (FTI) were measured. Statistical analysis used Tukey multiple comparison test. Significance was accepted at P < 0.05. Results: Oxandrolone improved lean body mass, bone mineral content and muscle strength compared with controls during treatment, P < 0.05. Serum IGF-1, T3 uptake, and FTI were significantly higher during drug treatment compared with controls, P < 0.05. Significant increases in height and weight with oxandrolone were observed after the end of treatment. Conclusions: Oxandrolone improved body composition and strength in severely burned children during the 12 months of treatment. Its effect on height and weight continued after treatment was discontinued.Przkora, R., Jeschke, M.G., Barrow, R.E., Suman, O.E., Meyer, W.J., Finnerty, C.C., Sanford, A.P., Lee, J.O., Chinkes, D.L., Mlcak, R.P., Herndon, D.N. Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
201012-Year within-wound study of the effectiveness of custom pressure garment therapyJABurns36975-983Pressure garment therapy is standard of care for prevention and treatment of hypertrophic scarring after burn injury. Nevertheless there is little objective data that confirms effectiveness. The purpose of this study was to determine the effectiveness of pressure garment therapy with objective data obtained with a randomized within-wound comparison. We enrolled consecutive patients with forearm injuries over a 12-year period. The subjects wore custom garments with normal and low compression randomized to either the proximal or distal zones. Hardness, color and thickness of wounds were objectively measured using appropriate devices; clinical appearance was measured by a panel masked to the identity of the pressure treated area. Wounds treated with normal compression were significantly softer, thinner, and had improved clinical appearance. There was no interaction of any effect with patient ethnicity. However, these findings were clinically evident only with moderate to severe scarring. We conclude that pressure garment therapy is effective, but that the clinical benefit is restricted to those patients with moderate or severe scarring. # 2010 Elsevier Ltd and ISBI. All rights reserved.Engrav, L. H., Heimbach, D. M., Rivara, F. P., Moore, M. L., Wang, J., Carrougher, G. J., Costa, B., Numhom, S., Calderon, J., Gibran, N. S.Northwest Regional Burn Model SystemYesdevopsadmin
2008Relationships between the Quality of Life Questionnaire (QLQ) and the SF-36 among Young Adults Burned as ChildrenJA Burns34 1163-1168OBJECTIVE: To examine the relationship between two measures that can be used to examine quality life among pediatric burn survivors. DESIGN: Prospective, correlational study. SETTING: Acute and rehabilitation pediatric burn care facility. PARTICIPANTS: Eighty young adult survivors of pediatric burns, who were 18-28 years of age, with burns of 30% or greater, and were at least 2 years after burn. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The SF-36 and the Quality of Life Questionnaire (QLQ) were used to assess participant's self-reported general health and long-term adjustment. RESULTS: Significant correlations (p< or =0.001) were found between the total quality of life score of the QLQ and the mental component scale of the SF-36. However, no significant correlations were found between the total quality of life score of the QLQ and the SF-36 physical component scale. CONCLUSIONS: Approximately 100,000 children are treated for burns annually, with a high percentage surviving, creating a challenge for health care professionals who need to prepare burn survivors with their psychosocial and physical well-being as adults. This study found that the SF-36 and QLQ are measuring somewhat different aspects of psychosocial and physical adjustment. It is recommended that both tools could be useful to the burn practitioner in assessing quality of life.Baker, C., Rosenberg, M., Mossberg, P., Holzer, C., Blakeney, P., Robert, R., Thomas, C., Meyer, W. Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2003Comparison of self-reported and monitored compliance of daily injection of human growth hormone in burned childrenJA Burns297697-701Objectives. We compared insulin-like growth factor (IGF-I) levels obtained in two groups with different methods of assessing compliance. Burned children were randomized to receive a daily injection of 0.05-0.1mg/kg per day of recombinant human growth hormone (rhGH) or placebo. Study design. One hundred twenty-five children (age range 6 months to 17 years) with total body surface area burns >40% participated in the study. Baseline levels of IGF-I were obtained at hospital discharge, at which time daily injections of rhGH or placebo were initiated. Assessment of IGF-I levels was repeated at 3-month intervals for 1 year. A directly monitored group met daily with research staff that witnessed the preparation and injection of the study drug. A self-reported group completed a Self Reported Compliance Questionnaire (SRCQ) that assessed compliance with drug regimen. A compliance of at least 85% (injections reported administered/maximal total injections possible) was accepted as being compliant. Data were analyzed using a one-way ANOVA followed by a Student Newman-Kuels test, with the results given as means+/-S.E.M. Results. The percent change in IGF-I levels between 6 and 9 months in the self-reported (22.7+/-7.9%) and monitored groups (21.9+/-8.6%) were similar. In contrast, the percent change in IGF-I levels in the placebo group was significantly decreased (-5.6+/-6.3%). Conclusions. Self-reported scores via an SRCQ is a potentially useful and valid method of assessing compliance of rhGH injections, as both reported and directly monitored methods yield similar changes in levels of IGF-I.Wilkins, J.P., Suman, O.E., Benjamin, D.A., Herndon, D.N.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2012Five- Year Outcomes after Oxandrolane Administration in Severely Burned Children: A Randomized Clinical Trial of Safety and Efficacy JA Journal of the American College of Surgeons2144489-502BACKGROUND:Oxandrolone, an anabolic agent, has been administered for 1 year post burn with beneficial effects in pediatric patients. However, the long-lasting effects of this treatment have not been studied. This single-center prospective trial determined the long-term effects of 1 year of oxandrolone administration in severely burned children; assessments were continued for up to 4 years post therapy. STUDY DESIGN: Patients 0 to 18 years old with burns covering 30% of the total body surface area were randomized to receive placebo (n152) or oxandrolone, 0.1 mg/kg twice daily for 12 months (n  70). At hospital discharge, patients were randomized to a 12-week exercise program or to standard of care. Resting energy expenditure, standing height, weight, lean body mass, muscle strength, bone mineral content (BMC), cardiac work, rate pressure product, sexual maturation, and concentrations of serum inflammatory cytokines, hormones, and liver enzymes were monitored. RESULTS: Oxandrolone substantially decreased resting energy expenditure and rate pressure product, increased insulin-like growth factor-1 secretion during the first year after burn injury, and, in combination with exercise, increased lean body mass and muscle strength considerably. Oxandrolone-treated children exhibited improved height percentile and BMC content compared with controls. The maximal effect of oxandrolone was found in children aged 7 to 18 years. No deleterious side effects were attributed to long-term administration. CONCLUSIONS: Administration of oxandrolone improves long-term recovery of severely burned children in height, BMC, cardiac work, and muscle strength; the increase in BMC is likely to occur by means of insulin-like growth factor-1. These benefits persist for up to 5 years post burn. ( J Am Coll Surg 2012;214:489–504. © 2012 by the American College of Surgeons)Laura J Porro, MD, David N Herndon, MD, FACS, Noe A Rodriguez, MD, Kristofer Jennings, PhD,Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2009Hypertrophic versus non hypertrophic scars compared by immunohistochemistry and laser confocal microscopy: type I and III collagens.JA Int Wound J.66445-52Although dermal collagens appear increased in hypertrophic scars, this has not been tested in tissue samples using objective methods. We compared the expression of types I and III collagen in hypertrophic and non hypertrophic scars at 6-12 and 18-24 months after burn using a quantitative method. Among 17 patients with extensive burns, 3 patients had acute scars, 8 had hypertrophic or non hypertrophic scars at 6-12 months after burn and 6 had hypertrophic or non hypertrophic scars at 18-24 months after burn. After clinical assessment of scars using the Vancouver scale, immunohistochemistry for types I and III collagens was performed. Images were captured with a laser scanning confocal microscope and the relative amounts of types I and III collagens were determined in superficial and deep dermis. The effects of time and scar type were assessed using two-way analysis of variance (ANOVA) and Tukey's test. Collagen III scar/normal ratios were higher in hypertrophic scars at both time points (P = 0.05). There were no differences in collagen I scar/normal ratios. Large variation was observed in scars during the acute phase regarding the expression of collagens. Easily accessed by immunohistochemistry and confocal microscopy, type III collagen deposition may help in determining scar phenotype, differentiating hypertrophic and non hypertrophic scars.Oliveira, G.V.., Hawkins, H.K., Chinkes, D., Burke, A., Tavares, A.L., Ramos-e-Silva, M., Albrecht, T.B,, Kitten, G.T., Herndon, D.N.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2007Physical and Psychological Rehabilitation Outcomes for Young Adults Burned as ChildrenJA Archives of Physical Medicine and Rehabilitation88Suppl 2s57-s64OBJECTIVE: To report physical and psychologic outcomes for young adult survivors of pediatric burns. DESIGN: Prospective, correlational study. SETTING: Acute and rehabilitation pediatric burn care facility. PARTICIPANTS: Eighty-three young adult survivors of pediatric burns, who were 18 to 28 years of age, with total body surface area (TBSA) burns of 30% or greater, and were at least 2 years postburn. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Physical outcomes were assessed by muscle strength tests, grip and pinch measurements, mobility levels, and self-care (activities of daily living) skills. Psychologic outcomes included behavioral problems, personality disorder, and incidence of psychiatric illness. An individually administered Structured Clinical Interview for Diagnosis, based on the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, for psychiatric diagnosis, was used to assess mental health, and behavioral problems were assessed with the Young Adult Self-Report. Participants reported educational achievement, employment status, state of transition from family of origin (home) to independent living, and pair bonding. The Short-Form 36-Item Health Survey and the Quality of Life Questionnaire were used to assess each participant's self-reported general health and quality of life. RESULTS: The majority of subjects had physical and psychologic outcomes that were within the normal range when compared with age-mates who had not experienced burns. The areas that were most likely to be impaired involved peripheral strength (wrist and grip). These deficits affected some self-care skills and correlated with TBSA. Standardized diagnostic interviews showed that greater than 50% of subjects qualified for a psychiatric diagnosis, with anxiety disorders as the most frequently occurring diagnosis. There were few significant correlations of the physical measurements or self-care skills with the burn size, psychologic problems, or social outcomes, and none appeared to be clinically important. CONCLUSIONS: Most of the people in this sample were functioning physically and psychosocially within normal limits as they reached adulthood. Although they appeared to function well as measured by standardized assessments, there were indications of private suffering that suggested they may not be functioning at an optimal level. The findings suggest that rehabilitation professionals could improve outcomes by including programs to develop overall muscle strength in severely burned children and by addressing concerns related to anxiety and other symptoms of psychologic distress.Baker, C.P., Russell, W.J., Meyer III, W., Blakeney, P.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2006Beneficial effects of extended growth hormone treatment after hospital discharge in pediatric burn patientsJA Ann. Surg.2436796-803OBJECTIVE: To study the efficacy of growth hormone given to severely burned children from discharge to 12 months after burn and for 12 months after the drug was discontinued. SUMMARY BACKGROUND DATA: We have previously shown that low-dose recombinant human growth hormone (rhGH), given to children after a severe thermal injury, successfully improved lean muscle mass, bone mineral content, and growth. The aim of the present study was to investigate long-term functional improvements after treatment. METHODS: Forty-four pediatric patients with over 40% total body surface area burns were studied for 24 months after burn. Patients were randomized to receive either rhGH (0.05 mg/kg body weight) or placebo. Height, weight, body composition, serum hormones, resting energy expenditure, cardiac function, muscle strength, and number of reconstructive procedures performed were measured during rhGH treatment and for 12 months after treatment was discontinued. Statistical analysis used Tukey's multiple comparison test. Significance was accepted at P < 0.05. RESULTS: Height, weight, lean body mass, bone mineral content, cardiac function, and muscle strength significantly improved during rhGH treatment compared with placebo (P < 0.05). This treatment significantly increased GH, IGF-I, and IGFBP-3, whereas serum cortisol decreased (P < 0.05). The number of operative reconstructive procedures was significantly lower with rhGH (P < 0.05). Improvements in height, bone mineral content, and IGF-1 concentrations persisted after rhGH treatment (P < 0.05). No side effects with rhGH were observed. CONCLUSIONS: Administration of rhGH for 1 year after burn was safe and improved recovery. These salutary effects continued after rhGH treatment was discontinued.Przkora, R., Herndon, D.N., Suman, O.E., Jeschke, M.G., Meyer, W.J., Chinkes, D.L., Mlcak, R.P., Huang, T., Barrow, R.E. Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2009The hypermetabolic response to burn injury and interventions to modify this responseJA Clin Plast Surg364583-96Severe burn injury is followed by a profound hypermetabolic response that persists up to 24 months after injury. It is mediated by up to 50-fold elevations in plasma catecholamines, cortisol, and inflammatory cells that lead to whole-body catabolism, elevated resting energy expenditures, and multiorgan dysfunction. All of these metabolic and physiologic derangements prevent full rehabilitation and acclimatization of burn survivors back into society. Modulation of the response by early excision and grafting of burn wounds, thermoregulation, early and continuous enteral feeding with high-protein high-carbohydrate feedings, and pharmacologic treatments have markedly decreased morbidity.Williams FN, Herndon DN, Jeschke MG.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2012The effect of obesity on adverse outcomes and metabolism in pediatric burn patientsJA International Journal of Obesity36 485--490HYPOTHESIS: Obesity in?uences metabolism and increases the incidence of clinical complications and worsens outcomes in pediatric burn patients. DESIGN: Retrospective, single-center study. SUBJECTS: In all, 592 severely burned pediatric patients who had burns covering more than 30% of the total body surface area and who were treated between 2001 and 2008 were enrolled in this study. Patients were divided into X85th percentile (n ¼ 277) and normal (n ¼ 315) weight groups based on body mass index (BMI) percentiles. RESULTS: Patients strati?ed below (normal) and X85th percentile had similar age, gender distribution and total burn size. No signi?cant differences were detected in the incidence of sepsis (11% for obese vs 10% for normal), the incidence of multiple organ failure (MOF) (21% for obese and 16% for normal) or mortality (11% for obese vs 8% for normal). Compared with the normal group, the X85th percentile group had low levels of constitutive proteins (a2macroglobulin and Apolipoprotein A1) (Po0.05 for both) as well as high levels of triglycerides and the acute-phase protein, C-reactive protein (Po0.05 for both) up to 60 days after injury. Patients X85th percentile showed a signi?cant higher loss of bone mineral density and lipolysis compared with normal individuals. Stepwise logistic regression analysis revealed that BMI had a positive predictive value towards the maximum DENVER2 score, an index of organ failure (Po0.001). CONCLUSIONS: BMIX85th percentile altered the post-burn acute phase and catabolic response but did not increase the incidence of sepsis, MOF or mortality in pediatric burn patients. Our results suggest that impaired metabolism and an altered in?ammatory response already exists in patients starting at the 85th percentile BMI.Kraft R, Herndon DN, Williams FN, Al-Mousawi AM, Finnerty CC, Jeschke MG.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2008Effects of a 12-Week rehabilitation program with music & exercise groups on range of motion in young children with severe burnsJA J Burn Care Res296939-948Previous studies indicate that rehabilitation programs supplemented with a strength and endurance-based exercise program improve lean body mass, pulmonary function, endurance, strength, and functional outcomes in severely burned children over the age of 7-years when compared with standard of care (SOC). To date, supplemental exercise programming for severely burned children under the age of 7-years has not yet been explored. The purpose of this study was to determine if a 12-week rehabilitation program supplemented with music & exercise, was more effective in improving functional outcomes than the SOC alone. This is a descriptive study that measured elbow and knee range of motion (ROM) in 24 severely burned children between ages 2 and 6 years. Groups were compared for demographics as well as active and passive ROM to bilateral elbows and knees. A total of 15 patients completed the rehabilitation with supplemental music and exercise, and data was compared with 9 patients who received SOC. Patients receiving the 12-week program significantly improved ROM in all joints assessed except for one. Patients receiving SOC showed a significant improvement in only one of the joints assessed. Providing a structured supplemental music and exercise program in conjunction with occupational and physical therapy seems to improve both passive and active ROM to a greater extent than the SOC alone.Neugebauer, C.T., Serghiou, M., Herndon, D.N., Suman, O.E.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2011Long term persistence of the pathophysiologic response to severe burn injuryJA PLoS One67 BACKGROUND: Main contributors to adverse outcomes in severely burned pediatric patients are profound and complex metabolic changes in response to the initial injury. It is currently unknown how long these conditions persist beyond the acute phase post-injury. The aim of the present study was to examine the persistence of abnormalities of various clinical parameters commonly utilized to assess the degree hypermetabolic and inflammatory alterations in severely burned children for up to three years post-burn to identify patient specific therapeutic needs and interventions. METHODOLOGY/PRINCIPAL FINDINGS: PATIENTS: Nine-hundred seventy-seven severely burned pediatric patients with burns over 30% of the total body surface admitted to our institution between 1998 and 2008 were enrolled in this study and compared to a cohort non-burned, non-injured children. Demographics and clinical outcomes, hypermetabolism, body composition, organ function, inflammatory and acute phase responses were determined at admission and subsequent regular intervals for up to 36 months post-burn. Statistical analysis was performed using One-way ANOVA, Student's t-test with Bonferroni correction where appropriate with significance accepted at pJeschke M.G., Gauglitz G.G., Kulp G.A., Finnerty C.C., Williams F.N., Kraft R., Suman O.E., Mlcak R.P., Herndon D.N. Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2003Recombinant human growth hormone increases thyroid hormone-binding sites in recovering severely burned childrenJA Shock195399-403Thyroxine (T4), Tri-iodothyronine (T3), and total serum protein levels are reduced in severely burned children. T4 and T3 are carried on serum transport proteins via thyroid hormone-binding sites (THBS). Treatment of bums with recombinant human growth hormone (rhGH) increases albumin (Alb) and prealbumin (PreAlb), which bind nearly 30% of circulating T4 and T3. This study investigated the effect of rhGH on THBS sites in burned children. Records of 11 acutely burned children with a total body surface area burned >40% who were randomized to either a daily subcutaneous injection of rhGH at 0.05 mg/kg/day or placebo for 6 months after discharge from hospital were reviewed. Thyroxine uptake percentage (TU%), Total T4 levels (TT4), free thyroxine index, Alb and PreAlb, and height and weight measurements taken at discharge and 6 months later were compared in both groups. In the six children who received rhGH, mean TU% had decreased from 41 +/- 1 to 33 +/- 1% by 6 months postdischarge, (P < 0.001), mean TT4 increased from 5.8 +/- 0.3 to 8.1 +/- 0.8 microg/dL, (P < 0.02), mean Alb increased from 2.0 +/- (0.6) to 3.5 +/- (0.1) g/dL (P < 0.0001), and mean PreAlb increased from 8.7 +/- 0.7 to 16.5 +/- 2.1 mg/dL, (P < 0.006). There were no significant changes in the five children in the placebo (control group), and height and weight did not significantly change in either group. rhGH significantly increases THBS in severely burned children, possibly through increases in serum Alb and PreAlb. The increases in circulating thyroxine observed in this group may be involved in the attenuation of growth arrest.Connolly, C.M., Barrow, R.E., Chinkes, D.L., Martinez, J.A., Herndon, D.N.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2006Comparison of carbon monoxide (CO) single breath pulmonary diffusing capacity with non-rebreathing, open-circuit CO pulmonary diffusing capacity in healthy childrenJA Pediatr. Pulmonol41111095-1102INTRODUCTION: The standard technique for assessing pulmonary diffusing capacity of the lungs (DL) for carbon monoxide (CO) is the single breath (SB) technique. SB_DLco in children can be problematic because it requires a vital capacity >1.5 L. We have developed an open-circuit technique (OC), which uses the wash-in of CO over a series of 8-10 normal breaths that does not require rebreathing. In this study, we compared the SB_DLco against the OC_DLco. METHODS: Nineteen healthy children between 7 and 18 years performed SB_DLco and OC_DLco tests. The mean SB_DLco was significantly larger than the mean OC_DLco. The mean difference OC_DLco minus SB_ DLco was: -2.92 +/- 4.21 ml/min/mm Hg, though the difference was negatively correlated with the mean of the two (r = 0.73). The lower mean OC_DLco was in part due to lower lung volume (as measured by alveolar volume (VA)) during the maneuver. In both groups there was a positive correlation between VA and DLco, and the mean VA was -2.17 +/- 1.07 L lower using OC compared to SB. The difference was again negatively correlated with the mean (r = 0.82). The mean OC minus SB difference in DLco/VA was: 6.06 +/- 1.98 ml/min/mm Hg/L, though this difference was positively correlated with the mean, r = 0.76. CONCLUSIONS: We found a good correlation between both techniques for DLco, VA, and DLco/VA. The OC offers the advantage of minimal subject cooperation, and may be preferable to use in children.Suman, O.E., Thomas, S., Beck, K.C., Mlcak, R.P., Herndon, D.N.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2010Whole body protein kinetics measured with a non-invasive method in severely burned childrenJA Burns3671006Persistent and extensive skeletal muscle catabolism is characteristic of severe burns. Whole body protein metabolism, an important component of this process, has not been measured in burned children during the long-term convalescent period. The aim of this study was to measure whole body protein turnover in burned children at discharge (95% healed) and in healthy controls by a non-invasive stable isotope method. Nine burned children (7 boys, 2 girls; 54±14 (S.D.)% total body area burned; 13±4 years; 45±20 kg; 154±14 cm) and 12 healthy children (8 boys, 4 girls; 12±3 years; 54±16 kg; 150±22 cm) were studied. A single oral dose of (15)N-alanine (16 mg/kg) was given, and thereafter urine was collected for 34 h. Whole body protein flux was calculated from labeling of urinary urea nitrogen. Then, protein synthesis was calculated as protein flux minus excretion, and protein breakdown as flux minus intake. At discharge, total protein turnover was 4.53±0.65 (S.E.)g kg body weight(-1) day(-1) in the burned children compared to 3.20±0.22 g kg(-1) day(-1) in controls (P=0.02). Expressed relative to lean body mass (LBM), the rates were 6.12±0.94 vs. 4.60±0.36 g kg LBM(-1) day(-1) in burn vs. healthy (P=0.06). Total protein synthesis was also elevated in burned vs. healthy children, and a tendency for elevated protein breakdown was observed. CONCLUSION: Total protein turnover is elevated in burned children at discharge compared to age-matched controls, possibly reflecting the continued stress response to severe burn. The oral (15)N-alanine bolus method is a convenient, non-invasive, and no-risk method for measurement of total body protein turnover.Borsheim E., Chinkes D.L., McEntire S.J., Rodrguez N.R., Herndon D.N., Suman O.E. Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2004Growth hormone effects on hypertrophic scar formation: A randomized controlled trial of 62 burned childrenJA Wound Repair Regen124404-411The hypercatabolism after massive pediatric burns has been effectively treated with recombinant human growth hormone, an anabolic agent that stimulates protein synthesis and abrogates growth arrest. While experimental studies have shown increased potential for fibrosis induced by growth hormone therapy, adverse effects on human scars have not been investigated. Our aim was to evaluate hypertrophic scar formation in 62 patients randomized to receive injections of 0.05 mg/kg/day of recombinant human growth hormone or placebo, from discharge until 1 year after burn. Scar scales were used to evaluate scar-severity at discharge, 6, 9, 12, and 18-24 months after burn, by three observers blinded to treatment. Computer-assisted planimetry allowed quantification of percentage of hypertrophic scar formation. Types I and III collagens were localized and quantified in scars and normal skin of patients from both groups, using immunohistochemistry with confocal laser microscopy analysis. Insulin-like growth factor-1 blood levels helped assess compliance. Statistical analysis showed that scar hypertrophy significantly increased from 6 to 12 months after injury in both groups, while decreasing at 18-24 months postburn. Types I and III collagens were statistically increased in the reticular layer of scars from both groups when compared to paired normal skin. Insulin-like growth factor-1 was significantly increased in the recombinant human growth factor-treated group. No differences were seen when recombinant human growth factor and control groups were compared using the scar scales, planimetry, or immunohistochemistry. We concluded that recombinant human growth hormone therapy did not adversely affect scar formation and should not contraindicate the administration of recombinant human growth hormone as a therapeutic approach to severely burned children.de Oliveira, G.V., Sanford, A.P., Murphy, K.D., de Oliveira, H.M., Wilkins, J.P., Wu, X.W., Hawkins, H.K., Kitten, G., Chinkes, D.L., Barrow, R.E., Herndon, D.N. Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2008Pathophysiologic response to severe burn injuryJA Ann. Surg.2483387-401OBJECTIVE: To improve clinical outcome and to determine new treatment options, we studied the pathophysiologic response postburn in a large prospective, single center, clinical trial. SUMMARY BACKGROUND DATA: A severe burn injury leads to marked hypermetabolism and catabolism, which are associated with morbidity and mortality. The underlying pathophysiology and the correlations between humoral changes and organ function have not been well delineated. METHODS: Two hundred forty-two severely burned pediatric patients [>30% total body surface area (TBSA)], who received no anabolic drugs, were enrolled in this study. Demographics, clinical data, serum hormones, serum cytokine expression profile, organ function, hypermetabolism, muscle protein synthesis, incidence of wound infection sepsis, and body composition were obtained throughout acute hospital course. RESULTS: Average age was 8 +/- 0.2 years, and average burn size was 56 +/- 1% TBSA with 43 +/- 1% third-degree TBSA. All patients were markedly hypermetabolic throughout acute hospital stay and had significant muscle protein loss as demonstrated by a negative muscle protein net balance (-0.05% +/- 0.007 nmol/100 mL leg/min) and loss of lean body mass (LBM) (-4.1% +/- 1.9%); P < 0.05. Patients lost 3% +/- 1% of their bone mineral content (BMC) and 2 +/- 1% of their bone mineral density (BMD). Serum proteome analysis demonstrated profound alterations immediately postburn, which remained abnormal throughout acute hospital stay; P < 0.05. Cardiac function was compromised immediately after burn and remained abnormal up to discharge; P < 0.05. Insulin resistance appeared during the first week postburn and persisted until discharge. Patients were hyperinflammatory with marked changes in IL-8, MCP-1, and IL-6, which were associated with 2.5 +/- 0.2 infections and 17% sepsis. CONCLUSIONS: In this large prospective clinical trial, we delineated the complexity of the postburn pathophysiologic response and conclude that the postburn response is profound, occurring in a timely manner, with derangements that are greater and more protracted than previously thought.Jeschke, M.G., Chinkes, D.L., Finnerty, C.C., Kulp, G., Suman, O.E., Norbury, W.B., Branski, L.K., Gauglitz, G.G., Mlcak, R.P., Herndon, D.N. Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2010Association between Dietary Fat Content and Outcomes on pediatric Burn Patients (1) JA J Surg Res1661e83-90BACKGROUND: The aim of the study was to compare a low fat/high-carbohydrate diet and a high-fat diet on clinical outcomes by a retrospective cohort study. METHODS: Nine hundred forty-four children with burns = 40% of their total body surface area (TBSA) were divided into two groups: patients receiving Vivonex T.E.N. (low-fat/high-carbohydrate diet; n = 518) and patients receiving milk (high-fat diet; n = 426). Patient demographics, caloric intake, length of hospital stay, and incidence of sepsis, mortality, hepatic steatosis, and organomegaly at autopsy were determined. RESULTS: Demographics and caloric intake were similar in both groups. Patients receiving Vivonex T.E.N. had shorter (intensive care unit) ICU stays (Vivonex T.E.N.: 31 ± 2 d; milk: 47 ± 2 d; P < 0.01), shorter ICU stay per % TBSA burn (Vivonex T.E.N.: 0.51 ± 0.02 d/%; milk: 0.77 ± 0.03 d/%; P < 0.01), lower incidence of sepsis (Vivonex T.E.N.: 11%; milk: 20%; P < 0.01), and lived significantly longer until death than those receiving milk (Vivonex T.E.N.: 20 ± 3 d; milk: 10 ± 2 d; P < 0.01). There was no difference in overall mortality between the two groups (Vivonex T.E.N.:15% versus milk: 13%; P < 0.9). Autopsies revealed decreased hepatic steatosis and decreased enlargement of kidney and spleen in patients receiving Vivonex T.E.N. CONCLUSIONS: The period with a low-fat/high-carbohydrate diet was associated with lower LOS, decreased incidence of organomegaly, infection, and hepatic steatosis post-burn compared with the period when a high-fat diet was used. These associations indicate the benefit of high carbohydrate/low fat nutrition; however, the findings in these time periods can also be likely due to the multifactorial effects of advances in burn care. We believe that these results have some relevance because high fat is associated with poorer outcomes compared with low fat.Lee J.O., Gauglitz G.G., Herndon D.N., Hawkins H.K., Halder S.C., Jeschke M.G. Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2011The GH/IGF-1 system in critical illnessJA Best Pract Res Clin Endocrinol Metab255759-67The Growth Hormone and Insulin-like Growth Factor-1 (IGF-1) axis plays a pivotal role in critical illness, with a derangement leading to profound changes in metabolism. Protein wasting with skeletal muscle loss, delayed wound healing, and impaired recovery of organ systems are some of the most feared consequences. The use of human recombinant Growth Hormone (rhGH) and Insulin-like Growth Factor-1 (IGF-1) - alone and in combination - has been studied extensively in preclinical and clinical trials. This article reviews the current knowlegde and clinical practice of the use of rhGh and IGF-1 in critically ill patients, with a special focus on the trauma and burns patient population.Elijah IE., Branski L.K., Finnerty C.C., Herndon D.N. Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2012Itch Assessment Scale for the Pediatric Burn SurvivorJA Journal of Burn Care & Research333419-424The objective of the study is to evaluate the validity and reliability of the Itch Man Scale developed in 2000 by Blakeney and Marvin in assessing the intensity of itch in the pediatric burn patient. Forty-five patients (31 males and 14 females; average age 9.9 ± 5.0 years; and % TBSA burned 41 ± 25%) with an established itch complaint were studied. They were asked to describe the severity of their itch by two independent raters to determine test-retest reliability. Individuals aged 6 years or older were assessed using parental informants. Concurrent validity was determined by comparing three scales to quantify the level of itch: the Itch Man Scale (a 5-point Likert scale), the 5-D Itch Scale (adapted from a scale for peripheral neuropathy), and the Visual Analog Scale for itch. Itch Man Scale ratings collected from independent raters showed a strong correlation (r = .912, P < .0001). The Itch Man Scale also correlated significantly with the Visual Analog Scale, the gold standard for measurement of pruritus (r = .798, P < .0001). The total summated score of the Duration, Degree, Direction, and Disability domains from the 5-D Itch Scale had a significant correlation with the Itch Man Scale (r = .614, P < .0001). The Degree domain is the only individual component with a significant correlation (r = .757, P < .0001). The Itch Man Scale is a reliable and valid tool to assess itching in pediatric burn patients and to quantify postburn pruritus. Morris V, Murphy LM, Rosenberg M, Rosenberg L, Holzer CE 3rd, Meyer WJ 3rd.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2001Effect of a 12-wk resistance exercise program on skeletal muscle strength in children with burn injuries.JA J. Appl. Physiol. 9131168-1175The posttraumatic response to burn injury leads to marked and prolonged skeletal muscle catabolism and weakness, which persist despite standard rehabilitation programs of occupational and physical therapy. We investigated whether a resistance exercise program would attenuate muscle loss and weakness that is typically found in children with thermal injury. We assessed the changes in leg muscle strength and lean body mass in severely burned children with >40% total body surface area burned. Patients were randomized to a 12-wk standard hospital rehabilitation program supplemented with an exercise training program (n = 19) or to a home-based rehabilitation program without exercise (n = 16). Leg muscle strength was assessed before and after the 12-wk rehabilitation or training program at an isokinetic speed of 150°/s. Lean body mass was assessed using dual-energy X-ray absorptiometry. We found that the participation in a resistance exercise program results in a significant improvement in muscle strength, power, and lean body mass relative to a standard rehabilitation program without exercise.Suman, O.E., Spies, R.J., Celis, M.M., Mlcak, R.P., Herndon, D.N. Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2011Intensive Insulin treatment increases donor site wound protein synthesis in burn patientsJA Surgery1494512-8BACKGROUND: In the treatment of burns, patients' own skin is the preferred material to cover burn wounds, resulting in the need to create a donor site wound. Enhancement of healing of the donor site wound would be beneficial in burn patients. Insulin, an anabolic agent, is used routinely to treat hyperglycemia after injury. We investigated whether intensive insulin treatment increases fractional synthesis rate (FSR) of the donor site wound protein and decreases the length of hospitalization normalized for total body surface area burned (LOS/TBSA). METHODS: FSR of the donor site wound protein was measured in pediatric patients randomized to control (n = 13) and insulin (n = 10) treatments. Depending on the postoperative day when the tracer study was done, studies were divided into "early" (days < 5) and "late" (days = 5) periods. RESULTS: FSR of the donor site wound protein was greater in the insulin group at the "early" period of wound healing (control vs insulin, 8.2 ± 3.8 vs 13.1 ± 6.9% per day; P < .05); but not at the "late" (control vs insulin, 19.7 ± 4.6 vs 16.6 ± 4.0% per day; P > .05). Despite these differences, LOS/TBSA was not decreased in the insulin group. Correlation analyses demonstrated that, independent of the treatment regimen, FSR positively correlated (P < .05) with time after creation of the donor site and negatively correlated (P < .05) with LOS/TBSA. CONCLUSION: Insulin treatment increased FSR of the donor site wound protein in the early period of wound healing; FSR correlated with LOS/TBSA independent of the treatment regimen.Tuvendorj D., Zhang X.L., Chinkes D.L., Aarsland A., Kulp G.A., Jeschke M.G., Herndon D.N. Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2006Symptoms of depression predict change in physical health after burn injuryJABurns: Journal of the International Society for Burn Injuries333292-298This study investigated the prevalence of symptoms of depression in patients hospitalized with severe burns and the association of symptoms of depression in the hospital with physical health 2 months after discharge, controlling for pre-burn physical health as measured by the SF-36 physical composite score. Survivors of acute burns were evaluated during the hospitalization (N = 262) and at 1 week (N = 165) and 2 months (N = 100) after discharge. The prevalence of at least mild to moderate symptoms of depression (Beck Depression Inventory 10) ranged from 23% to 26%. In-hospital symptoms of depression predicted change in physical health from pre-burn to 2 months post-discharge ( p = .02), controlling for patient demographics, burn severity, and symptoms of PTSD. These results suggest that patients should be screened for depression, both in-hospital and during rehabilitation after discharge.Thombs, Brett D., Bresnick, Melissa G., Magyar-Russell, Gina, Lawrence, John W., McCann, Una D., Fauerbach, James A.Johns Hopkins University Burn Injury Rehabilitation Model SystemNodevopsadmin
2007Psychological distress after major burn injuryJA Psychosomatic Medicine69 473-482Objective: To track the prevalence and stability of clinically significant psychological distress and to identify potentially modifiable inhospital symptoms predictive of long-term distress (physical, psychological, and social impairment). Method: We obtained data from the Burn Model Systems project, a prospective, multisite, cohort study of major burn injury survivors. The Brief SymptomFauerbach, James A., McKibben, Jodi, Bienvenu, O. Joseph, Magyar-Russell, Gina, Smoth, Michael T., Holavanahalli, Radha, Patterson, David, R., Wiechman, Shelley A., Blakeney, Patricia, Lezotte, DennisYesdevopsadmin
2010Growth curve trajectories of distress in burn patients.JA Journal of Burn Care Research31164-74Psychological adjustment after a major burn injury is a significant concern to providers and patients alike. Although efforts have been made to identify associated risk factors, little is known about heterogeneity in the levels or trajectories of adjustment in this population. This study used a novel application of Growth Mixture Modeling to identify subgroups of patients based on their longitudinal self-reported distress using the Brief Symptom Inventory (BSI). Data were drawn from the database of the Burn Model Systems project, a prospective, multisite, cohort study of major burn injury survivors. The BSI was used to assess symptoms in-hospital and at 6, 12, and 24 months postburn. Participants' T scores on the BSIs Global Severity Index provided a continuous measure of psychological distress. Analyses were conducted using participants' Global Severity Index T scores to discern distinct classes of respondents with similar trajectories across the 2-year follow-up. Results from the Growth Mixture Modeling analysis produced an ordered four-class model of psychological recovery from a major burn. Groups represented the equivalent of high, subthreshold, mild, and minimal symptom severity. Covariates significantly affected the intercept and slope of each class, as well as prediction of group assignment. These analyses demonstrate differences between individual recoveries after a major burn. Psychological distress symptoms remain largely stable over time and highlight the psychological vulnerability of this patient population.Mason, S.T., Corry, N., Gould, N, Amoyal, N., Wiechman, S.A., Holavanahalli, R., Banks, S., Arceneaux, L.L., Fauerbach, J.A.Johns Hopkins University Burn Injury Rehabilitation Model SystemNodevopsadmin
2011Functional and psychosocial outcomes of older adults after burn injury: results from a multicenter database of severe burn injury.Journal Journal of Burn Care Research32166-78https://pubmed.ncbi.nlm.nih.gov/21124232/A number of factors increase the susceptibility of older adults to burn injury. The majority of studies of older adults have focused on patient and injury factors related to mortality risk. However, little is known about the long-term functional and psychological outcomes of older adults after severe burn. The purpose of this study is to examine the long-term outcomes of older adults after burn injury. The authors performed an analysis of the outcomes of older adults (age 55 years or older) enrolled in a prospective study of burn injury outcomes. Change in living situation as well as distress, functional impairment, and quality of life were examined at discharge and at 6, 12, and 24 months after hospital discharge. Mixed effects modeling was performed to compare differences across age groups and time as well as to account for missing data. A total of 737 patients aged 55 years or older were enrolled and followed in the National Institute on Disability and Rehabilitation Research burn program. Patients in all age groups had significant deficits in Short Form-36, Functional Independence Measure, and Brief Symptom Inventory scores at time of discharge. Recovery of physical and psychosocial functioning was greatest from discharge to 6 months in patients aged 55 to 74 years and greatest at 1 year for patients aged 75 years or older. This study confirms that severe burn injury significantly impacts both functional outcome and psychosocial quality of life in older adults. However, the impact seems to be age related as are recovery trajectories. Rehabilitation programs lasting up to 1 year after injury could be of tremendous benefit in helping older adults achieve maximal potential recovery. Klein, M.B., Lezotte, D.C., Heltshe, S., Fauerbach, J., Holavanahalli, R.K., Rivara, F.P., Pham, T., Engrav, L.Northwest Regional Burn Model SystemYesdevopsadmin
2012ABC Publication TestJA654321ABC Journal Title23 This is the abstract..NULLYesdevopsadmin
2011Peritraumatic heart rate and posttraumatic stress disorder in patients with severe burns.JA Journal of Clinical Psychiatry724539-547OBJECTIVE: Previous studies have suggested a link between heart rate (HR) following trauma and the development of posttraumatic stress disorder (PTSD). This study expands on previous work by evaluating HR in burn patients followed longitudinally for symptoms of acute stress disorder (ASD) and PTSD. METHOD: Data were collected from consecutive patients admitted to the Johns Hopkins Burn Center, Baltimore, Maryland, between 1997 and 2002. Patients completed the Stanford Acute Stress Reaction Questionnaire (n = 157) to assess symptoms of ASD. The Davidson Trauma Scale was completed at 1 (n = 145), 6 (n = 106), 12 (n = 94), and 24 (n = 66) months postdischarge to assess symptoms of PTSD. Heart rate in the ambulance, emergency room, and burn unit were obtained by retrospective medical chart review. RESULTS: Pearson correlations revealed a significant relationship between HR in the ambulance (r = 0.32, P = .016) and burn unit (r = 0.30, P = .001) and ASD scores at baseline. Heart rate in the ambulance was related to PTSD avoidance cluster scores at 1, 6, 12, and 24 months. In women, HR in the ambulance was correlated with PTSD scores at 6 (r = 0.65, P = .005) and 12 (r = 0.78, P = .005) months. When covariates (gender, ß-blockers, Brief Symptom Inventory Global Severity Index score) were included in multivariate linear regression analyses, ambulance HR was associated with ASD and PTSD scores at baseline and 1 month, and the interaction of ambulance HR and gender was associated with PTSD scores at 6 and 12 months. Multivariate logistic regression results were similar at baseline and 12 months, which included an HR association yet no interaction at 6 months and a marginal interaction at 1 month. CONCLUSIONS: While peritraumatic HR is most robustly associated with PTSD symptom severity, HR on admission to burn unit also predicts the development of ASD. Gender and avoidance symptoms appear particularly salient in this relationship, and these factors may aid in the identification of subgroups for which HR serves as a biomarker for PTSD. Future work may identify endophenotypic measures of increased risk for PTSD, targeting subgroups for early intervention.Gould, N.F., McKibben, J., Hall, R., Corry, N., Amoyal, N., Mason, S.T., McCann, U.D., Fauerbach, J.A.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2011Spatial and temporal localization of the melanocortin 1 receptor and its ligand a-melanocyte-stimulating hormone during cutaneous wound repair.JA Journal of Histochemistry & Cytochemistry593278-288Growing evidence indicates that the melanocortin 1 receptor (MC1R) and its ligand a-melanocyte-stimulating hormone (a-MSH) have other functions in the skin in addition to pigment production. Activation of the MC1R/a-MSH signaling pathway has been implicated in the regulation of both inflammation and extracellular matrix homeostasis. However, little is known about the role of MC1R/a-MSH signaling in the regulation of inflammatory and fibroproliferative responses to cutaneous injury. Although MC1R and a-MSH localization has been described in uninjured skin, their spatial and temporal expression during cutaneous wound repair has not been investigated. In this study, the authors report the localization of MC1R and a-MSH in murine cutaneous wounds, human acute burns, and hypertrophic scars. During murine wound repair, MC1R and a-MSH were detected in inflammatory cells and suprabasal keratinocytes at the leading edge of the migrating epithelial tongue. MC1R and a-MSH protein levels were upregulated in human burn wounds and hypertrophic scars compared to uninjured human skin, where receptor and ligand were absent. In burn wounds and hypertrophic scars, MC1R and a-MSH localized to epidermal keratinocytes and dermal fibroblasts. This spatiotemporal localization of MC1R and a-MSH in cutaneous wounds warrants future investigation into the role of MC1R/a-MSH signaling in the inflammatory and fibroproliferative responses to cutaneous injury. This article contains online supplemental material at http://www.jhc.org.offcampus.lib.washington.edu Please visit this article online to view these materialsMuffley, L.A., Zhu, K.Q., Engrav, L.H., Gibran, N.S., Hocking, A.M.Northwest Regional Burn Model SystemYesdevopsadmin
2000The 2000 Clinical Research Award. Describing and predicting distress and satisfaction with life for burn survivors.JA Journal of Burn Care Rehabilitation216490-498We investigated ratings of emotional distress and satisfaction with life at discharge from the hospital and at a 6-month follow-up in a multisite sample of 295 adults hospitalized for the care of a major burn injury. Several psychosocial variables (history of alcohol abuse, marital status, and previous mental health) and some medical variables (days of intensive care, pulmonary complications, and hand burns) accounted for significant variance in the prediction of outcomes. Brief Symptom Inventory (distress) scores were higher and Satisfaction With Life Scale scores were significantly lower than those of a normative population at both measurement points. The results show the utility of biosocial models in which psychological and physical variables interact to influence adjustment and quality of life.Patterson, D.R., Ptacek, J.T., Cromes, F., Fauerbach, J.A., Engrav, L.Nodevopsadmin
2010Posttraumatic stress disorder and pain impact functioning and disability after major burn injury.JA Journal of Burn Care Research31113-25This study sought to clarify the prospective and concurrent associations of posttraumatic stress disorder (PTSD) and pain with functioning and disability after burn injury. The sample was composed of consecutive patients admitted to a regional burn center with major burn injuries (N = 171) who were followed at 1, 6, 12, and 24 months postdischarge. The predictor measures were the McGill Pain Questionnaire and Davidson Trauma Scale, and the outcome measures were Short Form-36 Health Survey subscales administered at 6, 12, and 24 months after discharge. Linear mixed-effects analyses were conducted to evaluate pain and PTSD as predictors of functional outcomes. Higher PTSD symptom severity soon after hospital discharge was prospectively related to poorer physical and social functioning and greater psychosocial disability (P < .001). However, significant PTSD-by-time interactions also predicted future physical functioning and disability, indicating that the deleterious effects of early PTSD were ameliorated by time. In addition, at each follow-up, PTSD symptoms were concurrently related to greater physical and psychosocial disability, poorer social functioning, and less vitality (P < .001). More severe pain at each follow-up, but not PTSD, was correlated with poorer concurrent physical functioning (P < .002). Significant interaction terms indicated that the concurrent effect of PTSD on psychosocial disability, social functioning, and vitality attenuated during the 24-month recovery period. These findings suggest that assessing PTSD and pain following burn injury may aid in predicting future functioning. Future work should confirm this and evaluate whether aggressively treating both PTSD and pain helps improve functioning after major burn injury.Corry, N.H., Klick, B., Fauerbach. J.A.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2011Functional genomics unique to week 20 post wounding in the deep cone/fat dome of the duroc/yorkshire porcine model of fibroproliferative scarring.JA PLoS One64e19024Abstract BACKGROUND: Hypertrophic scar was first described over 100 years ago; PubMed has more than 1,000 references on the topic. Nevertheless prevention and treatment remains poor, because 1) there has been no validated animal model; 2) human scar tissue, which is impossible to obtain in a controlled manner, has been the only source for study; 3) tissues typically have been homogenized, mixing cell populations; and 4) gene-by-gene studies are incomplete. METHODOLOGY/PRINCIPAL FINDINGS: We have assembled a system that overcomes these barriers and permits the study of genome-wide gene expression in microanatomical locations, in shallow and deep partial-thickness wounds, and pigmented and non-pigmented skin, using the Duroc(pigmented fibroproliferative)/Yorkshire(non-pigmented non-fibroproliferative) porcine model. We used this system to obtain the differential transcriptome at 1, 2, 3, 12 and 20 weeks post wounding. It is not clear when fibroproliferation begins, but it is fully developed in humans and the Duroc breed at 20 weeks. Therefore we obtained the derivative functional genomics unique to 20 weeks post wounding. We also obtained long-term, forty-six week follow-up with the model. CONCLUSIONS/SIGNIFICANCE: 1) The scars are still thick at forty-six weeks post wounding further validating the model. 2) The differential transcriptome provides new insights into the fibroproliferative process as several genes thought fundamental to fibroproliferation are absent and others differentially expressed are newly implicated. 3) The findings in the derivative functional genomics support old concepts, which further validates the model, and suggests new avenues for reductionist exploration. In the future, these findings will be searched for directed networks likely involved in cutaneous fibroproliferation. These clues may lead to a better understanding of the systems biology of cutaneous fibroproliferation, and ultimately prevention and treatment of hypertrophic scarring.Engrav, L.H., Tuggle, C.K., Kerr, K.F., Zhu, K.Q., Numhom, S., Couture, O.P., Beyer, R.P., Hocking, A.M., Carrougher, G.J., Ramos, M.L., Klein, M.B., Gibran, N.S.Northwest Regional Burn Model SystemYesdevopsadmin
