Fatigue in children and adolescents after burns: evaluating the problem using longitudinal data

Abstract

Purpose

Describe prevalence and severity of fatigue in children and adolescents with burns during six months after hospital discharge, identify potential explanatory variables, and examine the relationship with exercise capacity.

Materials and Methods

Fatigue was assessed using the Pediatric-Quality-of-Life-Inventory-Multidimensional-Fatigue-Scale (PedsQL-MFS) at discharge, and six weeks, three-, and six months after discharge. PedsQL-MFS scores ≥1 SD below the age-group specific non-burned reference mean were considered to signify fatigue.

Results

Twenty-two children and adolescents (13 boys/9 girls, age 6–18 years, with burns covering 2–34% of total body surface area) were included. The prevalence of fatigue decreased from 65% (11/17) at discharge to 28% (5/18) six months after discharge. At group level, fatigue severity decreased over time, reaching healthy reference values from six weeks after discharge and beyond. At individual level, the course of fatigue severity varied widely. Fatigue severity at six months after discharge could not be predicted by age, sex, or burn severity (p = 0.51, p = 0.58, p = 0.95, respectively). The association with exercise capacity was weak (r = 0.062–0.538).

Conclusions

More than a quarter of pediatric burn patients reported fatigue six months after discharge. Further research in larger populations is required, including also the impact of burn-related fatigue on daily functioning and quality of life.Trial registration number: OND1353942

Implications for rehabilitation

• Fatigue should be recognized as a potential consequence of (pediatric) burns, even several months post burn

• Fatigue should be assessed regularly after discharge in all children and adolescents with burns, as it seems not possible to predict its severity from age, sex, or burn severity characteristics

• The weak association between exercise capacity and self-reported fatigue suggests that burn-related fatigue is not simply a consequence of a reduced exercise capacity

Keywords:

• Pediatric burns
• fatigue
• PedsQL MFS
• exercise capacity

Acknowledgements

This study was carried out using the (Dutch version of the) PedsQL^TM Multidimensional Fatigue Scale, originally developed by Dr. James W. Varni. We would like to thank all the children and parents who participated in this study, and the research groups and physical therapists of the Maasstad Hospital Rotterdam and the Red Cross Hospital Beverwijk for their contribution to the data collection. Furthermore, we are grateful to the Dutch Burns Foundation for their financial support, the Dutch Burn Repository Group, for their contribution to the Dutch Burn Repository, and, accordingly, the Dutch Burns Foundation, Red Cross Hospital Beverwijk, Maasstad Hospital Rotterdam, and Martini Hospital Groningen for their support to the Dutch Burn Repository.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the Dutch Burns Foundation.