Association of Total Body Surface Area and Body Part With Mental Health Outcomes in Pediatric Burn Patients

Introduction: Burn injuries in children are associated with negative impacts on psychological and emotional well-being, yet specific risk indicators are not well researched. We hypothesize that children with greater total body surface area (TBSA) burned and burns in highly visible and functionally significant body parts are more likely to experience negative mental health outcomes compared to their counterparts. Materials and methods: Database review of 178 pediatric burn patients (median age: 13 ± 2.99) utilizing the Burns Model System National Database, retrospectively collected data between 2010 and 2023. Patient-Reported Outcomes Measurement Information System surveys obtained at 6 mo, 1 y, and 2 y postburn were utilized to assess mental health factors (anxiety, depression, peer relationships, pain interference, fatigue, and physical function). Mental health status was defined using Patient-Reported Outcomes Measurement Information System cut-off points with T-scores. Data were stratified by TBSA quartiles and body part affected (arm, head/neck/face, trunk, perineum, hand, leg, foot). Associations with TBSA and body parts were analyzed with chi-squared calculations using Excel, and demographic data was analyzed using logistic regression using R Studio. Results: At 1-y postburn, higher TBSA was associated with increased anxiety (P = 0.005), fatigue (P = 0.04), pain interference (P = 0.02), and poorer physical function (P = 0.003); however, there was no correlation with body part burned. By 2 y postburn, the difference in mental health outcomes by TBSA was no longer significant. Increased age was associated with a higher likelihood of depression (P = 0.002) and poorer peer relationships (P = 0.03). Conclusions: Children with greater TBSA burns or older age were associated with a higher likelihood of mental health consequences by 1 y postburn, regardless of which body part was affected. Understanding these relationships is essential for developing targeted interventions to support the psychological recovery of pediatric burn patients.