2007Symptoms of depression predict change in physical health after burn injury.Journal Burns333292-298https://pubmed.ncbi.nlm.nih.gov/17382189/This study investigated the prevalence of symptoms of depression in patients hospitalized with severe burns and the association of symptoms of depression in the hospital with physical health 2 months after discharge, controlling for pre-burn physical health as measured by the SF-36 physical composite score. Survivors of acute burns were evaluated during the hospitalization (N=262) and at 1 week (N=165) and 2 months (N=100) after discharge. The prevalence of at least mild to moderate symptoms of depression (Beck Depression Inventory > or = 10) ranged from 23% to 26%. In-hospital symptoms of depression predicted change in physical health from pre-burn to 2 months post-discharge (p=.02), controlling for patient demographics, burn severity, and symptoms of PTSD. These results suggest that patients should be screened for depression, both in-hospital and during rehabilitation after discharge. Thombs, B.D., Bresnick, M.G., Magyar-Russell, G, Lawrence, J.W., McCann, U.D., Fauerbach, J.A.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2011Comparing parent and child perceptions of stigmatizing behavior experienced by children with burn scars.JA Body Image8170-73https://pubmed.ncbi.nlm.nih.gov/21074503/This study examined perceptions of stigmatization in a sample of 85 pediatric burn survivors and their parents. Survivors and a parent independently completed the Perceived Stigmatization Questionnaire (PSQ) rating the frequency that the child experienced three types of stigmatizing behaviors: absence of friendly behavior, confused and staring behavior, and hostile behavior. The sample was divided into a high (top 25%) and low (bottom 75%) perceived stigmatization groups. The mean ratings of parents did not significantly differ from that of children reporting low stigmatization. The mean PSQ parent ratings were significantly lower than those of children reporting high stigmatization. Additionally, the concordance on PSQ subscale scores within child-parent dyads was significantly lower in children reporting high stigmatization relative to child-parent dyads of children reporting low stigmatization. Children surviving burns may experience stigmatization that is under-perceived by their parents. Clinicians should be alert to this potential discrepancy. Lawrence, J.W., Rosenberg, L.E., Rimmer, R.B., Thombs, B.D., Fauerbach, J.A.Yesdevopsadmin
2007Acute pain at discharge from hospitalization is a prospective predictor of long-term suicidal ideation after burn injury.JA Archives of Physical Medicine and Rehabilitation8812s36-42OBJECTIVE: To determine the extent to which pain contributes to risk for suicidal ideation after burn injury. DESIGN: This longitudinal cohort study evaluated participants at discharge, 6 months, and 1 year after burn injury. SETTING: Inpatient rehabilitation units of multiple regional burn centers. PARTICIPANTS: Survivors of major burns (N=128). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Pain severity, assessed using the Medical Outcomes Study 36-Item Short-Form Health Survey bodily pain subscale, and passive and active suicidal ideation, assessed by self-report. RESULTS: At each time point, approximately one quarter to one third of the sample reported some form of suicidal ideation. In logistic regression analyses, pain severity at discharge was the sole consistent predictor of suicidal ideation at follow-up, with greater pain severity being associated with enhanced risk for both passive and active suicidal ideation. These associations were observed even after controlling for discharge mental health. CONCLUSIONS: These are the first findings to suggest an association between acute pain severity and the development and maintenance of suicidal ideation in burn patients. Further research in this area, including the study of improved pain management programs as a prophylaxis against suicidal ideation, may benefit those who are at elevated suicide risk as a consequence of burn injuries.Edwards, R.R., Magyar-Russell, G., Thombs, B., Smith, M.T., Holavanahalli, R., Patterson, D.R., Blakeney, P., Lezotte, D, Haythornthwaite, J.A., Fauerbach, J.A.Johns Hopkins University Burn Injury Rehabilitation Model SystemNodevopsadmin
2011Perceived stigmatization and social comfort: Validating the constructs and their measurement among pediatric burn survivors. RehabilitationJA Rehabilitation Psychology554360-371OBJECTIVE: The current study implemented a four-step process to evaluate the measurement properties of the Perceived Stigmatization Questionnaire (PSQ) and the Social Comfort Questionnaire (SCQ) among long-term pediatric burn survivors. METHODS: First, a series of confirmatory factor analyses (CFAs) compared the hypothesized four-factor model--3 perceived stigmatization factors (absence of friendly behavior, confused and staring behavior, and hostile behavior)--and one social comfort factor to three other models. Second, we tested the measurement invariance of the instruments between pediatric and adult burn survivor samples. Third, possible differences in structural parameters across groups were tested. Fourth, we tested whether the three perceived stigmatization factors and the social comfort factor loaded on one second-order factor. Participants included 369 pediatric and 347 adult burn survivors. RESULTS: The four-factor model was superior to the comparison models. The PSQ and SCQ demonstrated measurement invariance. Factor variance, factor covariance, and the latent means of the PSQ did not vary across groups. The adult group had a significantly lower latent mean on the SCQ than the pediatric group. The three factors of the PSQ and the one-factor SCQ loaded on one second-order factor. CONCLUSION: The results of this study lend support to both the construct validity of perceived stigmatization and social comfort and the potential value of the PSQ and SCQ for studying the social experience of people with visible differences.Lawrence, J.W., Rosenberg, L.E., Rimmer, R.B., Thombs, B.D., Fauerbach, J.A.Yesdevopsadmin
2010The role of hyperglycemia in burned patients: evidence based studies”JA Shock33 13-MaySeverely burned patients typically experience a systemic response expressed as increased metabolism, inflammation, alteration of cardiac and immune function, and associated hyperglycemia. Hyperglycemia has been associated with an increased risk of morbidity and mortality in critically ill patients. Until recently and for many years, hyperglycemia has been expectantly managed and considered a normal and desired response of an organism to stress. However, findings reported from recent studies now suggest beneficial effects of intensive insulin treatment of critically ill patients. The literature on the management of hyperglycemia in severely burned patients is sparse, with most of the available studies involving only small numbers of burned patients. The purpose of this article is to describe the pathophysiology of hyperglycemia after severe burns and to review the available literature on the outcome of intensive insulin treatment and other anti-hyperglycemic modalities in burned patients in an evidence-based medical approach.Mecott, GA., Al-Mousawi,AM., Gauglitz, GG., Herndon, DN., Jeschke, MG. .Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2009Treatments for Common Psychiatric Conditions Among Children and Adolescent During Acute Rehabilitation and Reintegration Phases of Burn InjuryJA INTERNATIONAL JOURNAL OF PSYCHIATRY IN MEDICINE216549-558Arceneaux L.L., Meyer W.J. Yesdevopsadmin
2010Extent and magnitude of catecholamine surge in pediatric burned patientsJA Shock334369-74Increased catecholamine (CA) levels after severe burn are associated with stress, inflammation, hypermetabolism and impaired immune function. The CA secretion profiles in burned patients are not well described. Mechanisms, duration and extent of CA surge are unknown. The purpose of this large unicenter study was to evaluate the extent and magnitude of CA surge following severe burn in pediatric patients. Patients admitted between 1996 and 2008 were enrolled in this study. Twenty-four-hour urine collections were performed during acute hospitalization and up to 2 years post burn. Results from the samples collected from 12 normal, healthy volunteers were compared with the data from the burned patients. Relevant demographic and clinical information was obtained from Medical Records. Student’s t-test and one way ANOVA were used to analyze the data where appropriate. Significance was accepted at pKulp G.A., Herndon D.N., Lee J.O., Suman O.E., Jeschke M.G.. Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2009Modulation of the hypermetabolic response to trauma: temperature, nutrition, and drugsJA JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS2084489-502Williams F.N., Jeschke M.G., Chinkes D.L., Suman O.E., Branski L.K., Herndon D.N.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2009Absence of Exertional Hyperthermia in a 17 Year Old with Severe BurnsJAJ56732JOURNAL OF BURN CARE & RESEARCH304752-755An important safety concern when exercising burned patients is the potential for an excessive increase in core body temperature (hyperthermia = body core temperature >39°C) during exercise. We examined the thermoregulatory response to exercise in the heat (31°C, relative hwnidity 40%) in a 17 ·year-old boy with a 99% TBSA burn. A 30-rninute exercise test was performed at an intensity of 75% of his peak. aerobic capacity. Intestinal temperature was assessed via telemetry with an ingestible capsule. Intestinal temperature was measured before, during, and postexercise. The patient completed 12 minutes of the 30-minute exercise test. Starting core temperature was 36.98°C and increased O.69°C during exercise. After exercise, intestinal temperature continued. to increase, but no hypertbennia was noted. It has been reported that burned children can safely exercise at room temperature; however, the response in the heat is unknown. This patient did not develop exertional hyperthennia,which we propose is due to his low-fitness level and heat intolerance. However, the potential for hyperthermia would be increased if he was forced to mailltain a high relative workload ill the heat. We propose that severely burned individuals should be able to safely participate in physical activities. However, the decision to stop exercising should be accepted to avoid development of cxertional hyperthermia.McEntire S.J., Lee J.O., Herndon D.N. and Suman O.E.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2009Assessment of recovery from burn related neuropathy by electrodiagnostic testing.Journal Journal of Burn Care & Research30 4668-674https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2785113/The purpose of this study was to investigate the recovery of burn-related neuropathies by electrodiagnostic testing. Burn patients who presented to an American Burn Association verified burn center were interviewed and examined for clinical evidence of peripheral neuropathies by a physiatrist. Patients whom consented to participate were tested for electrodiagnostic evidence of peripheral neuropathy. Repeated studies were performed to assess for evidence of recovery. A total of 370 patients were screened. Thirty-six (9.73%) patients had clinical evidence of neuropathy. Eighteen male patients with a mean TBSA burn of 42% had nerve conduction studies performed. Etiologies of the injuries included eight flame, eight electrical, and three others. Seventy-three nerve conduction studies were performed and 58 of the tests were abnormal. The most commonly affected nerve was the median sensory (10). For patients with repeated tests, the mean time between tests was 169 days (SD, 140 days). There was a significant difference between the initial and follow-up test (McNemar's change test P=.009). In subset analysis of motor and sensory abnormalities, there was no significant difference (P=.07). The most common neuropathy identified in this cohort was the median sensory. Overall, there was improvement in the nerve conduction abnormalities examined. This study suggests that the prognosis for recovery after burn-related neuropathy is good. Gabriel, V., Kowalske, K., Holavanahalli, R.North Texas Burn Rehabilitation Model SystemYesdevopsadmin
2010Measurement of body composition in burned children: is there a gold standard?JA JOURNAL OF PARENTERAL AND ENTERAL NUTRITION34155-63Branski L., Norbury W., Herndon D., Chinkes D.L., Cochran A., Suman O., Benjamin D., Jeschke M.G.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2010Randomized Controlled Trial to Determine the Efficacy of Long-Term Growth Hormone Treatment in Severely Burned ChildrenJA ANNALS OF SURGERY2504145-154Branski L.K., Herndon D.N., Barrow R.E., Kulp G.A., Klein G.L., Suman O.E., Przkora R., Meyer W. 3rd, Huang T., Lee J.O., Chinkes D.L., Mlcak R.P., Jeschke M.G. . .Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2009Pain management in patients with burn injuriesJAJ49376?International Review of Psychiatry216522-30Wiechman Askay S., Patterson D., Sharar S., Mason S., Faber, B.Yesdevopsadmin
2006Medical and psychological aspects of rehabilitation from burn injuryJA American Journal of Physical Medicine & Rehabilitation854383-413Abstract not availableEsselman, P. C., Thombs, B. D., Magyar-Russel, G., Fauerbach, J.A.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2009The Effect of Virtual Reality on Pain and Range of Motion in Adults with Burn InjuriesJAJ57175JOURNAL OF BURN CARE & RESEARCH305785-791Few studies bave empirically investigated the effects of immersive virtual reality (VR) on postburn physical therapy pain control and range of motion (ROM). We performed a prospeetive, randomized controlled study of the effects of adding VR to standard therapy in adults receiving active-assisted ROM physical therapy, by assessing pain scores and maximal joint ROM immediately before and after therapy on two consecutive days. Thirty-nine inpatients, aged 21 to 57 years (mean 35 years), with a mean TBSA burn of 18% (range, 3-60%) were studied using a within-subject, crossover design. All patients received their regular pretberapy pharmacologic analgesia regimen. Duling physical therapy sessions on two consecutive days (VR one day and no VR the other day; order randomized), each patient participated in active-assisted ROM exercises with an ocrupational or physical therapist. At the con.elusion of each session, patients provided 0 tO'l 00 Graphic Rating Scale measurements of pain after each lO-minute treatment condition. On the day with VR, patients wore a head-position-tracked, medical care envirorunent-e)(cluding VB.. helmet with stereophonic sound and interacted in a virtual envirorunent conducive to burn care. ROM measurements for each joint exercised were recorded before and after each therapy session. Because of nonsignificant carryover and order eff ects, the data were analyzed using simple paired t-tests. VR reduced all Graphic Rating Scale pain scores (worst pain, time spent thinking about the pain, and pain unpleasantness by 27, 37, and 31% respectively), relative to the no VR condition. Average ROM improvement was slighdy greater with the VR condition; however, this difference failed to reach clinical or statistical significance (P = .243). Ninety-seven percent of patients reported zero to mild nausea after the VR session. Immersive VR effectively reduced pain and did not impair ROM during postbnrn physical therapy. VR is easily used in the hospital setting and offers a safe, nonpharmacologic adjunctive analgesic treatment. (J Burn Care Res 2009;30:785-791 )Carrougher, G, Hoffman, H, Nakamura, D, Lezotte, D, Soltani, M, Leahy, L, Engrav, L, Patterson, DYesdevopsadmin
2007Extended time to wound closure is associated with increased risk of heterotopic ossification of the elbowJA Journal of Burn Care & Research283447-450Heterotopic ossification (HO) is a well-recognized complication of burn injury that can result in significantly compromised limb function. The etiology and optimal treatment strategy for HO remain elusive. The purpose of this study was to examine the relationship between delay in elbow wound closure and the development of HO. We performed a case-control study to examine the relationship between delay in wound closure and development of HO. Cases (HO patients) were identified using our patient registry and matched with patients of similar age, burn size, and sex who did not develop HO. Time to wound closure was compared using bivariate statistics and the odds for developing HO based on time to wound closure was modeled using multivariate logistic regression. During the study period, a total of 45 patients developed elbow HO. When compared with controls matched for age, burn size, and sex, elbow wounds were open significantly longer in the cases than in the controls (48.7 days vs 24.2 days, P Klein, MB., Logsetty, S., Costa, B., Deters, L., Rue, T.C., Carrougher, G.J., Pickens, M., Engrav, L.H.Northwest Regional Burn Model SystemYesdevopsadmin
2009Post-traumatic growth and spirituality in burn recoveryJAJ48718International Review of Psychiatry216570-90For decades, research on long-term adjustment to burn injuries has adopted a deficit model of focusing solely on negative emotions. The presence of positive emotion and the experience of growth in the aftermath of a trauma have been virtually ignored in this field. Researchers and clinicians of other health and trauma populations have frequently observed that, following a trauma, there were positive emotions and growth. This growth occurs in areas such as a greater appreciation of life and changed priorities; warmer, more intimate relations with others; a greater sense of personal strength, recognition of new possibilities, and spiritual development. In addition, surveys of trauma survivors report that spiritual or religious beliefs played an important part in their recovery and they wished more healthcare providers were comfortable talking about these issues. Further evidence suggests that trauma survivors who rely on spiritual or religious beliefs for coping may show a greater ability for post-traumatic growth. This article reviews the literature on these two constructs as it relates to burn survivors. We also provide recommendations for clinicians on how to create an environment that fosters post-traumatic growth and encourages patients to explore their spiritual and religious beliefs in the context of the trauma.Wiechman Askay S., Magyar-Russel G.Northwest Regional Burn Model SystemYesdevopsadmin
2006Depression Symptoms Among Long-term Adult Burn SurvivorsJA Rehabilitation Psychology51 306-313.Objective: To determine the frequency and correlates of symptoms of depression experienced by long-term burn survivors. Design: An exploratory study of a cross-sectional, self-selected sample. Participants: 311 burn survivors who were at least 3 years postburn (M 20, SD 15). Main Outcome Measure: The Short Mood and Feelings Questionnaire, which is a self-report measure of symptoms of depression. Results: Depending on the cutoff score used, 20%–30% of the sample reported clinically significant symptoms of depression. A hierarchical multiple regression model accounted for 59% of the variance in symptoms of depression. Variables were entered in 3 blocks—burn characteristics, demographic characteristics, and psychosocial characteristics. Psychosocial characteristics such as social support and social comfort accounted for a majority of the variance.Lawrence, J.W., Thombs, B.D., Fauerbach, J.A.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2010Growth curve trajectories of distress in burn patients.JournalJ57972Journal of Burn Care & Research31164-72https://pubmed.ncbi.nlm.nih.gov/20061839/Psychological adjustment after a major burn injury is a significant concern to providers and patients alike. Although efforts have been made to identify associated risk factors, little is known about heterogeneity in the levels or trajectories of adjustment in this population. This study used a novel application of Growth Mixture Modeling to identify subgroups of patients based on their longitudinal self-reported distress using the Brief Symptom Inventory (BSI). Data were drawn from the database of the Burn Model Systems project, a prospective, multisite, cohort study of major burn injury survivors. The BSI was used to assesssymptoms in-hospital and at 6, 12, and 24 months postburn. Participants’ T scores on the BSIs Global Severity Index provided a continuous measure of psychological distress. Analyses were conducted using participants’ Global Severity Index T scores to discern distinct classes of respondents with similar trajectories across the 2-year follow-up. Results from the Growth Mixture Modeling analysis produced an ordered four-class model of psychological recovery from a major burn. Groups represented the equivalent of high, subthreshold, mild, and minimal symptom severity. Covariates significantly affected the intercept and slope of each class, as well as prediction of group assignment. These analyses demonstrate differences between individual recoveries after a major burn. Psychological distress symptoms remain largely stable over time and highlight the psychological vulnerability of this patient population. Mason S., Corry N., Gould N., Amoyal N., Gabriel V., Wiechman A.S., Holavanahalli R., Banks S., Arceneaux L., Fauerbach, J.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2009Virtual reality hypnosisJA Contemporary Hypnosis26140-47Wiechman Askay, S.Northwest Regional Burn Model SystemYesdevopsadmin
2009Effect of acute and chronic alcohol abuse on pain management in a trauma centerJA Expert Rev Neurother92271-277The proper management of acute pain has been identified as a primary indicator of quality assurance in US trauma centers. Nearly half of all trauma patients are injured while intoxicated and 75% of these patients have chronic alcohol problems. The management of pain caused by injuries in patients with alcohol problems poses unique challenges. Biases exist regarding the crosstolerance effects of ethanol and opioids and the pain thresholds of patients with substance abuse histories. The purpose of this review is to examine some of the factors that inform our decisions of how to manage acute pain in this population and to review the empirical evidence that exists.Wiechman Askay, S., Bombardier, C.H., Patterson, D.R.Northwest Regional Burn Model SystemYesdevopsadmin
2008Confirmatory factor analysis of the Short Form Mcgill Pain Questionnaire (MPQ-SF) with burn patientsJA Journal of Burns and Wounds: Eplasty8 e54Abstract not availableMason, S. T., Arceneaux, L. L., Abouhassan, W., Lauterbach, D., Seebach, C., Fauerbach, J. A.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2007An analysis of the long-distance transport of burn patients to a regional burn centerJA Journal of Burn Care & Research28149-55The concentration of specialized burn care to relatively few centers within relatively large geographic regions requires an organized system of patient triage, referral, and transport. The purpose of this study was to identify systematic errors in either the initial evaluation or care of burn patients requiring transport more than 90 miles to a single regional burn center. Therefore, we undertook a descriptive analysis of patients transported more than 90 miles to a single regional burn center from 2000 to 2003. The outcomes of interest were duration of transport, errors in burn size estimation, errors in fluid management, appropriateness of intubation, and complications during transport. During the years 2000 to 2003, there were 1877 admissions to the burn center; 949 (51%) were transferred from an outside facility. Of these 949, 424 (45%) were transferred more than 90 miles from a referring facility to our burn center. The average transport time from injury to our burn center was 7.2 hours (range, 1.6–48). There were no patient deaths during transport, and the most common complications were loss of or inability to secure intravenous access and inability to secure an airway. Burn size estimates differed significantly (P < .001) between referring providers and burn center physicians. This study confirms that patients can be transported safely and efficiently over long distances to a regional burn center. Given the current geographic distribution of burn centers and concerns about declining numbers of burn surgeons, organized systems of patient triage and transport may become increasingly important.Klein, M.B., Nathens, A.B., Emerson, D., Heimbach, D.M., Gibran, N.S.Northwest Regional Burn Model SystemYesdevopsadmin
2010Confirmatory Factor Analysis and Invariance of the Short Form McGill Pain Questionnaire (MPQ-SF) in a Longitudinal Sample of Burn PatientsJA ePlasty8 494-504Maston, S.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2007Psychological Health and Function Following burn injuries: Setting research prioritiesJA Journal of Burn Care & Research284587-592Abstract not availableFauerbach, J.A., Pruzinsky, T., Saxe, G.N.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2007Propranolol does not increase inflammation, sepsis, or infectious episodes in severely burned childrenJA Journal of Trauma-Injury Infection and Critical Care62 676-81Background: Propranolol, a nonselective 1–2 antagonist, attenuates hypermetabolism and catabolism in severely burned patients. However, recent data suggest that propranolol impairs immune function and enhances inflammation. The purpose of the present study was to determine the effect of propranolol administration on infection, sepsis, and inflammation in severely burned pediatric patients. Patients: A prospective, intent-totreat study was performed; patient demographics (age, gender, burn size, and mortality); infectious episodes (colony count greater then 105); and sepsis (guidelines by the society of critical care medicine) were determined. Hypermetabolic response was determined by resting energy expenditure (REE), and the inflammatory response was determined by measuring serum cytokine expression. Results: Two hundred forty-five patients (143 controls, 102 propranolol) were included into the study. There were no differences between the control and propranolol groups for age, gender distribution, burn size, third degree burn, and length of stay. Mortality was 6% in the control group and 5% in the propranolol group. Propranolol significantly decreased REE and predicted REE during acute hospital stay. Forty-three patients developed infections in the control group (30%), whereas 21 developed infections in the propranolol group (21%). The incidence of sepsis was 10% for controls and 7% for propranolol. Analysis of the cytokine expression profile in 20 patients in each group revealed that propranolol significantly decreased serum tumor necrosis factor and interleukin-1 compared with controls (p < 0.05). Conclusion: Propranolol treatment attenuates hypermetabolism and does not cause increased incidence of infection and sepsis.Jeschke, M., Norbury, W., Finnerty, C., Branski, L., Herndon D.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2007Burns as a result of assault: associated risk factors, injury characteristics, and outcomesJA Journal of Burn Care & Research28121-28The purpose of this study was to identify specific premorbid factors and injury characteristics associated with intentional burn injuries and to compare outcomes for individuals injured by assault and those with unintentional injuries. Participants sustaining major burns from May 1994 to August 2005 and consenting to a multisite, prospective, longitudinal outcome study were included. Etiology of the injury was classified as intentional (i.e., assault) or unintentional. Subjects Kaufman, M.S., Graham, C.C., Lezotte, D., Fauerbach, J.A., Gabriel, V., Engrav, L.H., Esselman, P.Yesdevopsadmin
