Two-year follow-up of outcomes related to scarring and distress in children with severe burns

Abstract

Purpose: We assessed the perception of scarring and distress by pediatric burn survivors with burns covering more than one-third of total body surface area (TBSA) for up to 2 years post-burn.

Methods: Children with severe burns were admitted to our hospital between 2004 and 2012, and consented to this IRB-approved-study. Subjects completed at least one Scars Problems and/or Distress questionnaire between discharge and 24 months post burn. Outcomes were modeled with generalized estimating equations or using mixed linear models. Significance was accepted at p < 0.01.

Results: Responses of 167 children with a mean age of 7 ± 5 years and burns covering an average 54 ± 14% of TBSA were analyzed. Significant improvements over the 2-year period were seen in reduction of pain, itching, sleeping disturbance, tightness, range of motion, and strength (p < 0.01). There was a significantly increased persistent desire to hide the scarred body areas over time (p < 0.01). The perception of mouth scarring, inability to portray accurate facial expressions, and skin coloration did not improve over the follow-up period.

Conclusions: According to self-assessment questionnaires, severely burned children exhibit significant improvements in their overall perception of scarring and distress. However, these patients remain self-conscious with respect to their body image even 2 years after burn injury.

Implications for Rehabilitation

• According to self-assessment questionnaires, severely burned children perceive significant improvements in scarring and distress during the first 2 years post burn. Significant improvements were seen in reduction of pain, itching, sleeping disturbances, tightness, range of motion, and strength (p < 0.01).

• Burn care providers should improve the treatment of burns surrounding the mouth that with result in scarring, and develop strategies to prevent skin discoloration. Careful evaluation of pain and sleeping disorders during the first year post burn are warranted to improve the patient rehabilitation.

• Overall, significantly more female patients expressed a persistent desire to hide their scarred body areas. The rehabilitation team should provide access to wigs or other aids to pediatric burn survivors to address these needs.

Keywords:

• Itch
• pain
• children
• burns
• self-perception

Acknowledgements

The authors thank Robert A. Rodriguez and Perla J. Gonzalez for collecting of the questionnaires, and Dr. Kasie Cole for editing and proofreading of the manuscript.

Disclosure statement

All authors made substantial contributions to the conception or design of the work (AAF, CCF, CRA, GH, KME, OES, PW, WJM) or to the acquisition, analysis, or interpretation of data for the work (AAF, CCF, DNH, GH, LKB, LPK, OES) and the drafting of the work or revising the intellectual content (all authors).

The authors report no conflicts of interest.

Funding

This study was supported by the National Institutes of Health (P50 GM060338, UL1TR000071, T32 GM008256, RO1-GM056687, RO1–112936, R01-HD049471), the Shriners Hospitals for Children (71006, 71008, 71009, 80100, 84080, 84291) and the National Institute on Disability, Independent Living, and Rehabilitation Research (90DP00430100).