Early treatment of acute stress disorder in children with major burn injury

Objective: This study examines retrospectively the response rate of pediatric burn survivors with acute stress disorder to either imipramine or fluoxetine. Methods: On retrospective chart review, 128 intensive care unit patients (85 boys, 43 girls) witti 52% ± 20% total body surface area burn, length of stay of 32.8 ± 25.2 days, mean age of 9.1 ± 4.7 yrs, and age range of 13 months to 19 yrs met criteria for acute stress disorder after 3:2 days of symptoms and were treated with either imipramine or fluoxetine. If significant improvement did not occur within 7 days, the medication was either increased or switched to the other class. Results: Initially, 104 patients were treated with imipramine and 24 with fluoxotine. A total of 84 patients responded to imipramine: seven of these patients required a higher dose. A total of 18 patients responded to initial fluoxetine treatment. Of 26 nonrespondors to the initial medication, 13 imipramine failures and one fluoxetine failure refused further treatment. The other 12 responded to the second medication. Therefore, 114 of 128 treated patients (89%) responded to either fluoxetine (mean dose, 0.30 ± 0.14 mg/kg) or imipramine (mean dose, 1.30 ± 0.55 mg/kg). Response was independent of sex and age but was less for those with burns of >60% total body surface area. The side effects of each medication were not significant. Most patients continued treatment for ≥3 months; some required 6 months of treatment before successful discontinuation. Conclusions: Early treatment of acute stress disorder with either imipramine or fiuoxetine is often able to reduce its symptoms. This is a review of a single hospital's experienco in managing psychiatric distress in this very high-risk group of burned children. Additional clinical studies are needed before generalizing these findings.