2007Prevalence of major psychiatric illness in young adults who were burned as childrenJA Psychosomatic Medicine69 377-382Objective: To determine the prevalence of major psychiatric illness in a group of young adults who suffered significant burn injury as children. Method: A total of 101 persons (58 males, 43 females), aged 21 2.6 years, 14.0 5.4 years postburn of 54% 20% total body surface area, were assessed for serious past and present mental illness by using a Structured Clinical Interview (SCID) for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) Axis I diagnoses. Results: The SCID findings demonstrated that the prevalence of any Axis I major mental illness was 45.5% for the past month (current) and 59.4% for lifetime. These rates of overall disorder and the rates for most specific disorders were significantly higher than those found in the US population of comparable age. Logistic regression was used to examine demographic and burn characteristics as predictors of current and lifetime psychiatric disorder within the burn survivor sample. The female gender was significantly associated with higher rates of any current disorder. Other demographic and burn characteristics were not significantly related to the overall prevalence of current or lifetime disorder. Only a small number of those with disorders reported any current mental health treatment. Conclusions: Significant burn injury as a child leads to an increased risk of developing a major mental illness. Young adults who suffered major burn injury as children should be screened for these illnesses to initiate appropriate treatment. Meye,W., Blakeney, P., Thomas, C., Russell, W., Robert, R., Holzer III, CE Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2007Depression in burn reconstruction patients: Symptom prevalence and association with body image dissatisfaction and physical functionJA General Hospital Psychiatry29114-20Objective: This study investigated the prevalence and the clinical correlates of symptoms of depression among burn reconstruction patients. Method: A sample of 224 burn reconstruction patients completed the Beck Depression Inventory (BDI), the SF-36 Health Survey and the Satisfaction with Appearance Scale. Results: The prevalence of at least mild to moderate symptoms of depression (BDI z10) was 46%. Female patients were disproportionately represented in this burn reconstruction population (46%) compared to all survivors from the burn center (29%; P b.001) and compared to a national sample of burn survivors (27%; P b.001). Compared to males, female patients presented for consultation much longer after a burn injury ( P b.001), tended to have smaller burns ( P=.06) and were less likely to have facial burns ( P=.08). Depressive symptoms were largely predicted by body image dissatisfaction (b =.58; P b.001), with additional variance predicted by physical function (b = .13; P=.07). The effect of patient and burn injury variables on depressive symptoms was mediated by body image dissatisfaction and physical function. Conclusion: The high prevalence of significant symptoms of depression in burn reconstruction patients and their relationship with body image suggest the importance of the routine psychological screening of patients seeking reconstruction services.Thombs, B.D., Haines, J., Bresnick, M.G., Magyar-Russell, G., Fauerbach, J.A., Spence, R.J.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2009The beneficial effects of plasma exchange after severe burn injuryJA J Burn Care Res302243-48Severe burn injury results in a systemic inflammatory response that leads to increased capillary permeability and fluid leak into the interstitium. This global systemic capillary leak can be attributed, at least in part, to inflammatory mediators produced as a result of cellular injury. Plasma exchange has been used in the management of a number of illnesses with a significant inflammatory component, and, therefore, may have a role in the early management of burn injury. The purpose of this study was to review our institutional experience using plasma exchange in the management of severe burn injury. We performed a retrospective review of all patients receiving plasma exchange at our burn center between 2001 and 2005. Data collected included the following: burn size, presence of inhalation injury, resuscitation fluid received, urine output, lactate levels, base deficit levels, and hematocrit before and after the exchange procedure. A total of 37 patients underwent plasma exchange during the 5-year study period and seven patients underwent two plasma exchange treatments. Average TBSA burned was 48.6% (range 18-82) and 73% of patients sustained an inhalation injury. After plasma exchange, hourly fluid volume received significantly decreased (P < .05) and base deficit, lactate, and hematocrit levels significantly improved. Plasma exchange in the early resuscitation period was associated with decreased fluid administration, as well as increased urine output in the period during and immediately after the procedure. These data suggest that plasma exchange may provide a useful tool in the management of severe burn injury.Klein, M. B., Edwards, J. A., Kramer, C. B., Nester, T., Heimbach, D. M., Gibran, N. S.Northwest Regional Burn Model SystemYesdevopsadmin
2007Blood transfusions are associated with increased risk for development of sepsis in severely burned pediatric patientsJA Critical Care Medicine35 579-83transfusion of blood products in severely burned pediatric patients. Design: Retrospective, cohort study. Setting: Shriners Hospital for Children and University Hospital. Patients: Severely burned pediatric patients with >30% total body surface area (TBSA) burn. Interventions: None. Measurements and Main Results: Two hundred seventy-seven pediatric burn patients over a period of 7 yrs (1997–2004) were included in the study, with 25 patients being septic at admission and therefore excluded. Patients were stratified according to TBSA burn and presence or absence of inhalation injury. The amounts of packed red blood cells (RBCs) and fresh frozen plasma (FFP) were recorded during hospital stay before the development of sepsis. Blood product administration was normalized for the number of surgeries and divided into two groups: high (RBCs >20/FFP >5) or low (RBCs Jeschke, M.G., Chinkes, D.L., Finnerty, C.C., Przkora, R., Pereira, C.T., Herndon, D.N.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2009Using Qmethodology to identify reasons for distress in burn survivors postdischargeJA J Burn Care Res30183-91Reasons for distress after burn injuries have not been codified based on any type of acceptable empirical or statistical technique. The unique design methodology proposed in this study can identify the most common reasons cited for causing distress in burn survivors after discharge. A Q-sort task was developed with the assistance of our burn advisory group. After identifying 50 possible reasons for distress after discharge, each reason was placed on a laminated game card. In compliance with Qmethodology, a game board was developed that allowed patients to rank order each reason from "not causing distress" to "causing significant distress." A total of 69 burn survivors were enrolled in the study at four different time points: 1 month, 6 months, 1 year and 2 years postdischarge. After factor analysis, four factors accounted for all of the participants across time points. This indicates that at least four distinct groups of people can be categorized according to themes raised in rating reasons for distress. This Q-sort technique allowed us to capture the complexity of conceptualizing human distress by categorizing clusters of reported problems into similar groups. This methodology shows great promise for developing interventions that target unique needs of burn survivors.Wiechman Askay S., Stricklin, M., Carrougher, G.J., Patterson, D. R., Klein, M. B., Esselman, P. C., Engrav, L. H.Northwest Regional Burn Model SystemYesdevopsadmin
2007Beta-blockade in burnsJA Novartis Foundation Symposium280 238-48A significant proportion of the mortality and morbidity of severe burns is attributable to the ensuing hypermetabolic response that typically lasts for at least 9-12 months post-injury. This is associated with impaired wound healing, increased infection risks, erosion of lean body mass, hampered rehabilitation and delayed reintegration of burn survivors into society. The endocrine status is markedly altered during this period with an initial and then sustained increase in proinflammatory 'stress' hormones such as cortisol and other glucocorticoids, and catecholamines including epinephrine and norepinephrine by the adrenal medulla and cortex. These hormones exert catabolic effects leading to muscle wasting, the intensity of which depends upon the percentage of total body surface area (TBSA) involved, as well as the time elapsed since initial injury. Pharmacological and non-pharmacological strategies may be used to reverse the catabolic effect of thermal injury. Of these, beta-adrenergic blockade with propranolol has been the most efficacious anti-catabolic therapy in the treatment of burns. The underlying mechanism of action of propranolol is still unclear, however its effect appears to occur due to an increased protein synthesis in the face of a persistent protein breakdown and reduced peripheral lipolysis. This article aims to review the current understanding of catecholamines in postburn muscle wasting and focuses on the clinical and metabolic effects of beta-blockade in severe burns.Pereira CT., Jeschke, MG., Herndon, DN.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2008Contractures in burn injury part II: Investigating joints of the handJA J Burn Care Res294606-613This study prospectively examines the incidence and severity of hand contractures after burn injury and determines predictors of contracture development. Data were collected prospectively from 1993 to 2002 for adult burn survivors admitted to a regional burn center. Demographic and medical data were collected on each subject. Primary outcome measures include presence of contractures, number of contractures, and the severity of contractures at each of the hand joints at hospital discharge. The metacarpal-phalangeal, proximal inter-phalangeal (PIP), and distal inter-phalangeal joints of all digits and the wrist joints are included in this study. Regression analysis was performed to determine predictors of the presence, severity, and number of contractures. Of the 985 study patients, 23% demonstrated at least one hand contracture at hospital discharge. Those with a contracture averaged ten contractures per person. Most contractures were mild (48%) or moderate (41%) in severity. The wrist was the most frequently affected joint (22%). Statistically significant predictors of contracture development include concomitant medical problems, total body surface area grafted and presence of hand burn and hand grafting (P < .05). Predictors of the number of contractures include length of stay, concomitant medical problems, burn size and presence of hand burn and grafting (P < .05). Contractures of the hand are a significant complication of burn injury. Clinicians can use the contracture predictors to help target interventions for those patients most at risk of developing hand contractures. Given the functional importance of the hand in daily living, the burn care community is challenged to find new ways of preventing and treating hand contractures.Schneider, J. C., Holavanahalli, R., Helm, P., O'Neil, C., Goldstein, R., Kowalske, K.North Texas Burn Rehabilitation Model SystemYesdevopsadmin
2008Expression of collagen genes in the cones of skin in the Duroc/Yorkshire porcine model of fibroproliferative scarringJAJ Burn Care Res295815-27During the past decades there has been minimal improvement in prevention and treatment of hypertrophic scarring. Reasons include the lack of a validated animal model, imprecise techniques to dissect scar into the histologic components, and limited methodology for measurement of gene expression. These problems have been addressed with the Duroc/Yorkshire model of healing, laser capture microdissection, and the Affymetrix Porcine GeneChip. Here we compared collagen gene expression in fibroproliferative healing in the Duroc breed to nonfibroproliferative healing in the Yorkshires. We made shallow and deep dorsal wounds, biopsied at 1, 2, 3, 12, and 20 weeks. We sampled the dermal cones by laser capture microdissection, extracted and amplified the RNA, and hybridized Affymetrix Porcine GeneChips. We also obtained samples of human hypertrophic scar approximately 20 weeks postinjury. Data were normalized and statistical analysis performed with mixed linear regression using the Bioconductor R/maanova package. Genes for further analysis were also restricted with four biologic criteria, including that the 20-week deep Duroc expression match the human samples. Eleven collagen genes and seven collagen types were differentially over expressed in deep Duroc wounds including 1a1, 1a2, 3a1, 4a1, 4a2, 5a1, 5a2, 5a3, 6a3 (transcript variant 5), 14a1 and 15a1. COL7a1 gene was differentially under expressed in deep Duroc wounds. The results suggest that collagens I, III, IV, V, VI, VII, XIV, and XV1 are involved in the process of fibroproliferative scarring. With these clues, we will attempt to construct the regulatory pathway(s) of fibroproliferative healing.Zhu, K.Q., Carrougher, G.J., Couture, O.P., Tuggle, C.K., Gibran, N.S., Engrav, L.H.Northwest Regional Burn Model SystemYesdevopsadmin
2007Outcomes after deep full-thickness hand burnsJA Archives of Physical Medicine and Rehabilitation8812 Suppl 2S30-S35OBJECTIVE: To measure hand-specific functional performance after deep full-thickness dorsal hand burns. DESIGN: Descriptive, cross-sectional study. SETTING: The 2005 Phoenix Society's World Burn Congress, Baltimore, MD. PARTICIPANTS: Volunteer sample of burn survivors (N=32) with full-thickness dorsal hand burns with extensor mechanism involvement, who consented to participate. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Total active motion of joints, Jebsen-Taylor Hand Function Test (JTHFT), and Michigan Hand Questionnaire (MHQ). RESULTS: Subjects had large burns (mean percentage total body surface area, 58%). Digit involvement was severe, with more than 50% having amputations and 22% with a boutonnière deformity. Forty percent of subjects had poor functional range with total active motion of less than 180 degrees . Scores on the JTHFT were lower than normative scores, and subjects reported most difficulty in performing MHQ activities of daily living (ADLs). CONCLUSIONS: Even with partial amputation or loss of extensor mechanisms, the intact flexor muscles facilitate function by allowing for a modified grasp and enable patients to be independent in most ADL tasks. Training programs can be developed to meet specific goals despite residual hand deformities caused by deep full-thickness burns.Holavanahalli, R. K., Helm, P. A., Gorman, A. R., Kowalske, K. J.North Texas Burn Rehabilitation Model SystemYesdevopsadmin
2009Influence of comorbidities and age on outcome following burn injury in older adultsJA J Burn Care Res302307-14Despite advances in medical and surgical techniques, older adults tend to be at high risk for adverse outcomes following burn injury. The purpose of this study was to examine the relative impacts of age and medical comorbidities on outcome following injury in a cohort of older adults. This was a retrospective study of all patients age 55 and over admitted to the University of Washington Burn Center from 1999 to 2003. To examine the effect of baseline medical comorbidities on outcome, a Charlson Comorbidity Index score was calculated for each patient. Multivariate regression analyses were used to examine the impact of age and comorbidities on mortality and other complications. Patient records were also matched with the National Death Index to determine the effects of age and comorbidities on mortality within 1 year following hospital discharge. A total of 325 patients who were of 55 years and older were admitted to the burn center during the 5-year study period. The overall mortality rate was 18.5%. Mortality was independently associated with age, inhalation injury, and burn size. One-year mortality was significantly associated with those older than age 75 and the Charlson score. Longer length of stay was significantly associated with burn size, inhalation injury, and total number of in-hospital complications. This study demonstrates that patient age-independent of baseline medical comorbidities-and TBSA burn are the most significant factors impacting in-hospital mortality risk following burn injury. Higher number of medical comorbidities was associated with increased mortality risk within 1 year following discharge.Lundgren, R. S., Kramer, C. B., Rivara, F. P., Wang, J., Heimbach, D. M., Gibran, N. S., Klein, M. B.Northwest Regional Burn Model SystemYesdevopsadmin
2007Effect of insulin on the inflammatory and acute phase response after burn injuryJA Critical Care Medicine359S519-523After a severe burn, the liver plays a pivotal role by modulating inflammatory processes, metabolic pathways, immune functions, and the acute phase response. Therefore, liver integrity and function are important for recovery. A thermal injury, however, causes hepatic damage by inducing hepatic edema, fatty infiltration, hepatocyte apoptosis, and metabolic derangements associated with insulin resistance and impaired insulin signaling. In preliminary studies, we found that these pathophysiological processes are related to hepatic inflammation, altered intracellular signaling, and mitochondrial dysfunction. We hypothesize that modulation of these processes with insulin could improve hepatic structure and function and, therefore, outcome of burned and critically ill patients. Insulin administration improves survival and decreases the rate of infections in severely burned and critically ill patients. Here, we show that insulin administration decreases the synthesis of proinflammatory cytokines and signal transcription factors and improves hepatic structure and function after a severe burn injury; insulin also restores hepatic homeostasis and improves hepatic dysfunction postburn via alterations in the signaling cascade.Jeschke, M., Boehning, D., Finnerty, C., Herndon, D.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2008Pediatric palm contact burns: A ten-year reviewJA Journal of Burn Care & Research294614-618Management and proper approach to pediatric palm burns remains unclear. Our burn center's approach includes early, aggressive range of motion therapy, combined with a period of watchful waiting, reserving grafting only for those palms that do not heal in a timely manner. We reviewed our experience using this approach over a 10-year period. We performed a retrospective review of all pediatric patients with palm burns admitted to our burn center from 1994 to 2004. A total of 168 patients (194 palms) were included in the study. The average patient was 1.3 years old. A total of 168 of the injured palms (87%) healed without need for surgery. The average time to healing was 13 days (range 5-34). The 19 patients (26 palms, 13.4%) who underwent excision and grafting were managed with thick split thickness skin grafts. Of these, four patients (five palms, 19.2%) underwent secondary reconstruction, at an average of 166 days after the initial surgery. Of the 168 (87%) palms managed without surgery, only three patients (four palms) required late reconstruction (2.4%). Reconstructive procedures consisted of full-thickness skin grafts (n = 7) and z-plasty (n = 2). We have found that the majority of patients in this study healed without need for acute or reconstructive surgery. We therefore recommend aggressive hand therapy and conservative surgical management of palm burns in children.Scott, J. R., Costa, B. A., Gibran, N. S., Engrav, L. H., Heimbach, D. M., Klein, M. B.Northwest Regional Burn Model SystemYesdevopsadmin
2007The effect of oxandrolone on the endocrinologic, inflammatory, and hypermetabolic responses during the acute phase postburnJA Ann Surg2463351-360; 360-362OBJECTIVE AND SUMMARY BACKGROUND DATA: Postburn long-term oxandrolone treatment improves hypermetabolism and body composition. The effects of oxandrolone on clinical outcome, body composition, endocrine system, and inflammation during the acute phase postburn in a large prospective randomized single-center trial have not been studied. METHODS: Burned children (n = 235) with >40% total body surface area burn were randomized (block randomization 4:1) to receive standard burn care (control, n = 190) or standard burn care plus oxandrolone for at least 7 days (oxandrolone 0.1 mg/kg body weight q.12 hours p.o, n = 45). Clinical parameters, body composition, serum hormones, and cytokine expression profiles were measured throughout acute hospitalization. Statistical analysis was performed by Student t test, or ANOVA followed by Bonferroni correction with significance accepted at P < 0.05. RESULTS: Demographics and clinical data were similar in both groups. Length of intensive care unit stay was significantly decreased in oxandrolone-treated patients (0.48 +/- 0.02 days/% burn) compared with controls (0.56 +/- 0.02 days/% burn), (P < 0.05). Control patients lost 8 +/- 1% of their lean body mass (LBM), whereas oxandrolone-treated patients had preserved LBM (+9 +/- 4%), P < 0.05. Oxandrolone significantly increased serum prealbumin, total protein, testosterone, and AST/ALT, whereas it significantly decreased alpha2-macroglobulin and complement C3, P < 0.05. Oxandrolone did not adversely affect the endocrine and inflammatory response as we found no significant differences in the hormone panels and cytokine expression profiles. CONCLUSIONS: In this large prospective, double-blinded, randomized single-center study, oxandrolone shortened length of acute hospital stay, maintained LBM, improved body composition and hepatic protein synthesis while having no adverse effects on the endocrine axis postburn, but was associated with an increase in AST and ALT.Jeschke, M. G., Finnerty, C. C., Suman, O. E., Kulp, G., Mlcak, R. P., Herndon, D. N.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2008The factor age and the recovery of severely burned childrenJA Burns34141-44PURPOSE: It is not known if the recovery of pediatric burn patients is age-dependent. The aim of this study was to investigate the effect of age on the recovery of body composition of severely burned children. PROCEDURES: Pediatric patients with massive burns, >or= 40% of total body surface area, were followed over 2 years. Patients were divided into two age groups: 0-3.9 years old and 4-17.9 years old at the time of burn. Body composition was determined at hospital discharge, 6, 9, 12, 18, and 24 months after burn using dual-X-ray absorptiometry. Data analysis was performed using a two way ANOVA followed by Tukey's correction when appropriate. Significance was accepted at pPrzkora, R., Herndon, D., Jeschke, M.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2007Restoration of functionJA Journal of Burn Care & Research284611-614Restoration of function is crucial to the performance of activities of daily living, vocational and recreational activities, as well as to community integration and psychosocial aptitude. Strategies to optimize restoration of function include both physical considerations as well as metabolic considerations that can significantly impact physical capacity. Given the breadth of this topic, Drs. Herndon and deLateur focused on two of the most critical facets of restoration of function: metabolic support of the burn patient and exercise/fitness.Helm, P., Herndon, D., Delateur, B.Yesdevopsadmin
2008Hospital costs associated with pediatric burn injuryJA Journal of Burn Care & Research294632-637Modern burn care is a resource intensive endeavor requiring specialized equipment, personnel, and facilities in order to provide optimum care. The costs associated with burn injury to both patients and society as a whole can be multifaceted and large. The purpose of this study was to evaluate the association between hospital costs, patient characteristics, and injury factors in a cohort of pediatric patients admitted to a regional burn center. We performed a review of the hospital charges accrued by pediatric patients (age Klein, M. B., Hollingworth, W., Rivara, F. P., Kramer, C. B., Askay, S. W., Heimbach, D. M., Gibran, N. S.Northwest Regional Burn Model SystemYesdevopsadmin
2008Combination of recombinant human growth hormone and propranolol decreases hypermetabolism and inflammation in severely burned childrenJA pediatric critical care medicine92209-216OBJECTIVE: Recombinant human growth hormone (rhGH) is a salutary modulator of posttraumatic metabolic responses. However, rhGH administration is associated with deleterious side effects, such as hyperglycemia, increased free fatty acids, and triglycerides, which limit its use. Administration of beta-blocker attenuates cardiac work and resting energy expenditure after severe thermal injury and improves fat metabolism and insulin sensitivity. Therefore, the combination of rhGH plus propranolol appears ideal. The aim of the present study was to determine whether rhGH plus propranolol improves hypermetabolism and the inflammatory and acute phase response after severe burn without causing adverse side effects. DESIGN: Prospective randomized control trial. SETTING: Shriners Hospitals for Children. PATIENTS: Fifteen pediatric patients with burns > 40% total body surface area, 0.1-16 yrs of age, admitted within 7 days after burn. Fifteen children were matched for burn size, age, gender, inhalation injury, and infection and served as controls. INTERVENTIONS: Patients in the experimental group received rhGH (0.2 mg/kg/day) and propranolol (to decrease heart rate by 15%) for > or = 15 days. MEASUREMENTS AND MAIN RESULTS: Outcome measurements included resting energy expenditure, body composition, acute phase proteins, and cytokines. Both cohorts were similar in age, burn size, gender, and accompanying injuries. Percent predicted resting energy expenditure significantly decreased in patients receiving rhGH/propranolol (Delta -5% +/- 8%) compared with controls (Delta +35% +/- 20%) (p < .05). rhGH/propranolol administration significantly decreased serum C-reactive protein, cortisone, aspartate aminotransferase, alanine aminotransferase, free fatty acids, interleukin-6, interleukin-8, and macrophage inflammatory protein-1beta when compared with controls, while growth hormone/propranolol increased serum insulin-like growth factor-I, insulin-like growth factor binding protein-3, growth hormone, prealbumin, and interleukin-7 when compared with placebo (p < .05). CONCLUSIONS: rhGH in combination with propranolol attenuates hypermetabolism and inflammation without the adverse side effects found with rhGH therapy alone.Jeschke, M., Finnerty, C., Kulp, G., Przkora, R., Mlcak, R., Herndon, D.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2008Are serum cytokines early predictors for the outcome of burn patients with inhalation injuries who do not survive?JA Critical Care123R81Introduction Severely burned patients suffering from inhalation injury have a significantly increased risk for mortality compared with burned patients without inhalation injury. Severe burn is associated with a distinct serum cytokine profile and alterations in cytokines that contribute to morbidity and mortality. The aim of the present study was therefore to determine whether severely burned pediatric patients with concomitant inhalation injury who had a fatal outcome exhibited a different serum cytokine profile compared with burn patients with inhalation injury who survived. Early identification followed by appropriate management of these high-risk patients may lead to improved clinical outcome. Methods Thirteen severely burned children with inhalation injury who did not survive and 15 severely burned pediatric patients with inhalation injury who survived were enrolled in the study. Blood was collected within 24 hours of admission and 5 to 7 days later. Cytokine levels were profiled using multiplex antibody coated beads. Inhalation injury was diagnosed by bronchoscopy during the initial surgery. The number of days on the ventilator, peak inspiratory pressure rates, arterial oxygen tension (PaO2)/fraction of inspired oxygen (FiO2) ratio and incidence of acute respiratory distress syndrome were recorded for those patients. Results Significantly altered levels of IL-4, IL-6, IL-7, IL-10, and IL-13 were detected within the first 7 days after admission in serum from burn pediatric patients with concomitant inhalation injury who did not survive when compared with similar patients who did (P < 0.05). Alterations in these cytokines were associated with increased incidence of acute respiratory distress syndrome, number of days under ventilation, increased peak inspiratory pressure, and lower PaO2/FiO2 ratio in this patient population. Multiple logistic regression analysis revealed that patients with increased IL-6 and IL-10 as well as decreased IL-7 serum levels had a significantly greater risk for mortality (P < 0.05). Conclusion Early alterations in serum levels of IL-6, IL-7 and IL-10 may constitute useful predictive markers for identifying patients those who have sustained a burn with concomitant inhalation injury and who have high mortality.Gauglitz, G., Finnerty, C., Herndon, D., Mlcak, R., Jeschke, M.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2008The Prevalence of PTSD in Children with Burns who were Previously Diagnosed with ASDJA Journal of Burn Care & Research29 S166N/ARosenberg, L., Rosenberg, M., Perry, J., Sharp, S., Richardson, L., Holzer, C., Meyer, W.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2007Burn size determines the inflammatory and hypermetabolic responseJA Critical Care114R90BACKGROUND: Increased burn size leads to increased mortality of burned patients. Whether mortality is due to inflammation, hypermetabolism or other pathophysiologic contributing factors is not entirely determined. The purpose of the present study was to determine in a large prospective clinical trial whether different burn sizes are associated with differences in inflammation, body composition, protein synthesis, or organ function. METHODS: Pediatric burned patients were divided into four burn size groups: 80% TBSA burn. Demographic and clinical data, hypermetabolism, the inflammatory response, body composition, the muscle protein net balance, serum and urine hormones and proteins, and cardiac function and changes in liver size were determined. RESULTS: One hundred and eighty-nine pediatric patients of similar age and gender distribution were included in the study (80% TBSA burn, n = 21). Patients with larger burns had more operations, a greater incidence of infections and sepsis, and higher mortality rates compared with the other groups (P < 0.05). The percentage predicted resting energy expenditure was highest in the >80% TBSA group, followed by the 60-79% TBSA burn group (P < 0.05). Children with >80% burns lost the most body weight, lean body mass, muscle protein and bone mineral content (P < 0.05). The urine cortisol concentration was highest in the 80-99% and 60-79% TBSA burn groups, associated with significant myocardial depression and increased change in liver size (P < 0.05). The cytokine profile showed distinct differences in expression of IL-8, TNF, IL-6, IL-12p70, monocyte chemoattractant protein-1 and granulocyte-macrophage colony-stimulating factor (P < 0.05). CONCLUSION: Morbidity and mortality in burned patients is burn size dependent, starts at a 60% TBSA burn and is due to an increased hypermetabolic and inflammatory reaction, along with impaired cardiac function.Jeschke, M., Mlcak, R., Finnerty, C., Norbury, W., Gauglitz, G., Kulp, G., Herndon, D.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2008Age differences in inflammatory and hypermetabolic postburn responsesJA Pediatrics1213497OBJECTIVE: The aim of this study was to identify contributors to morbidity and death in severely burned patients 4 years of age lost body weight and lean body mass. The inflammatory cytokine profile showed no differences between the 3 age groups, whereas liver size increased significantly in the 10- to 18-year-old group and was lowest in the 0- to 3.9-year-old group. Acute-phase protein and cortisol levels were significantly decreased in the toddler group, compared with the older children. Cardiac data indicated increased cardiac work and impaired function in the toddler group, compared with the other 2 age groups. CONCLUSIONS: Increased mortality rates for young children are associated with increased cardiac work and impaired cardiac function but not with the inflammatory and hypermetabolic responses. Jeschke, Marc G., Norbury, William B., Finnerty, Celeste C., Mlcak, Ronald P., Kulp, Gabriela A., Branski, Ludwik K., Gauglitz, Gerd G., Herndon, Blair, Swick, Aron, Herndon, David N.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2008Assessment of skin blood flow perfusion differences in burned and nonburned skinJA Journal of Burn Care & Research292S140N/AMcEntire, S., Herndon, D., Suman, O.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2007Changes in liver function and size after a severe thermal injuryJA Shock282172-177Hepatic homeostasis and metabolism are essential for survival in critically ill and severely burned patients. There is evidence that the liver undergoes hypertrophy after burn. However, the extension and the duration of liver enlargement are not known. The aim of the present study was to determine the changes in liver size, weight, and hepatic protein synthesis in a large prospective clinical trial throughout acute hospitalization and up to 12 months after burn. Liver size was measured by means of ultrasound, and liver weight was calculated weekly during short-term hospital stay and at 6, 9, and 12 months after burn. The liver size was then compared with the predicted liver size for each individual. The levels of hepatic proteins and enzymes were determined by using standard laboratory techniques. One hundred two children were included in the study, with 58% +/- 2% total body surface area and 45% +/- 2% third-degree burn. Liver size and weight significantly increased during the first week after burn (mean +/- SEM, 85% +/- 5%), peaked at 2 weeks after burn (mean +/- SEM, 126% +/- 19%), and, at discharge, increased by 89% +/- 10%. At 6, 9, and 12 months, the liver weight increased by 40% to 50% compared with the predicted liver weight. The hepatic protein synthesis was affected up to 9 months after burn. The liver demonstrates a significant enlargement during short-term hospitalization, accompanied with impairment in the hepatic protein synthesis. The treatment to prevent liver enlargement and the improved impaired function may result in a reduction of complications accompanied with liver hypertrophy and failure.Jeschke, M., Mlcak, R., Finnerty, C., Herndon, D.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2007Sex differences in the long-term outcome after a severe thermal injuryJA Shock275461-165We have recently shown that during the acute phase, postburn female pediatric burn patients had significantly increased levels of anabolic hormones with an associated decreased hypermetabolism leading to a significant shorter intensive care unit stay compared with male patients. The aim of the present study was to determine possible differences between girls and boys in body composition, hypermetabolism, and hormone pattern in the long term. Sixty-two children (1-16 years old) who sustained a severe thermal injury (>or=40% total body surface area) were included into the study. Patients were further divided into girls (n = 22) and boys (n = 40). Patient demographics, nutritional support, and mortality were noted. Resting energy expenditure (REE) was measured by indirect calorimetry, body composition by dual-energy x-ray absorptiometry (Hologic Inc, Waltham, Mass) at discharge, 3, 6, 9, 12, 18, and 24 months after burn. In addition, blood was drawn at the same time points, and serum hormones were measured. There were no significant differences between girls and boys for demographics, nutritional intake, or concomitant injuries. Predicted REE was significantly decreased in girls at discharge, 6, 12, and 18 months postburn (P < 0.05). Dual-energy x-ray absorptiometry scan showed that girls had improved change in bone mineral content and percent fat compared with boys (P < 0.05). There were no differences in changes in height, body weight, lean body mass, and total fat between groups. Girls had significantly higher levels of insulinlike growth factor 1, insulinlike growth factor binding protein 3, free thyroxine index, T4, and insulin when compared with boys (P < 0.05). No differences were found for T3 uptake, osteocalcin, cortisol, growth hormone, and parathyroid hormone (PTH) between groups. Data indicate that girls have a reduced REE associated with changes in bone content and endogenous anabolic hormones.Jeschke, M. G., Przkora, R., Suman, O. E., Finnerty, C. C., Mlcak, R. P., Pereira, C. T., Sanford, A. P., Herndon, D. N.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2007Effects of cessation of a structured and supervised exercise conditioning program on lean mass and muscle strength in severely burned childrenJA Phys Med Rehabil8812 Suppl 2S24-29OBJECTIVE: To determine whether the benefits of exercise by burned children are maintained 3 months after the exercise program is concluded. DESIGN: Randomized, controlled prospective study. SETTING: Pediatric burn hospital. PARTICIPANTS: Twenty severely burned children with a 40% or greater total body surface area burn, with main outcome measures completed before exercise training, immediately after 12 weeks of exercise training (intervention), and 12 weeks after training ended. INTERVENTION: Randomization into a 12-week standard rehabilitation program at home (n=9) or a 12-week standard hospital rehabilitation program supplemented with an exercise-training program beginning 6 months after burn injury (n=11). MAIN OUTCOME MEASURES: Assessment of lean body mass (LBM) using dual-energy x-ray absorptiometry and of leg isokinetic muscle strength at a speed of 150 degrees /s were done before, after the 12-week rehabilitation and exercise training program, and 3 months after the exercise program was completed (12mo postburn). The effects of exercise on the dependent variables were analyzed by repeated-measures analysis of variance. If we found a significant overall effect of time and/or intervention, we did a post hoc test for multiple comparison (Holm-Sidak). Results are expressed as mean +/- standard error. RESULTS: The mean percentage increase in LBM and muscle strength was significantly greater in the exercise group (6.4%+/-1.9%, 40.7%+/-8.6%, respectively) than in the no-exercise group (1.9%+/-2.6% vs 3.4%+/-4.5%, respectively). Three months after cessation of the exercise program, LBM remained relatively unchanged in the no-exercise group (3.5%+/-1.8%). In contrast, LBM in the exercise group increased significantly (10.7%+/-4.8%, P=.03). In addition, muscle strength further increased by 17.9%+/-10.1% in the exercise group versus 7.2%+/-3.4% in the no-exercise group, although neither percentage increase was significant (P=.08 for exercise vs P=.61 for no exercise). Absolute values in LBM and muscle strength for both groups at 12 months postburn continued to be below historical or concurrent age-matched, nonburned children. CONCLUSIONS: Participation in an exercise program resulted in a greater improvement in LBM and muscle strength in the exercise group than in the no-exercise group. Three months after the exercise training ended, there were persistent mild-to-moderate increases in LBM and muscle strength. Absolute levels continued to be below previously reported nonburned, age-matched values, however, which underscores the need for continued exercise to improve LBM and muscle strength in severely burned children.Suman, O., Herndon, D.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2007Hypertrophic scar, wound contraction and hyper-hypopigmentationJA J Burn Care Res284593-597For decades, hypertrophic scarring, contraction, and pigment abnormalities have altered the future for children and adults after thermal injury. The hard, raised, red and itchy scars; shrunken wounds; and hyper- and hypo-pigmented scars are devastating to physical and psychosocial outcomes. The specific causes remain essentially unknown and, at present, prevention and treatment are symptomatic and marginal at best.Engrav, L.H., Garner, W.L, Tredget, E.E.Northwest Regional Burn Model SystemYesdevopsadmin
2001Effectiveness of virtual reality-based pain control with multiple treatmentsJA The Clinical Journal of Pain173229-235OBJECTIVE: The current study explored whether immersive virtual reality continues to reduce pain (via distraction) with repeated use. SETTING: The study was conducted in a burn care unit at a regional trauma center. PATIENTS: Seven patients aged 9-32 years (mean age of 21.9 years; average of 23.7% total body surface area burned [range, 3-60%]) performed range-of-motion exercises of their injured extremity under an occupational therapist's direction on at least 3 separate days each. INTERVENTION: For each physical therapy session, each patient spent equal amounts of time in virtual reality and in the control condition (no distraction). The mean duration of physical therapy in virtual reality was 3.5, 4.9, and 6.4 minutes for the first, second, and third session, respectively. Condition order was randomized and counter-balanced. OUTCOME MEASURES: For each of the three physical therapy sessions, five visual analog pain scores for each treatment condition served as the dependent variables. RESULTS: Pain ratings were statistically lower when patients were in virtual reality, and the magnitude of pain reduction did not diminish with repeated use of virtual reality. The results of this study may be examined in more detail at www.vrpain.com. CONCLUSIONS: Although the small sample size limits generalizability. results provide converging preliminary evidence that virtual reality can function as a strong nonpharmacological pain reduction technique for burn patients during physical therapy. Results suggest that virtual reality does not diminish in analgesic effectiveness with three (and possibly more) uses. Virtual reality may also have analgesic potential for other painful procedures or pain populations. Practical implications are discussed.Hoffman, H.G., Patterson, D.R, Carrougher, G.J., Sharar, S.R.Northwest Regional Burn Model SystemYesdevopsadmin
2004Opioid creep is real and may be the cause of "fluid creep"JA Burns306583-590Recent studies have shown that burn patients receive larger volumes of fluids than predicted by the Baxter formula and the reason for this is unclear. One potential reason is that increased analgesics are used which couldblunt the response to fluid resuscitation. The purpose of this study was to compare the administration of opioid agonists in patients treated at a single burn center in the 1970s and in the year 2000. We performed a retrospective chart review comparing two matched cohorts. Group I consisted of 11 patients admitted between 1975 and 1978. Group II consisted of 11 patients admitted in 2000 matched for age, sex and %TBSA. Patients in Group II received a significantly higher mean opioid equivalent than those in Group I (26.5 ' 12.3 versus 3.9 ' 2.2 in the first 24 h, P < 0.001). In addition, in Group II, a larger variety and combination of opioid agonists were used. This review demonstrates a significant increase from the 1970s to 2000 in the type, dose prescribed and dose delivered of opioid agonists. Along with "fluid creep", we have also increased our use of opioid agonists or "opioid creep". Higher doses of opioid agonists may have hemodynamic consequences, which may contribute to the increased fluid volumes.Sullivan, S.R., Friedrich, J.B., Engrav, L.H., Round, K.A., Heimbach, D.M., Heckbert, S.R., Carrougher, G.J., Lezotte, D.C., Wiechman, S.A., Honari, S., Klein, M.B., Gibran, N.S.Northwest Regional Burn Model SystemYesdevopsadmin
2003Immersive virtual reality for reducing experimental ischemic painJA International Journal of Human-Computer Interaction153469-486This study explored the novel use of immersive virtual environments as a nonpharmacologic pain control technique and whether it works for both men and women. Fourteen female and 8 male students underwent pain induced via a blood pressure cuff ischemia lasting 10 min or less. Pain ratings increased significantly every 2 min during the no distraction phase (0 to 8 min) and dropped dramatically during the last 2 min period when participants were in the virtual environment (a 59% drop for women and a 41% drop for men). Five visual analog pain scores for each treatment condition served as the primary dependent variables. All 22 participants reported a drop in pain in the virtual environment, and the magnitude of pain reduction from the virtual environment was large (a 52% drop) and statistically significant. This is the first study to show immersive virtual environment distraction is also effective for women. The results show that virtual environments can function as a strong nonpharmacologic pain reduction technique, showing the same pattern of results obtained from recent clinical studies using virtual environments with burn patients during physical therapy. Practical applications of virtual environment pain reduction, and the value of a multidisciplinary approach to studying pain are discussed.Hoffman, H.G., Garcia-Palacios, A., Kapa, V., Beecher, J., Sharar, S.R.Northwest Regional Burn Model SystemYesdevopsadmin
2005Changes in VEGF and nitric oxide after deep dermal injury in the femal, red Duroc pig - Further similarities between female, Duroc scar and human hypertrophic scarJA Burns31110-MayDespite decades of research, our understanding of human hypertrophic scar is limited. A reliable animal model could significantly increase our understanding. We previously confirmed similarities between scarring in the female, red, Duroc pig and human hypertrophic scarring. The purpose of this study was to: (1) measure vascular endothelial growth factor (VEGF) and nitric oxide (NO) levels in wounds on the female Duroc; and (2) to compare the NO levels to those reported for human hypertrophic scar. Shallow and deep wounds were created on four female Durocs. VEGF levels were measured using ELISA and NO levels with the Griess reagent. VEGF and NO levels were increased in deep wounds at 10 days when compared to shallow wounds (p < 0.05). At 15 weeks, VEGF and NO levels had returned to the level of shallow wounds. At 21 weeks, VEGF and NO levels had declined below baseline levels in deep wounds and the NO levels were significantly lower (p < 0.01). We found that VEGF and NO exhibit two distinctly different temporal patterns in shallow and deep wounds on the female Durocs. Furthermore, NO is decreased in female, Duroc scar as it is in human, hypertrophic scar further validating the usefulness of the model.Zhu, K.Q., Engrav, L.H., Armendariz, R., Muangman, P., Klein, M.B., Carrougher, G.J., Deubner, H., Gibran, N.S.Northwest Regional Burn Model SystemYesdevopsadmin
2000Use of virtual reality for adjunctive treatment of adult burn pain during physical therapy: A controlled studyJA The Clinical Journal of Pain163244-250OBJECTIVE: The pain experienced by burn patients during physical therapy range of motion exercises can be extreme and can discourage patients from complying with their physical therapy. We explored the novel use of immersive virtual reality (VR) to distract patients from pain during physical therapy. SETTING: This study was conducted at the burn care unit of a regional trauma center. PATIENTS: Twelve patients aged 19 to 47 years (average of 21% total body surface area burned) performed range of motion exercises of their injured extremity under an occupational therapist's direction. INTERVENTION: Each patient spent 3 minutes of physical therapy with no distraction and 3 minutes of physical therapy in VR (condition order randomized and counter-balanced). OUTCOME MEASURES: Five visual analogue scale pain scores for each treatment condition served as the dependent variables. RESULTS: All patients reported less pain when distracted with VR, and the magnitude of pain reduction by VR was statistically significant (e.g., time spent thinking about pain during physical therapy dropped from 60 to 14 mm on a 100-mm scale). The results of this study may be examined in more detail at www.hitL.washington.edu/projects/burn/. CONCLUSIONS: Results provided preliminary evidence that VR can function as a strong nonpharmacologic pain reduction technique for adult burn patients during physical therapy and potentially for other painful procedures or pain populations.Hoffman, H.G., Patterson, D.R., Carrougher, G.J.Northwest Regional Burn Model SystemYesdevopsadmin
2004Nerve quantification in female red Duroc pig (FRDP) scar compared to human hypertrophic scarJA Burns30157-64A significant impediment to studying hypertrophic scar is the lack of an animal model. We have confirmed similarities between scarring in the female red Duroc pig (FRDP) and human hypertrophic scar and conclude that this model warrants validation. Reports have suggested that the cutaneous nervous system may play a role in hypertrophic scar development and several studies have shown nerve density in hypertrophic scar to be increased. The purpose of this study was to further validate the FRDP model of hypertrophic scar by quantifying nerves in FRDP tissue and comparing the findings to human hypertrophic scar. Wounds of varying depth were created on the backs of two FRDP and tissue samples were harvested at 10 days, 1 month and 5 months post-wounding. Human specimens were obtained from six burn patients. Immunohistochemistry was performed and digital images were captured. Color subtractive computer-assisted image analysis was used to quantify nerve density and nerve area fraction. The results demonstrate that nerve tissue is increased in FRDP scar tissue and is quite similar to that in human hypertrophic scar and to that described in the literature. These data provide additional evidence that the FRDP model may be useful for studying hypertrophic scarring.Liang, Z., Engrav, L.H., Muangman, P., Muffley, L.A., Zhu, K.Q., Carrougher, G.J., Underwood, R.A., Gibran, N.S.Northwest Regional Burn Model SystemYesdevopsadmin
2008Assault and substance abuse characterize burn injuries in homeless patientsJA J Burn Care Res293461-467The homeless are at an increased risk for traumatic injury, but little is known about the injury etiology and outcome of homeless persons who sustain burn injuries. In this study, we analyze patient and injury characteristics of homeless persons admitted to a regional burn center. This is a retrospective cohort study of patients admitted to our burn center between 1994 and 2005. A total of 3700 adult patients were admitted during the study period and, of these, 72 (1.9%) were homeless. The cohort of homeless patients was compared with domiciled adult patients admitted during the same time period, analyzing baseline patient and injury characteristics and injury outcomes. Overall, homeless patients had more extensive burn injuries than domiciled patients (17.8% vs 11.2%TBSA, P < .001) and overall longer lengths of hospital stay (22 vs 12 days, P < .001). The homeless population also had significantly higher rates of alcohol (80.6% vs 12.8%, P < .001) and drug abuse (59.4% vs 12.8%, P < .001), history of mental illness (45.2% vs 11.0%, P < .001), and injury by assault (13.9% vs 2.0%, P < .001). Homeless patients tended to have more severe injuries; higher rates of substance abuse and mental illness; increased incidence of assault by burning; and longer lengths of hospital stay. Hospitalization of a homeless patient following injury may provide a unique opportunity to address co-occurring substance abuse and mental illness and approach injury prevention to improve patients' outcomes and reduce injury recidivism.Kramer, C.B., Gibran, N.S., Heimbach, D.M., Rivara, F.P., Klein, M.B.Northwest Regional Burn Model SystemYesdevopsadmin
2003Impairment after burns: A two-center, prospective reportJA Burns297671-675Impairment rating is regularly reported for trauma and other conditions but rarely for burns. The purposes of this study were: (1) to report impairment collected prospectively at our burn center, (2) to relate this impairment to measures of psychosocial and functional outcome, and (3) to compare these data to similar data from another burn center to verify that rating impairment is standardized and that the impairments are similar. We studied 139 patients from the University of Washington (UW) Burn Center and 100 patients from the University of Texas (UT) Southwestern Burn Center. The average whole person impairment (WPI) ratings at the University of Washington were 17% and this correlated with total body surface area burned and days off work. It did not correlate with Brief Symptom Inventory (BSI), Functional Independence Measure (FIM), Short-Form 36-Item Health Survey (SF-36), Satisfaction With Life Scale (SWLS), and the Community Integration Questionnaire (CIQ). Average whole person impairment ratings at UT Southwestern were similar at 19%. Several components of the impairment rating, however, differed at the two institutions. To minimize this variation, we recommend: (1) use the skin impairment definitions of the fifth edition of the Guides to the Evaluation of Permanent Impairment (or the most recent published versions of the Guide), and (2) include sensory impairment in healed burns and skin grafts in the skin impairment.Costa, B.A., Engrav, L.H., Holavanahalli, R., Lezotte, D.C., Patterson, D.R., Kowalske, K.J., Esselman, P.C.Yesdevopsadmin
2005Substance P levels and neutral endopeptidase activity in acute burn wounds and hypertrophic scarJA Plast Reconstr Surg11541095-102BACKGROUND: Substance P, a cutaneous neuroinflammatory mediator released from peripheral nerves, plays a role in responses to injury. Neutral endopeptidase is a cell membrane-bound metallopeptidase enzyme that regulates substance P activity. The question of substance P involvement in hypertrophic scar development has been based on observations that hypertrophic scars have increased numbers of nerves. The authors hypothesized that hypertrophic scar has greater substance P levels and decreased neutral endopeptidase activity compared with uninjured skin and acute partial-thickness burns, which may contribute to an exuberant response to injury. METHODS: The authors obtained small skin samples of deep partial-thickness burns (n = 7; postburn days 7 to 78) and uninjured skin (n = 14) from patients (eight male patients and six female patients; 2 to 71 years old) undergoing burn wound excision. Hypertrophic scar samples were obtained from six patients (three male patients and three female patients; 8 to 47 years old) undergoing surgical excision 13 to 64 months after burn injury. Protein concentrations were determined using a bicinchoninic acid assay. Substance P concentration was determined by means of indirect enzyme-linked immunosorbent assay. Neutral endopeptidase activity was measured using an enzymatic assay that quantifies a fluorescent degradation product, methoxy-2-naphthylamine (MNA). Substance P and neutral endopeptidase data were standardized to sample weight. RESULTS: Substance P levels were greater in hypertrophic scar (3506 pg/g) compared with uninjured skin (1698 pg/g; p < 0.03) and burned skin (958 pg/g; p < 0.01). Hypertrophic scar samples had decreased neutral endopeptidase enzyme activity (8.8 pM MNA/hour/microg) compared with normal skin (16.3 pM MNA/hour/microg; p < 0.05). Acute burn wounds (27.9 pM MNA/hour/microg) demonstrated increased neutral endopeptidase enzyme activity (p < 0.05). CONCLUSIONS: Increased substance P concentration in hypertrophic scar correlates with histologic findings of increased nerve numbers in hypertrophic scar samples. Decreased neutral endopeptidase enzyme activity in hypertrophic scar may contribute to increased available substance P that may result in an exuberant neuroinflammatory response.Scott, J.R., Muangman, P.R., Tamura, R.N., Zhu, K.Q., Liang, Z., Anthony, J., Engrav, L.H., Gibran, N.S.Northwest Regional Burn Model SystemYesdevopsadmin
2004Water-friendly virtual reality pain control during wound careJA Journal of Clinical Psychology602189-95Recent research suggests that entering an immersive virtual environment can serve as a powerful nonpharmacologic analgesic for severe burn pain. The present case study describes an attempt to use water-friendly virtual reality (VR) technology with a burn patient undergoing wound care in a hydrotherapy tub. The patient was a 40-year-old male with 19% total body surface area deep flame/flash burns to his legs, neck, back, and buttocks. The virtual reality treatment decreased the patient's sensory and affective pain ratings and decreased the amount of time spent thinking about his pain during wound care. We believe that VR analgesia works by drawing attention away from the wound care, leaving less attention available to process incoming pain signals. The water-friendly VR helmet dramatically increases the number of patients with severe burns that could potentially be treated with VR (see http://www.vrpain.com).Hoffman, H.G., Patterson, D.R., Magula, J., Carrougher, G.J., Zeltzer, K., Dagadakis, S., Sharar, S.R.Northwest Regional Burn Model SystemYesdevopsadmin
2007Review of the female Duroc/Yorkshire pig model of human fibroproliferative scarringJA Wound Repair Regen15Suppl 1S32-S39Hypertrophic scarring after burns is an unsolved problem and remains as devastating today as it was in the 40s and it may be that the main reason for this is the lack of an accepted, useful animal model. The female, red Duroc pig was described as a model of hypertrophic scarring nearly 30 years ago but then vanished from the literature. This seemed strange since the authors reported that 12 of 12 pigs developed thick scar. In the mid 90s we explored the model and found that, indeed, the red Duroc pig does make thick scar. Other authors have established that the Yorkshire pig does not heal in this fashion so there is the possibility of a same species control. We have continued to explore the Duroc/Yorkshire model and herein describe our experiences. Is it a perfect model of hypertrophic scarring? No. Is it a useful model of hypertrophic scarring? Time will tell. We have now obtained gene expression data from the Duroc/Yorkshire model and analysis is underway.Zhu, K.Q., Carrougher, G.J., Gibran, N.S., Isik, F.F., Engrav, L.H.Northwest Regional Burn Model SystemYesdevopsadmin
2003What is the prevalence of hypertrophic scarring following burnsJA Burns294299-302Hypertrophic scarring after burns remains a major problem and is considered to be "common". Pressure garments are commonly used as treatment even though there is little sound data that they reduce the prevalence or magnitude of the scarring. In 1999 we began a study of the efficacy of pressure garments on forearm burns. After studying 30 patients, mainly white adults, we found no hypertrophic scar in either those treated with pressure or without. This prompted us to review the literature on the prevalence of hypertrophic scarring after burns and found only four articles with a relatively small number of patients and only three geographical locations. It became clear that the prevalence of hypertrophic scarring is really unknown. We then did a retrospective study of 110 burn survivors and counted all hypertrophic scars of all sizes and locations in all races and found the prevalence hypertrophic scarring to be 67% which conflicts with the published reports and our prospective study and suggests that further research is necessary. We concluded that a worldwide, prospective survey is necessary to establish the prevalence of hypertrophic scarring after burns. In this article we are calling for and offering to organize this survey.Bombaro, K.M., Engrav, L.H., Carrougher, G.J., Wiechman, S.A., Faucher, L., Costa, B.A., Heimbach, D.M., Rivara, F.P., Honari, S.Northwest Regional Burn Model SystemYesdevopsadmin
2005Patterns of grease burn injury: Development of a classification systemJA Burns316765-767Grease burns occur commonly in the home during food preparation. It has been our observation that grease burns follow a particular pattern of injury. The purpose of this study was to review our institutional experience in the management of these burns to develop a classification scheme. We performed a retrospective review of patients admitted to our burn center with grease burns. Subjects were identified through our database and their charts were reviewed with particular attention to burn distribution, TBSA and need for grafting. We excluded workplace burns and children under the age of six. A total of 249 patients who fit the above criteria were admitted with grease burns to our burn center from 1993 to 2003. The sequence of events leading to burn and its distribution followed a consistent pattern. The majority of patients (86%) had an isolated upper extremity burn or upper extremity burn in combination with a face, trunk or lower extremity burn. Forty percent of patients required at least one excision and grafting procedure. Grease burns associated with cooking at home follow predictable patterns of injury. Based on these patterns we proposed a classification system for domestic grease burns.Klein, M.B., Gibran, N.S., Emerson, D., Sullivan, S.R., Honari, S., Engrav, L.H., Heimbach, D.M.Northwest Regional Burn Model SystemYesdevopsadmin
2004Is supra-Baxter resuscitation in burn patients a new phenomenonJA Burns305464-466Baxter described the use of 4 cm3/kg/%TBSA as a guideline for fluid resuscitation after burns. However, recent studies have shown that, at the present time, patients generally receive greater than the "Baxter" formula. Pruitt has called this phenomenon "fluid creep," and it has the potential for significant consequences including abdominal and extremity compartment syndromes and severe pulmonary insults. The purpose of this paper is to determine if this supra-Baxter resuscitation is a new phenomenon. We performed a retrospective chart review with two cohorts of patients. Group 1 consisted of 11 patients admitted between 1975 and 1978 to our burn center. Group 2 consisted of 11 patients admitted to our burn center in 2000 who were matched for age, sex, and percent total body surface area burned. Group 1 received 3.6 +/- 1.1 cm3/kg/% TBSA of fluid in the first 24 h. Group 2 received 8.0 +/- 2.5 cm3/kg/% TBSA, which is 100% more than the Baxter formula. There was no difference in the median age, weight, or 24-h urine output between the two groups. Our data demonstrate that the "fluid creep" phenomenon is relatively new.Friedrich, J.B., Sullivan, S.R., Engrav, L.H., Round, K.A., Blayney, C.B., Carrougher, G.J., Heimbach, D.M., Honari, S., Klein, M.B., Gibran, N.S.Northwest Regional Burn Model SystemYesdevopsadmin
2007Factors influencing the efficacy of virtual realtiy distraction analgesia during postburn physical therapy: Preliminary results from 3 ongoing studiesJA Archives of Physical Medicine and Rehabilitation8812 Suppl 2S43-S49OBJECTIVE: To assess the efficacy and side effects of immersive virtual reality (VR) distraction analgesia, as well as patient factors associated with VR analgesic efficacy in burn patients who require passive range-of-motion (ROM) physical therapy (PT). DESIGN: Prospective, randomized, controlled, within-subject trials. SETTING: Regional level I burn center in a university-affiliated urban hospital. PARTICIPANTS: Patients (age range, 6-65y) who required passive ROM PT in sessions lasting 3 to 15 minutes after cutaneous burn injury. INTERVENTIONS: Standard analgesic (opioid and/or benzodiazepine) care and standard analgesic care plus immersive VR distraction. MAIN OUTCOME MEASURE: Self-reported subjective pain ratings (0 to 100 graphic rating scale). RESULTS: A total of 146 treatment comparisons were made in 88 subjects, 75% of whom were children ages 6 to 18 years. Compared with standard analgesic treatment alone, the addition of VR distraction resulted in significant reductions in subjective pain ratings for worst pain intensity (20% reduction), pain unpleasantness (26% reduction), and time spent thinking about pain (37% reduction). Subjects' age, sex, ethnicity, size of initial burn injury, or duration of therapy session did not affect the analgesic effects of VR distraction. Nausea with the standard care plus VR distraction condition was infrequent (15%) and mild, with 85% of the subjects reporting no nausea. Children provided higher subjective reports of "presence" in the virtual environment and "realness" of the virtual environment than did adults, but age did not affect the analgesic effects of VR distraction. CONCLUSIONS: When added to standard analgesic therapy, VR distraction provides a clinically meaningful degree of pain relief to burn patients undergoing passive ROM PT. Multiple patient factors do not appear to affect the analgesic effect. Immersive VR distraction is a safe and effective nonpharmacologic technique with which to provide adjunctive analgesia to facilitate patient participation in rehabilitation activities.Sharar, S.R., Carrougher, G.J., Nakamura, D., Hoffman, H.G., Blough, D.K., Patterson, D.R.Northwest Regional Burn Model SystemYesdevopsadmin
2001The effectiveness of virtual reality pain control with multiple treatments of longer durations: A case studyJA International Journal of Human-Computer Interaction13112-JanImmersive virtual reality (VR) has proved to be potentially valuable as a pain control technique for patients with severe burns undergoing wound care and physical therapy. Recent studies have shown that single, 3-min visits to a virtual world can dramatically reduce the amount of pain experienced duringwoundcare, and the illusion of going inside the computer-generated world helps make VR analgesia unusually effective. This case study explored whether VR continues to reduce pain when the duration and frequency of VR treatments are increased to more practical levels.Apatient with deep flash burns covering 42% of his body spent varying amounts of time performing physical therapy with and without virtual reality. Five subjective pain ratings for each treatment condition served as the dependent measures. The magnitude of pain reduction with VR, and the patient’s illusion of "going into" the virtual world did not diminish with repeated administration and longer treatment durations. Practical implications are discussed. The results of this study may be examined in more detail at www.hitl.washington.edu/projects/burn/.Hoffman, H.G., Patterson, D.R., Carrougher, G.J., Nakamura, D., Moore, M., Garcia-Palacios, A., Furness, T.A.Northwest Regional Burn Model SystemYesdevopsadmin
2004Further similarities between cutaneous scarring in the female, red Duroc pig and human hypertrophic scarringJA Burns306518-30Knowledge of the pathophysiology of hypertrophic scarring following deep dermal injuries is minimal due to the lack of an animal model. We previously confirmed that thick scars in female, red Duroc pigs (FRDP) are similar to human hypertrophic scar. The purpose of this study was to evaluate TGFbeta1, IGF-1, decorin, and versican expression in FRDP wounds. Deep and shallow wounds on the backs of two FRDPs were studied over 5 months. Immunohistochemistry was performed for TGFbeta1, IGF-1, decorin, and versican. TGFbeta1 and IGF-1 mRNA were evaluated by in situ hybridization and RT-PCR. In shallow wounds (1) TGFbeta1 protein was not detectable and IGF-1 protein was seen at 10 days post-wounding. TGFbeta1 and IGF-1 mRNA were elevated for 30 days. (2) Decorin protein was not detected at 10th day, but returned to levels of uninjured skin. (3) Versican protein was not detectable at any time. In deep wounds, (1) TGFbeta1 and IGF-1 protein and mRNA were elevated early, (2) decorin protein was greatly reduced for the first 90 days, and (3) versican protein was present from 30 to 150 days. These findings correlate with findings reported in the literature for human hypertrophic scar and further validate the FRDP model of hypertrophic scarring.Zhu, K.Q., Engrav, L.H., Tamura, R.N., Cole, J.A., Muangman, P., Carrougher, G.J., Gibran, N.S.Northwest Regional Burn Model SystemYesdevopsadmin
2003The female, red Duroc pig as an animal model of hypertrophic scarring and the potential role of the cones of skinJA Burns297649-664Hypertrophic scarring occurs after deep dermal wounds. Our understanding of the etiology is poor; one reason is the lack of an animal model. In 1972, Silverstein described scarring in the Duroc pig but the model was never confirmed nor disproved. Another reason, as we previously suggested, is that hypertrophic scarring only occurs within regions of human skin that contain cones and the cones have not been studied in relation to hypertrophic scarring. We, therefore (i) explored healing in the female, red Duroc model for similarities to human hypertrophic scarring, studying wound thickness, appearance, healing status at 3 weeks, histology, and immunocytochemical localization of decorin, versican, TGFbeta1 and IGF-1; and (ii) examined Duroc skin for cones. We found that healing after deep wounds in Duroc pigs is similar, but not identical, to human hypertrophic scarring. We also found that Duroc skin contains cones. Healing in the female, red Duroc pig is sufficiently similar to human hypertrophic scarring to warrant further study so that it can be accepted or rejected as a model of human hypertrophic scarring. In addition, the relationship of the cones to hypertrophic scarring needs further detail and can be studied in this model.Zhu, K., Engrav, L., Gibran, N., Cole, J., Matsumura, H., Piepkorn, M., Isik, F., Carrougher, G.J., Muangman, P.M., Yunusov, M.Y., Yang, T.M.Northwest Regional Burn Model SystemYesdevopsadmin
2007Comparing the Body-Esteem of Adolescent and Young Adult Burn Survivors to a Non-burned Norm Group.JA Journal of Burn Care & Research524631Abstract not availableLawrence, J. W., Rosenberg, L., Fauerbach, J. A.Yesdevopsadmin
2006Histology of the thick scar on the female, red Duroc pig: final similarities to human hypertrophic scar.JA Burns326669-677The etiology and treatment of hypertrophic scar remain puzzles even after decades of research. A significant reason is the lack of an accepted animal model of the process. The female, red Duroc pig model was described long ago. Since the skin of the pig is similar to that of humans, we are attempting to validate this model and found it to be encouraging. In this project we quantified myofibroblasts, mast cells and collagen nodules in the thick scar of the Duroc pig and compared these to the values for human hypertrophic scar. We found the results to be quite similar and so further validated the model. In addition, we observed that soon after wounding an inflammatory cell layer forms. The thickness of the inflammatory layer approaches the thickness of the skin removed as if the remaining dermis “knows” how much dermis is gone. In deep wounds this inflammatory layer thickens and this thickness is predictive of the thickness of the ultimate scar.Harunari, N., Zhu, K. Q., Armendariz, R.T., Deubner, H., Muangman, P., Carrougher, G. J., Isik, F. F., Gibran, N. S., Engrav, L.H.Northwest Regional Burn Model SystemYesdevopsadmin
2000Personality predictors of injury-related PTSD.JA Journal of Nervous and Mental Disease188 510-517This longitudinal, cohort study examined the effect of personality traits on the emergence of posttraumatic stress disorder (PTSD) in a recently traumatized, civilian, mixed-gender sample with significant injuries. Burn survivors (N = 70) were administered the NEO-Personality Inventory (NEO-PI) and the Structured Clinical Interview for DSM III-R (SCID) at hospital discharge and readministered the SCID 4 and 12 months later. Overall, the sample of burn survivors scored significantly higher on neuroticism and extraversion and lower on openness, agreeableness, and conscientiousness relative to a normative national sample. Furthermore, multivariate analysis of variance revealed that PTSD symptom severity groups (i.e., single symptom, multiple symptoms, subthreshold PTSD, PTSD) were differentially related to neuroticism and extraversion. Planned comparisons indicated that neuroticism was higher and extraversion was lower in those who developed PTSD compared with those who did not develop PTSD.Fauerbach, J. A., Lawrence, J., Schmidt, C., Munster, A., Costa, P.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2007Symptoms of depression and anxiety as unique predictors of pain-related outcomes following burn injury.JA Annals of Behavioral Medicine343312-322Background: The adverse consequences of burn injuries include pain and psychological distress, which show bidirectional associations. However, much of the existing research has relied on global measures of distress that do not separate distinct symptoms of anxiety and depression.Purpose: The purpose is to assess the prospective effects of anxiety and depression on pain and functional outcomes following burn injury.Methods: This article describes a 2-year cohort study in patients hospitalized for serious burn injuries (assessments at discharge and 6-month, 1-year, and 2-year follow-up). Linear mixed effects analyses were conducted to model anxiety and depression’s unique longitudinal effects; at each time point, depressive and anxiety symptoms were studied as predictors of subsequent changes in pain, fatigue, and physical function.Results: When studied in separate prediction models, both depression and anxiety were strong prospective predictors of greater pain, more fatigue, and physical dysfunction at the subsequent time point (psEdwards, R. R., Smith, M. T., Klick, B., Magyar-Russell, G., Haythornthwaite, J. A., Holavanahalli, R., Patterson, D. R., Blakeney, P., Lezotte, D., McKibben, J., Fauerbach, J. A.Yesdevopsadmin
2007Respiratory management of inhalation injuryJA Burns33 13-FebAdvances in the care of patients with major burns have led to a reduction in mortality and a change in the cause of their death. Burn shock, which accounted for almost 20 percent of burn deaths in the 1930s and 1940s, is now treated with early, vigorous fluid resuscitation and is only rarely a cause of death. Burn wound sepsis, which emerged as the primary cause of mortality once burn shock decreased in importance, has been brought under control with the use of topical antibiotics and aggressive surgical debridement. Inhalation injury has now become the most frequent cause of death in burn patients. Although mortality from smoke inhalation alone is low (0–11 percent), smoke inhalation in combination with cutaneous burns is fatal in 30 to 90 percent of patients. It has been recently reported that the presence of inhalation injury increases burn mortality by 20 percent and that inhalation injury predisposes to pneumonia. Pneumonia has been shown to independently increase burn mortality by 40 percent, and the combination of inhalation injury and pneumonia leads to a 60 percent increase in deaths. Children and the elderly are especially prone to pneumonia due to a limited physiologic reserve. It is imperative that a well organized, protocol driven approach to respiratory care of inhalation injury be utilized so that improvements can be made and the morbidity and mortality associated with inhalation injury be reduced.Micak, R. P., Surrian, 0. E., Herndon, O. N.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2005Stress disorders following traumatic injury: Assessment and treatment considerations.JA Primary Psychiatry12351-55Traumatic injury is a relatively common occurrence, with approximately 40 million injury-related visits to emergency departments in the United States per year. Psychiatric complications of physical injury are a public health concern. Approximately 12% to 16% of survivors of traumatic injury are diagnosed with acute stress disorder (ASD), and 30% to 36% warrant a diagnosis of posttraumatic stress disorder (PTSD) 12 months after the traumatic event. Phenomena related to injury, such as blood loss, pain, administration of narcotic analgesics, and traumatic brain injury, as well as high rates of premorbid psychiatric and substance abuse and/or dependence disorders, often overlap with stress-related symptoms of psychological origin. This complicates the assessment of dissociative processes required for the diagnosis of ASD, as well as the three core PTSD symptom clusters (re-experiencing of the trauma, avoidance and numbing, and hyperarousal). This article reviews specific aspects of stress disorders in the context of traumatic injury, with a focus on aspects of assessment. Psychopharmacologic and behavioral treatment recommendations are also reviewed.Thombs, B. D., Fauerbach, J. A., McCann, U. D.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2007Time to school reentry following burn injury is quite short.JA Journal of Burn Care and Research283478-481Returning to school is an important indicator of functional aptitude and emotional adjustment in school-aged patients after burn injury. Only two reports in the burn literature provide objective data on time to school re-entry. However, these analyses did not address the impact of patient and burn injury characteristics on time to return to school. The purpose of this study was to determine the time for school re-entry and to identify the factors associated with re-entry time in a cohort of burned children treated at our burn center. We performed a retrospective review of all school age children treated at our burn center from 1997 to 2003 who were entered into a federally funded longitudinal research database for patients with severe burn injury. Time to school re-entry after discharge was calculated for each patient, and multivariate regression was used to identify the factors associated with longer time to return to school. A total of 64 patients were included in this study. The average time to school re-entry was 10.5 days (range, 0-40) and the median time was 7.5 days. Gender (male), age, and length of hospital stay were significantly associated (P < .05) with longer time to return to school. The average time to school return is quite short. Further studies are needed to increase understanding of the factors influencing longer time to re-entry and also to examine children's experiences upon re-entry.Christiansen, M., Carrougher, G. J., Engrav, L. H., Wiechman-Askay, S., Kramer, C. B., Gibran, N. S., Klein, M.B.Northwest Regional Burn Model SystemYesdevopsadmin
2000The effect of early body image dissatisfaction on subsequent psychological and physical adjustment following disfiguring injury.JA Psychosomatic Medicine62 576-582OBJECTIVE: The impact of body image dissatisfaction on quality of life after severe burn injury was investigated after controlling for other determinants of outcome (ie, injury, distress, and preburn quality of life). Fauerbach, J., Heinberg, L., Lawrence, J., Munster, A., Palombo, D., Richter, D.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2008Acute stress disorder and posttraumatic stress disorder: A prospective study of prevalence, course and predictors in a sample with major burn injuriesJA Journal of Burn Care Research29122-35This is one of the largest prospective studies of patients with major burn injuries to use psychometrically sound methods to track and predict posttraumatic stress disorder (PTSD) across 2 years after burn. The principal objectives were to investigate the utility of self-report measures in detecting acute stress disorder (ASD) and PTSD, and in tracking and predicting PTSD. Participants were adult patients admitted for treatment of a major burn injury. The Stanford Acute Stress Reaction Questionnaire (SASRQ) was used to assess ASD symptomatology at discharge (n = 178), and the Davidson Trauma Scale was used to assess PTSD symptoms at scheduled follow-ups at 1 (n = 151), 6 (n = 111), 12 (n = 105), and 24 (n = 71) months after burn. The prevalence of in-hospital ASD was 23.6%, and 35.1, 33.3, 28.6, and 25.4% of the participants met PTSD criteria at 1, 6, 12, and 24 months, respectively. Clinically significant and reliable change in PTSD symptomatology during the 24 months was uncommon. SASRQ diagnostic cutoff and total scores each robustly predicted PTSD at the first three follow-ups and all four follow-ups, respectively. A SASRQ empirically derived cutoff score (> or =40) yielded moderate-high sensitivities (0.67-0.71) and specificities (0.75-0.80), and predicted PTSD at each follow-up. In conclusion, ASD and PTSD are prevalent following major burn injuries, ASD symptomatology can reliably predict PTSD up to 24 months later, and, once established, PTSD usually persists. Research is needed to determine whether early recognition and treatment of persons with in-hospital ASD can improve long-term outcomes.McKibben, J., Bresnick, M. G., Askay Wiechman, S. A., Fauerbach, J. A.Yesdevopsadmin
2006A test of the moderating role of importance of appearance in the relationship between perceived scar severity and body. -esteem among adult burn survivors.JA Body Image32101-111This study tested the hypothesis that the relationship between subjective burn scar severity and body-esteem is moderated by importance of appearance. Three hundred and forty-six adult burn survivors completed a mailed or online survey. The three subscales of the Body-Esteem Scale for Adolescents and Adults (BE-Appearance [satisfaction with general appearance], BE-Weight [weight satisfaction], BE-Others [others' evaluations of one's body and appearance]) were regressed onto sex, subjective burn scar severity, importance of appearance and their two- and three-way interactions. With one exception, the hypothesized main effects were significant in each of the regression equations. As hypothesized, importance of appearance moderated the relationship between subjective burn scar severity and body-esteem for BE-Appearance and BE-Other but not BE-Weight. The results of this study are consistent with the cognitive model of body-esteem. Clinical implications are discussed.Lawrence, J. W., Fauerbach, J. A, Thombs, B. D.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2003Grief and Loss Following Burn Injury: How Mental Health Practitioners Can Help.JA Grief Matters: The Australian Journal of Grief and Bereavement6234-39Abstract not availableFauerbach, J. A., Fogel, J., Neel, M.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2009Approach-avoidance coping conflict in a sample of burn patients at risk for posttraumatic stress disorder.Journal Depression and Anxiety26 9838-50https://pubmed.ncbi.nlm.nih.gov/19170120/BACKGROUND: Following an acute burn injury, higher distress is consistently observed among individuals exhibiting a conflict between approach coping (e.g., processing) and avoidance coping (e.g., suppression) relative to those individuals who use only one of these methods. Study objectives were to determine if contradictory coping messages would lead to such approach-avoidance coping conflict and to determine if experiment-induced coping conflict is also associated with higher distress. METHODS: Participants (n=59 adults hospitalized with acute burn injuries) were assigned randomly to experimental conditions differing in the order in which training was provided in two ways of coping with posttrauma re-experiencing symptoms (i.e., process-then-suppress versus suppress-then-process). The primary dependent variable was coping behavior during the 24-hr posttraining period. Coping behavior was categorized as approach coping (processing), avoidance coping (suppressing), or approach-avoidance coping conflict (both) on the basis of median splits on subscales assessing these behaviors. Secondary analyses examined the relationship between this experiment-induced coping conflict and re-experiencing symptoms. RESULTS: Results indicated that participants in the process-then-suppress condition, relative to the suppress-then-process condition, were significantly more likely to exhibit approach-avoidance coping conflict (i.e., above median split on both processing and suppressing) during the next 24 hr. Furthermore, approach-avoidance coping conflict was associated with greater re-experiencing symptoms assessed via self-report and by blinded coding of recorded speech. CONCLUSIONS: It is concluded that the order of coping skill training can influence treatment outcome, success of coping methods, and overall levels of distress. therefore, training in stabilizing and calming methods should precede training in active processing following stressful life events. Fauerbach, J. A., Lawrence, J. W., Fogel, J., Richter, L., Magyar-Russell, G., McKibben, J., McCann, U.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2008Assessment of muscle function in severely burned childrenJA Burns344452-459Introduction: The posttraumatic response to a severe burn leads to marked and prolonged skeletal muscle catabolism and weakness, which persist despite standard rehabilitation programs of occupational and physical therapy. We investigated the degree to which the prolonged skeletal muscle catabolism affects the muscle function of children 6 months after severe burn. Methods: Burned children, with >40% total body surface area burned, were assessed at 6 months after burn in respect to lean body mass and leg muscle strength at 1508/s. Lean body mass was assessed using dual-energy X-ray absorptiometry. Leg muscle strength was assessed using isokinetic dynamometry. Nonburned children were assessed similarly, and served as controls. Results: We found that severely burned children (n = 33), relative to nonburned children (n = 46) had significantly lower lean body mass. Additionally they had significantly lower peak torque as well total work performance using the extensors of the thigh. Conclusions: Our results serve as an objective and a practical clinical approach for assessing muscle function and also aid in establishing potential rehabilitation goals, and monitoring progress towards these goals in burned children.Alloju, S., Herndon, D., McEntire, S., Suman, O.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2006Frequency and Correlates of Depression Symptoms Among Long-TermJARehabilitation Psychology514306-313Objective: To determine the frequency and correlates of symptoms of depression experienced by long-term burn survivors. Design: An exploratory study of a cross-sectional, self-selected sample. Participants: 311 burn survivors who were at least 3 years postburn (M = 20, SD = 15). Main Outcome Measure: The Short Mood and Feelings Questionnaire, which is a self-report measure of symptoms of depression. Results: Depending on the cutoff score used, 20%-30% of the sample reported clinically significant symptoms of depression. A hierarchical multiple regression model accounted for 59% of the variance in symptoms of depression. Variables were entered in 3 blocks-burn characteristics, demographic characteristics, and psychosocial characteristics. Psychosocial characteristics such as social support and social comfort accounted for a majority of the variance.Lawrence, John W., Fauerbach, James A., Thombs, Brett D.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2007Assets and liabilities of the Burn Model System data model: A comparison with the National Burn Registry.JA Archives of Physical Medicine and Rehabilitation8812 Suppl 2S7-17Objectives To determine whether the Burn Model System (BMS) population is representative of the larger burn population and to investigate threats to internal and external validity in a multicenter longitudinal database of severe burns. Design Cohort data for the BMS project have been collected since 1994. Follow-up data have been collected at 6, 12, and 24 months postburn. The demographic and burn characteristics of the BMS population were compared with those of patients in the National Burn Registry (NBR). Setting The BMS, which collected data for these analyses from 5 regional burn centers in the United States, and the NBR dataset, which is a registry of information collected through the Trauma Registry of the American College of Surgeons and includes data from 70 hospitals in the United States and Canada. Participants BMS study participants were severely burned patients treated at 1 of the 5 participating burn centers. We compared the BMS population with that of the NBR both in total and filtered to include only patients with comparable injuries. Interventions Not applicable. Main Outcome Measures Comparable demographic and burn characteristics contained in both the NBR and the 5-center BMS longitudinal database and baseline and follow-up distributions of demographic variables and burn characteristics in the BMS database. Results Although minor deviations in demographic distributions were found between the BMS and NBR and between discharge and follow-up populations, our results show that the BMS population sample is internally and externally valid and is adequate for answering research questions. Conclusions Cohort studies examining long-term outcomes have the potential flaw of using a nonrepresentative study population. The BMS population was found to be sufficiently representative, but future analyses will require cautious and purposeful application of statistical adjustment strategies.Lezotte, D., Hills, R., Heltshe, S., Holavanahalli, R., Klein, M., Fauerbach, J., Blakeney, P., Engrav, L.Yesdevopsadmin
2006An outcome analysis of patients transferred to a regional burn center: transfer status does not impact survivalJA Burns328940-945BACKGROUND: Optimal burn care is provided at specialized burn centers. Given the geographic location of these centers, many burn patients receive initial treatment at local emergency departments prior to transfer. The purpose of this study was to determine whether patients transferred from other facilities have worse outcomes than those admitted directly from the field. STUDY DESIGN: A retrospective cohort study was performed comparing the outcomes of patients admitted to our burn center directly from the field with patients requiring transfer from a preliminary care facility. The outcomes of interest were mortality, length of stay, length of stay/TBSA burned, number of operations and hospital charges. Poisson regression or Cox proportional hazards model was used to evaluate differences in outcomes after adjusting for potential confounders. RESULTS: From 2000 to 2003 a total of 1877 patients were admitted to our burn center and 953 (51%) were transferred from a preliminary care facility. No difference (pKlein, M. B., Nathens, A. B., Heimbach, D. M., Gibran, N.SNorthwest Regional Burn Model SystemYesdevopsadmin
2002Coping with the stress of a painful medical procedure.JA Behavior Research and Therapy40 1003-1015To evaluate its effect on procedure-related distress, the focus of attention was manipulated by providing training to hospitalized acute burn patients (n=42). Participants were randomly assigned to attention focusing (i.e. attending to procedural sensations) or music distraction (i.e. attention diverting) coping interventions, or to usual care during the target dressing change. Coping behavior (i.e. distraction, focusing, and three confounding methods, ignoring, catastrophizing, reinterpreting), tension and intrusiveness were evaluated 24 h retrospectively (i.e. for the prior procedure), during the targeted procedure, and 30 min after the target procedure. When coping during the target procedure by ignoring, reinterpreting, and catastrophizing were covaried, the music distraction group experienced significantly fewer intrusions, and the attention focus group had more intrusions. Additionally, secondary analyses revealed that coping by ignoring during the prior day's procedure significantly predicted higher procedural tension during, and more intrusions following, the targeted procedure. Suppression-based forms of emotion-focused coping may be enhanced by training in the use of an explicit distractor.Fauerbach, J. A., Lawrence, J. W., Haythornthwaite, J. A., Richter, L.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2008Sleep onset insomnia symptoms during hospitalization for major burn injury predict chronic painJA Pain1383497-506Both cross-sectional studies of chronic pain and sleep deprivation experiments suggest a bidirectional relationship between sleep and pain. Few longitudinal studies, however, have assessed whether acute-insomnia following traumatic injury predicts the development of persistent pain. We sought to evaluate: 1) whether in-hospital insomnia independently predicts long-term pain after burn injury and 2) whether in-hospital pain predicts future insomnia symptoms. We analyzed data on 333 subjects hospitalized for major burn injury (72.7% male; mean age = 41.1 years ±14.5) who were participating in the multi-site, Burn Model System project. Subjects completed measures of health, function (SF-36), and psychological distress (Brief Symptom Inventory) while in-hospital, at 6, 12, and 24 months after discharge. Participants were categorized as either having or not having sleep onset insomnia at discharge. Linear mixed effects analyses revealed that persons reporting insomnia at discharge (40.5%) had significantly decreased improvement in pain and increased pain severity during long-term follow up (pSmith, M. T., Klick, B., Kozachik, S., Edwards, R. R., Holavanahalli, R., Wiechman, S., Blakeney, P., Lezotte, D., Fauerbach, J. A.Yesdevopsadmin
2008The WeeFIM Instrument - A pediatric measure of functional independence to predict longitudinal recovery of pediatric burn patientsJA Developmental Neurorehabilitation11139-50Burns create a myriad of complications that affect the child's developmental, functional and aesthetic status. The WeeFIM is a standardized measure of functional performance developed for use in children 6-months to 8-years of age but with application through adolescence. It includes 18 domains of performance which are scored on a 7-point scale from 'total assistance' to 'complete independence'. In this study, the WeeFIM was used to evaluate the influence of burn size on functional independence and on time to recovery. METHODS: Children, 6 months to 16 years of age, with total body surface area (TBSA) bums of 10-100% burn injury were recruited for a 2-year longitudinal study. Due to unstable WeeFIM measurements on children 6 months to 6 years, analyses on normalized WeeFIM scores among subjects 6-16 years are presented. Children were evaluated at discharge from acute care, 6 months, 1 year and 2 years after burn injury. FINDINGS: In this analysis, 454 WeeFIM evaluations from 249 patients, 6-16 years of age, were reviewed. While mean WeeFIM scores varied significantly at discharge based on the size of burn, there were no significant differences in any of the WeeFIM scales at 24 months post-burn. At 24 months, the mean WeeFIM score for all children, independent of size of their bum, indicated full independence. Hands-on assistance was not required for performing activities of daily living (ADLs). The rates of improvement differed statistically by size of bum. Maximum improvement was attained by 6 months for 10-15% TBSA burns, 12 months for 16-30% burns, 12 months for 31-50% burns and 24 months for 51-100% TBSA. CONCLUSION: The WeeFIM can be utilized by burn centres to describe diminished functional capacity at discharge from acute care for severely burnt children. The tool can be used to track return to baseline independence after a major burn injury in a paediatric population.Serghiou, M.H., Rose, M.W., Pidcock, F.S., Esselman P.C., Engrav, L.H., Kowalske, K.J., Lezotte, D.L.Yesdevopsadmin
2007Augmented exercise in the treatment of deconditioning from major burn injury.JA Archives of Physical Medicine and Rehabiltation8812 Suppl 2S18-23Objective To investigate the efficacy of a 12-week exercise program in producing greater improvement in aerobic capacity in adult burn survivors, relative to usual care. Design Randomized, controlled, double-blinded trial. Setting Burn center. Participants A population-based sample of 35 adult patients admitted to a burn center for treatment of a serious burn injury. Intervention A 12-week, 36-session, aerobic treadmill exercise program where work to quota (WTQ) participants intensified their exercise according to preset quotas and work to tolerance (WTT) participants continued to their tolerance. Participants completed a maximal stress test at baseline and 12 weeks to measure physical fitness. Main Outcome Measure Maximal aerobic capacity. Results The WTT and the WTQ exercise groups both made significant improvements in aerobic capacity from baseline to 12 weeks (t=-3.60, P=.01; t=-3.17, P=.01, respectively). The control group did not (t=-1.39, P=.19). WTT and WTQ participants demonstrated significantly greater improvements in aerobic capacity in comparison to the control group members (F=4.6, P=.05). The WTT and WTQ groups did not differ significantly from each other with regard to their respective improvements in aerobic capacity (F=.014, P=.907). Conclusions The aerobic capacity of adult burn survivors can be improved with participation in a structured, 12-week exercise program after injury.de Lateur, B. J., Magyar-Russell, G., Bresnick, M. G., Bernier, F. A., Ober, M. S., Krabak, B. J., Ware, L., Hayes, M. P., Fauerbach, J. A.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2007Building the Research Teams of the Future: Changing the ParadigmJA Journal of Burn Care & Research284631-33Abstract not availableHerndon, D. N.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2001Brief cognitive intervention for acute pain during burn dressing changes.JA Annals of Behavioral Medicine23142-49This study tested the efficacy of 2 brief cognitive interventions in supplementing regular medical treatment for pain during burn dressing change. Forty-two burn inpatients were randomly assigned to 3 groups: sensory focusing, music distraction, and usual care. Patients reported pain, pain relief, satisfaction with pain control and pain coping strategies. The sensory focusing group reported greater pain relief compared to the music distraction group and a reduction in remembered pain compared to the usual care group, although group differences were not observed on serial pain ratings. In addition, after controlling for burn size and relevant covariates, regression analyses indicated that catastrophizing predicted pain, memory for pain, and satisfaction with pain control. Refinement of the sensory focusing intervention is warranted to reduce catastrophic thinking and improve pain relief.Haythornthwaite, J. A., Lawrence, J. W., Fauerbach, J. A.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2008From Survival to Socialization: A Longitudinal Study of Body Image in Survivors of Severe Burn Injury.JA Journal of Psychosomatic Research642205-212Objective Little is known about the course of body image dissatisfaction following disfiguring injury or illness. The objective of this study was to test a proposed framework for understanding the trajectory of body image dissatisfaction among burn survivors and to longitudinally investigate the role of body image in overall psychosocial functioning. Methods A sample of 79 survivors of severe burn injuries completed the Satisfaction with Appearance Scale (SWAP), the Importance of Appearance subscale of the Multidimensional Body–Self Relations Questionnaire, and the SF-36 in the hospital and at 6 and 12 months postdischarge (SWAP and SF-36). A repeated-measures analysis of covariance model was used to assess the course of body image dissatisfaction over time, and a path analysis model tested the role of body image dissatisfaction in mediating the relationship between preburn and postburn psychosocial functioning. Results Female sex (PThombs, B. D., Notes, L. D., Lawrence, J. W., Magyar-Russell, G., Bresnick, M. G., Fauerbach, J. A.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2007The microvasculature in cutaneous wound healing in the female red Duroc pig is similar to that in human hypertrophic scar and different from that in the female Yorkshire pig.JA Journal of Burn Care and Research283500-506The female red Duroc pig has been found to be a promising model of hypertrophic scarring. The female Yorkshire pig has been demonstrated to heal in a very different manner, more resembling human normotrophic scarring. Given these observations, we studied microvessel density, an important aspect of wound healing, in human hypertrophic scars and the scars of the female Duroc and Yorkshire pigs. We studied microvessel density in uninjured skin; hypertrophic scars at 6 months or less, 7 to 12, and longer than 12 months; female Duroc tissues at 3 weeks and 3 and 5 months; and similar Yorkshire tissue, including uninjured skin and shallow and deep wounds. Antifactor VIII-related antigen was used to mark the endothelial cells. Computed assessment of microvessel density was used to quantify the microvasculature. In human hypertrophic scars, the microvessels were increased dramatically, and microvessel density and area were significantly elevated. We found similar results in the Duroc tissues at 5 months after deep wounding. In contrast, we found far less microvasculature and, at 5 months, the values had returned to normal in the Yorkshire tissues. This quantitative study of microvessel density further validates the female Duroc pig as an animal model of hypertrophic scarring and the female Yorkshire pig as a control.Xie, Y., Zhu, K. Q., Deubner, H., Emerson, D. A., Carrougher, G. J., Gibran, N. S., Engrav, L.H.Northwest Regional Burn Model SystemYesdevopsadmin
2003Health outcomes for burn surviviors: A 2-year follow-upJAJ47032.Rehabilitation Psychology483189-194Study used the Sickness Impact Profile (SIP) to examine the health outcomes of burn survivors at 1 month, 1 year, and 2 years after burn injury. The SIP is used to measure the perceived impact of sickness on the performance of a broad range of daily activities. SIP scores for burn survivors were compared cross-sectionally with those of other medical populations. Results indicated that burn survivors experienced relatively low sickness impact compared to other medical populations within 1 year of injury. Participants reported worse psychosocial function than physical function. Overall health improved between 1 month and 1 year postinjury, after which it stabilized and remained unchanged at the end of the second year.Williams, Rhonda, Doctor, Jason, Patterson, David, Gibran, NicoleNorthwest Regional Burn Model SystemYesdevopsadmin
2001Rates, trends, and severity of depression after burn injuriesJAJ43483.Journal of Burn Care & Rehabilitation226417-424Study examines the rates and severity of depression in burn patients over a 2-year period. The Beck Depression Inventory was administered at 1 month, 1 year, and 2 years after discharge. Results showed that depression ratings were relatively high throughout the different time points. At 1 month, 54 percent of patients showed symptoms of moderate to severe depression, and at 2 years, 43 percent of the patients responding still reported moderate to severe depression. The findings illustrate the importance of identifying and treating depression early, since it will not likely subside if left untreated.Wiechman Askay, S., Ptacek, J. T., Patterson, D. R., Gibran, N. S., Engrav, L. E., Heimbach, D. M.Northwest Regional Burn Model SystemYesdevopsadmin
2007Use of the Beck Depression Inventory for assessing depression in patients hospitalized with severe burn Disentangling symptoms of depression from injury and treatment factorsJA Burns : Journal of the International Society for Burn Injuries335547-553The objective of this study was to assess whether scores on the Beck Depression Inventory (BDI) are biased by injury severity among hospitalized survivors of burn (N = 262). A confirmatory factor analysis (CFA) model was developed with a general depression factor that loaded on all items and somatic and cognitive factors that were orthogonal to the general factor and to each other. The model fit the data well and substantially better than an alternative three-factor model with correlated factors. Percent total body surface area burned (TBSA) was significantly associated with the general depression factor ( p = .04), but also with the orthogonal somatic factor ( p < .001), suggesting biased measurement due to overlap between somatic symptoms of depression and the severity of the burn injury. Analysis of item communalities, however, suggested that only approximately 2% of total predicted item variance was associated with bias related to injury severity. It was concluded that, despite a small amount of bias, the BDI is a reasonably accurate clinical tool even in the context of severe burn. Appropriate adjustments for bias, however, should be made in research with the BDI among patients with acute burn.Thombs, Brett D.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2002Evaluation of a peer consultation program for burn inpatients: 2000 ABA paperJAJ44697.Journal of Burn Care & Rehabilitation236449-453.Study evaluates a peer consultation program for patients in a large burn unit. Three specially trained survivors of burn injuries made 167 visits to 108 current inpatients and their families, who in turn, completed evaluation forms for each visit. Results indicated that patients reported that the peer consultants approached them in an appropriate manner, answered their questions, and provided useful support and information.Williams, Rhonda M., Patterson, David R., Schwenn, Clay, Day, Jeanette, Bartman, Mark, Engrav, Loren H.Northwest Regional Burn Model SystemYesdevopsadmin
1996Clinical evaluation of an acellular allograft dermal matrix in full-thickness burnsJAJ30816.Journal of Burn Care & Rehabilitation172124-136Clinical study examines the AlloDerm process that functions as a permanent dermal full-thickness autograft transplant that could reduce donor site trauma and complications. Current treatment is transplantation of split-thickness autografts that close the wound but create another at the donor site. The development of biosynthetic dermal substitutes is based on the mesh degrading in the wound healing process leaving behind fibroblasts and dermal proteins. The AlloDerm process removes the cells of both the epidermis and dermis and avoiding a specific immune response. The results of the AlloDerm processed matrix did not cause an inflammatory response. The migration and attachment of keratinocytes was supported by the meshed autograft. The study demonstrated that the success rate of the dermal matrix grafts and applied autografts were dependent on following a prescribed dressing protocol. Acceptance was highest when proper hydration of the grafted wound was maintained for 5 to 7 days after surgery. Perioperative care was critical to successful outcome. Another observation was that the higher take rates of thinner autografts applied over the dermal matrix promoted faster healing, less depigmentation and reduced scaring.Wainwright, D., Madden, M., Luterman, A., Hunt, J., Monafo, W., Heimbach, D., Kagan, R., Sittig, K., Dimick, A., Herndon, D.Yesdevopsadmin
2004Effects of exogenous growth hormone on resting pulmonary function in children with thermal injuryJAJ47624.Journal of Burn Care & Rehabilitation253287-293Suman, Oscar E., Mlcak, Ronald P., Herndon, David N.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2002Effect of exercise training on pulmonary function in children with thermal injuryJAJ44064.Journal of Burn Care & Rehabilitation234288-293Suman, O. E., Mlcak, R. P., Herndon, D. N.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
1996Use of a pneumatonometer in burn scar assessment (the 1996 clinical research award)JAJ33590.Journal of Burn Care & Rehabilitation171 Spann, K., Mileski, W. J., Atiles, L., Purdue, G., Hunt, J.North Texas Burn Rehabilitation Model SystemYesdevopsadmin
2003Effect of exogenous growth hormone and exercise on lean mass and muscle function in children with burnsJAJ48256.Journal of Applied Physiology9462273-2281Suman, Oscar E., Thomas, Steve J., Wilkins, Judy P., Mlcak, Ronald P., Herndon, David N.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2006Contractures in burn injury: Defining the problemJAJ50974.Journal of Burn Care and Research274508-514Schneider, J.C., Holavanahalli, R., Helm, P., Goldstein, R., Kowalske,K.North Texas Burn Rehabilitation Model SystemYesdevopsadmin
2000The 2000 clinical research award: Describing and predicting distress and satisfaction with life for burn survivors.JAJ41103.Journal of Burn Care & Rehabilitation216490-498https://pubmed.ncbi.nlm.nih.gov/11194801/Study examining burn survivors' emotional distress and life satisfaction at hospital discharge and 6-month follow-up, and the relationship between these outcomes and medical and psychosocial variables. Data were from 295 adults hospitalized for major burn injuries. Results show that distress scores were higher and life satisfaction scores were lower than for a normative sample. Several psychosocial variables (history or alcohol abuse, marital status, and previous mental health) and medical variables (days of intensive care, pulmonary complications, and hand burns) accounted for significant variance in outcomes. Patterson, D. R., Ptacek, J. T., Cromes, F., Fauerbach, J. A., Engrav, L.Spaulding New England Regional Spinal Cord Injury CenterYesdevopsadmin
2003The rehabilitation/school matrix: A model for accommodating the noncompliant child with severe burnsJAJ46317.Journal of Burn Care & Rehabilitation245342-346Case study describes a model of care used to accommodate a child with burns and significant compliance issues. This model included services provided by the medical and educational systems and extended from acute recovery through reintegration into the classroom. Educational reentry was facilitated by including a transitional period in a special-needs classroom in a freestanding special needs school. Funding for special educational services was obtained by identifying the child's eligibility under the Individuals with Disabilities Education Act (IDEA).Pidcock, F. S., Fauerbach, J. A., Ober, M., Carney, J.Georgia Model Traumatic Brain Injury SystemYesdevopsadmin
2005Social support correlates with survival in patients with massive burn injuryJAJ49182.Journal of Burn Care & Rehabilitation264352-356The charts of 36 patients with large burn areas were examined to determine if survivors exhibit presenting variables that predict survival. Sixteen patients (44 percent) survived and 20 did not survive. Outcome data analyzed included age, weight, total burn size, full-thickness burn size, length of intensive care unit stay, length of hospital stay, comorbidity, inhalation injury, use of plasmapheresis, escharotomy, infection, wound coverage with a dermal template, and the presence of social support systems. There were no significant differences in age, total burn size, inhalation injury, or need for escharotomy between the 2 groups. Full-thickness burn size was significantly smaller for survivors than for non-survivors. Survivors were more likely than non-survivors to have social support.Muangman, Pornprom, Sullivan, Stephen R., Wiechman, Shelley, Bauer, Gregory, Honari, Shari, Heimbach, David M., Engrav, Loren H., Gibran, Nicole S.Northwest Regional Burn Model SystemYesdevopsadmin
2001Dexter: A tool to facilitate impairment ratingsJAJ43481.Journal of Burn Care & Rehabilitation226397-400Study evaluates the Dexter Evaluation and Therapy System, a tool used to calculate physical impairment in burn patients. The system records muscle strength, extremity and spine range of motion deficits, skeletal impairment, and sensory loss. Ten manually recorded impairment ratings were compared with 10 performed on the Dexter. The time taken to rate impairment was significantly reduced by using the Dexter system. The time saving occurs primarily at 3 points: (1) electronic entering of data directly from the measuring instruments, (2) immediate compilation of data, and (3) rapid generation of reports.Moore, M. L., Engrav, L. H., Vedder, N. B., Gibran, N. S., Esselman, P., Costa, B. A.Northwest Regional Burn Model SystemYesdevopsadmin
2004The 2003 clinical research award: Visible vs hidden scars and their relation to body esteemJAJ47775.Journal of Burn Care & Rehabilitation25125-32Survivors of burn injury were surveyed to determine the relationship among burn characteristics (scarring, severity, and visibility), social stigmatization, social support, depression, and body esteem. Participants were also asked to rate the presence or absence of scars on 15 body parts, total body surface area burned, and number of surgeries. The correlation between visible scarring and different aspects of body esteem and perception of other reactions to appearance was statistically significant but low. Visible scarring had a low but significant correlation with perceived stigmatization, was unrelated to self-satisfaction with weight, and was not correlated with depression. Results suggest that burn characteristics are less important than social and emotional variables in determining the body esteem among burn survivors.Lawrence, John W., Fauerbach, James A., Heinberg, Leslie, Doctor, MarionJohns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2003Personality, coping, chronic stress, social support and PTSD symptoms among adult burn survivors: A path analysisJAJ46168.Journal of Burn Care & Rehabilitation24163-72Study examined the effects of personality, coping strategies, chronic stress, and social support on the development of posttraumatic stress disorder (PTSD) following a severe burn injury. Path analyses were conducted to test a model of the relationship between the predictor variables and PTSD symptoms. Participants completed questionnaires measuring each of the variables while in the hospital; PTSD symptoms were measured during hospitalization and again at 1 month and 6 months after discharge. Of the five personality factors, only neuroticism showed a significant relationship with PTSD. At each time point, chronic stress and social support were associated with higher PTSD symptoms. Higher active coping was associated with higher PTSD. The best predictor of PTSD symptoms at 1 and 6 months was PTSD symptoms at hospitalization.Lawrence, John W., Fauerbach, James A.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2006The reliability and validity of the perceived stigmatization questionnaire (PSQ) and the social comfort questionnaire (SCQ) among an adult burn survivor sampleJAJ50653.Psychological Assessment181106-111Article describes the development and initial evaluation of the Perceived Stigmatization Questionnaire (PSQ) and the Social Comfort Questionnaire (SCQ). The PSQ measures the frequency of various stigmatizing social behaviors experienced by people with physical distinctions. The SCQ is designed to measure social isolation and the violation of privacy effect for people with appearance distinctions. Three hundred sixty-one adult burn survivors completed the PSQ, SCQ, and other measures. Both the PSQ and SCQ had good internal consistency indices. Factor analysis of the PSQ yielded 3 factors (absence of friendly behavior, confused/staring behavior, and hostile behavior). The SCQ had 1 factor. Conjoint factor analysis with measures of related constructs (body esteem, body-esteem importance, depression, social support) suggested that PSQ and SCQ measure distinct constructs. Correlations with the related psychosocial constructs and burn characteristics suggested the PSQ and SCQ have good convergent and discriminant validity. Limitations of the study are discussed.Lawrence, J. W., Fauerbach, J. A., Heinberg, L. J., Doctor, M.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2001Neuropathy after burn injuryJAJ42998.Journal of Burn Care & Rehabilitation225353-357Study evaluating the incidence of neuropathy in 572 patients with major burn injuries and investigate the clinical correlates for both mononeuropathy and general peripheral poly neuropathy. This study demonstrates that neuropathy is a common complication (11%) of severe burn injury with incidence increasing with age, electrical cause and alcohol abuse.Kowalske, K., Holavanahalli, R., Helm, P.North Texas Burn Rehabilitation Model SystemYesdevopsadmin
2005Adult campfire burns: Two avenues for preventionJAJ50406.Journal of Burn Care & Rehabilitation265440-442Medical records of 27 adults admitted to a burn center from July 1998 to July 2003 with injuries resulting from campfire burns were retrospectively reviewed. Particular attention was given to mechanism of injury, intoxication level, burn size, and surgeries performed. Two distinct mechanisms of injury emerged: contact with the campfire and flash/flame injuries from igniting the fire. Eighty-one percent of patients who sustained contact burns were intoxicated, compared with 11 percent of those who sustained flash/flame injuries.Klein, Matthew B., Heimbach, David M., Honari, Shari, Engrav, Loren H., Gibran, Nicole S.Northwest Regional Burn Model SystemYesdevopsadmin
1996Development, implementation, and conclusions of critical pathways: walk, don't runJAJ33574.Journal of Burn Care & Rehabilitation176Part 2, S7-S9Hunt, JohnNorth Texas Burn Rehabilitation Model SystemYesdevopsadmin
2006Profile of patients lost to follow-up in the burn injury rehabilitation model systems' longitudinal databaseJAJ51475.Journal of Burn Care & Research275703-712Holavanahalli, R. K., Lezotte, D. C., Hayes, M. P., Minhajuddin, A., Fauerbach, J. A., Engrav, L. H., Helm, P. A., Kowalske, K. J.Yesdevopsadmin
1996Alcohol, drug intoxication, or both at the time of burn injury as a predictor of complications and mortality in hospitalized patients with burnsJAJ33591.Journal of Burn Care and Rehabilitation176532-39Grobmyer, S. R., Maniscalco, S. P., Purdue, G. F., Hunt, J. L.North Texas Burn Rehabilitation Model SystemYesdevopsadmin
1999Prolonged adjustment difficulties among those with acute posttrauma distress following burn injuryJAJ50598.Journal of Behavioral Medicine224359-378Fauerbach, James A., Lawrence, John W., Munster, Andrew M., Palombo, Debra A., Richter, DanielJohns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2006Burn rehabilitation: State of the scienceJAJ50658.American Journal of Physical Medicine and Rehabilitation854383-413Esselman, Peter C., Thombs, Brett D., Magyar-Russell, Gina, Fauerbach, James A.Yesdevopsadmin
2002The relationship of ambivalent coping to depression symptoms and adjustmentJAJ44775.Rehabilitation Psychology474387-401Fauerbach, James A., Lawrence, John W., Bryant, Amy G., Smith, Jennifer H.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2001Community integration after burn injuriesJAJ42252.Journal of Burn Care & Rehabilitation223221-227Esselman, P. C., Ptacek, J. T., Kowalske, K., Cromes, G. F., deLateur, B. J., Engrav, L. H.Yesdevopsadmin
1998Work status and attrition from longitudinal studies are influenced by psychiatric disordersJAJ36910.Journal of Burn Care & Rehabilitation193247-252Fauerbach, J. A., Lawrence, J., stevens, S., Munster, A.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2007Barriers to return to work after burn injuries.JA Archives of Physical Medicine and Rehabilitation8812 Suppl 2S50-56Objective To identify barriers to return to work after burn injury as identified by the patient. Design A cohort study with telephone interview up to 1 year. Setting Hospital-based burn centers at 3 national sites. Participants Hospitalized patients (N=154) meeting the American Burn Association criteria for major burn injury, employed at least 20 hours a week at the time of injury, and with access to a telephone after discharge. Intervention Patients were contacted via telephone every 2 weeks up to 4 months, then monthly up to 1 year after discharge. Main Outcome Measures A return to work survey was used to identify barriers that prevented patients from returning to work. A graphic rating scale determined the impact of each barrier. Results By 1 year, 79.7% of patients returned to work. Physical and wound issues were barriers early after discharge. Although physical abilities continued to be a significant barrier up to 1 year, working conditions (temperature, humidity, safety) and psychosocial factors (nightmares, flashbacks, appearance concerns) became important issues in those with long-term disability. Conclusions The majority of patients return to work after a burn injury. Although physical and work conditions are important barriers, psychosocial issues need to be evaluated and treated to optimize return to work.Esselman, P. C., Wiechman Askay, S., Carrougher, G., Lezotte, D., Holavanahalli, R. K., Magyar-Russell, G., Fauerbach, J. A., Engrav, L.Northwest Regional Burn Model SystemYesdevopsadmin
2002Regulating acute posttrauma distressJAJ44063.Journal of Burn Care & Rehabilitation234249-257Fauerbach, J. A., Richter, L., Lawrence, J. W.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2002Coping with body image changes following a disfiguring burn injuryJAJ50597.Health Psychology212115-121Fauerbach, James A., Heinberg, Leslie J., Lawrence, John W., Bryant, Amy G., Richter, Linda, Spence, Robert J.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
1998The quota system in burn rehabilitationJAJ35721.Journal of Burn Care & Rehabilitation195436-440Ehde, D. M., Patterson, D. R., Fordyce, W. E.Northwest Regional Burn Model SystemYesdevopsadmin
2005The 2004 clinical research award. Burden of burn: A norm-based inquiry into the influence of burn size and distress on recovery of physical and psychosocial functionJAJ48431.Journal of Burn Care & Rehabilitation26121-32Study examined the degree of impairment and rate of recovery among individuals with differing levels of physical and psychological burden. Physical burden groups were defined by burn size and psychological burden groups were defined by in-hospital distress. Analyses compared groups across level of burden and with published normative data. Assessments reflected health and function status during the month before burn, at discharge, and at 6 and 12 months after burn. Results showed that physical functioning was significantly more impaired and the rate of physical recovery was slower among those with either a large physical burden or large psychological burden. Psychosocial functioning was also more impaired and the rate of psychosocial recovery slower among those with greater psychological burden.Fauerbach, James A., Lezotte, Dennis, Hills, Rebecca A., Cromes, G. Fred, Kowalske, Karen, de Lateur, Barbara J., Goodwin, Cleon W., Blakeney, Patricia, Herndon, David N., Wiechman, Shelley A., Engrav, Loren H., Patterson, David R.Yesdevopsadmin
2001Barriers to employment among working-aged patients with major burn injuryJAJ41643.Journal of Burn Care & Rehabilitation22126-34Fauerbach, James A., Engrav, Loren, Kowalske, Karen, Brych, Sabina, Bryant, Amy, Lawrence, John, Li, Guohua, Munster, Andrew, de Lateur, BarbaraYesdevopsadmin
2007Acute pain at discharge from hospitalization is a prospective predictor of long-term suicidal ideation after burn injury.Journal Archives of Physical Medicine & Rehabilitation8812 Suppl 2S36-S42https://pubmed.ncbi.nlm.nih.gov/18036980/OBJECTIVE: To determine the extent to which pain contributes to risk for suicidal ideation after burn injury. DESIGN: This longitudinal cohort study evaluated participants at discharge, 6 months, and 1 year after burn injury. SETTING: Inpatient rehabilitation units of multiple regional burn centers. PARTICIPANTS: Survivors of major burns (N=128). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Pain severity, assessed using the Medical Outcomes Study 36-Item Short-Form Health Survey bodily pain subscale, and passive and active suicidal ideation, assessed by self-report. RESULTS: At each time point, approximately one quarter to one third of the sample reported some form of suicidal ideation. In logistic regression analyses, pain severity at discharge was the sole consistent predictor of suicidal ideation at follow-up, with greater pain severity being associated with enhanced risk for both passive and active suicidal ideation. These associations were observed even after controlling for discharge mental health. CONCLUSIONS: These are the first findings to suggest an association between acute pain severity and the development and maintenance of suicidal ideation in burn patients. Further research in this area, including the study of improved pain management programs as a prophylaxis against suicidal ideation, may benefit those who are at elevated suicide risk as a consequence of burn injuries. Edwards, R. R., Magyar-Russell, G., Thombs, B., Smith, M. T., Holavanahalli, R. K., Patterson, D. R., Blakeney, P., Lezotte, C., Haythornthwaite, J. A., Fauerbach, J. A.Johns Hopkins University Burn Injury Rehabilitation Model SystemYesdevopsadmin
2001The effects of exercise programming vs traditional outpatient therapy in the rehabilitation of severely burned childrenJAJ42251.Journal of Burn Care & Rehabilitation223214-220Study comparing the efficacy and effects of exercise programming versus traditional outpatient therapy for children with severe burns. Participants were 21 children with burns covering > 40% of body surface area, who were randomly assigned to an exercise group (n = 11) and an outpatient group (n = 10). Results of evaluations at 6 and 9 months post-burn show that muscular strength and functional outcome (walked) increased significantly for both groups, and that increases were greater for the exercise group.Cucuzzo, N. A., Ferrando, A., Herndon, D. N.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2002Predictors of quality of life as measured by the burn specific health scale in persons with major burn injuryJAJ44555.Journal of Burn Care & Rehabilitation233229-234Study analyzed data prospectively obtained from adults with major burn injury 2 months after hospital discharge and 12 months after injury to determine (1) how their quality of life (QOL) changed over time, and (2) what specific functional, emotional, and social variables are able to predict QOL. The Burn Specific Health Scale (BSHS) was used to assess QOL. The independent predictor variables were assessed using the Brief Symptom Inventory (BSI), the Functional Assessment Screening Questionnaire (FASQ), the Functional Independence Measure (FIM), the Pain Analog Scale (PAS), and the Community Integration Questionnaire (CIQ). BSHS global scores did not change across the measurement periods. Variables that predicted more favorable BSHS global scores were: (1) less emotional distress and pain at 2 months, (2) less emotional distress and pain and better community reentry at 6 months, and (3) less emotional distress and better community reentry at 12 months.Cromes, G. F., Holavanahalli, R., Kowalske, K., Helm, P.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2007The effects of Oxandrolone and exercise on muscle mass and function in children with severe burnsJA Pediatrics1191109-116Przkora, Rene, Herndon, David N, Suman, Oscar E.Yesdevopsadmin
2007The NIDRR Burn Model System Database: A tool for the multi-center study of the outcome of burn injuryJA Journal of Burn Care Research28 84-96Advances in critical care and surgical management have significantly improved survival following burns over the past several decades. However, today, survival alone is an insufficient outcome. The National Institute on Disability and Rehabilitation Research (NIDRR) has created a program to evaluate the long-term sequelae of burn injuries. As part of this multi-center program, a comprehensive demographic and outcome database has been developed to study functional and psychosocial outcomes following burns. The purpose of this study was to review the design, structure and data obtained in the first decade of theNIDRRburn program. Methods: This was a descriptive study of the NIDRRdatabase structure and content. There are four centers in the current funding cycle. Data is uploaded on a regular basis to a central Data Center. For this study all data from 1994-2004 was analyzed. Raw data from all fields were analyzed to produce summary descriptive statistics. Results: A total of 4600 patients have been entered into theNIDRRdatabase. 3449 (75%) patients were alive at discharged and consented for follow up. The majority of patients enrolled were male (71% ), but gender differences were less at extremes of age. 22% of patients over age 16 had not graduated high school and 27% were unemployed at the time of injury. Over 10% of patients had history of alcohol and/or substance abuse. The majority of patients following burn injury were discharged to their own home (67%), or someone else’s home (12%). 290 (6%) patients required an amputation as a result of their injury. The majority of these amputations (200 or 69%) were of the digits. 155 (3%) and 136 (3%) of patients had an upper extremity and lower extremity mononeuropathy, respectively. At six months following discharge 36 (4%) children were not back to school. The number of children in school decreased to 23 (3%) at one year following discharge and to 14 (1%) at two years following injury. At six months following discharge, 992 (43%) patients were not working, this decreased to 726 (36%) at one year and 512 (26%) at two years, which is equivalent to the percentage of patients not working at the time of injury. Conclusions: The NIDRR database provides an expansive repository of injury and outcome data. The database was designed to focus on patient outcome and, therefore, provides a core of data that can be utilized in the analysis of the functional and psychosocial impact of burn injury and for the design of interventions to enhance the quality of life of burn survivors.Klein, M.B., Lezotte, D.L., Fauerbach, J.A., Herndon, D.N., Kowalske, K.J., Carrougher, G.J., DeLateur, B.J., Holavanahalli, R., Esselman, P.C., Engrav, L.H.Yesdevopsadmin
2003Effect of a supervised exercise and physiotherapy program on surgical interventions in children with thermal injuryJAJ48252.Journal of Burn Care & Rehabilitation24157-61Study examined the need for surgical intervention in children with burn injuries who received a supervised, hospital-based exercise and physical therapy program compared to pediatric burn patients who received conventional physical therapy in their homes. Fifty-three patients were evaluated at 6, 9, 12, 18, and 24 months after injury for scar formation, range of motion, and need for surgery. Results indicated that patients enrolled in the supervised exercise program received fewer surgical interventions than children in the physical therapy group. This document is included in NCDDR's Guide to Resources Produced by National Institute on Disability and Rehabilitation Research (NIDRR) Grantees: Infants, Children, and Youth with Disabilities, number B.4.Celis, Mario M., Suman, Oscar E., Huang, Ted T., Yen, Peter, Herndon, David N.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin
2001Time off work and return to work rates after burns: Systematic review of the literature and a large two-center seriesJournalJ43482.Journal of Burn Care & Rehabilitation226401-405Reviews literature that provides objective data on the ability to return to work after burns and analyzes data obtained from participants at 2 regional burn centers who were employed outside the home at the time of injury. The literature searched from 1966 through October 2000 yielded 10 articles with objective data that revealed a mean time off work of 9.6 weeks and burn severity was found as the most important predictor of time off work. In the two-center study, 66 percent of burn survivors had returned to work at 6 months and 90 percent had returned at 24 months following burn. The mean time off work for those who had returned by 24 months was 17 weeks.Brych, S. B., Engrav, L. H., Rivara, F. P., Ptacek, J. T., Lezotte, D. C., Esselman, P. C., Kowalske, K. J., Gibran, N. S.Northwest Regional Burn Model SystemYesdevopsadmin
2015Reliable scar scoring system to assess photographs of burn patientsJournalJ74974Journal of Surgical Research1992688-697Study modified an existing scar scale and tested the reliability of the new scale in assessing burn scars from photographs. The new scale consisted of three parameters as follows: scar height, surface appearance, and color mismatch. Each parameter was assigned a score of 1 (best) to 4 (worst), generating a total score of 3 to 12. Five physicians with burns training scored 120 representative photographs using the original and modified scales. Reliability was analyzed using coefficient of agreement, Cronbach alpha, intraclass correlation coefficient (ICC), variance, and coefficient of variance. Analysis of variance was performed using the Kruskal-Wallis test. Color mismatch and scar height scores were validated by analyzing actual height and color differences. Results indicated that the ICC, the coefficient of agreement, and Cronbach alpha were higher for the modified scale than those of the original scale. The original scale produced more variance than that in the modified scale. Sub-analysis demonstrated that, for all categories, the modified scale had greater correlation and reliability than the original scale. The correlation between color mismatch scores and actual color differences was 0.84 and between scar height scores and actual height was 0.81. The results suggest that the modified scar scale is a simple, reliable, and useful scale for evaluating photographs of burn patients.Mecott, Gabriel A., Finnerty, Celeste C., Herndon, David N., Al-Mousawi, Ahmed M., Branski, Ludwik K., Hegde, Sachin, Kraft, Robert, Williams, Felicia N., Maldonado, Susana A., Rivero, Haidy G., Rodriguez-Escobar, Noe, Jeschke, Marc G.Pediatric Burn Injury Rehabilitation Model SystemYesdevopsadmin