Recovery curves for pediatric burn survivors advances in patient-oriented outcomes

Lewis E. Kazis, Austin F. Lee, Mary Rose, Matthew H. Liang, Nien Chen Li, Xinhua S. Ren, Robert Sheridan, Janet Gilroy-Lewis, Fred Stoddard, Michelle Hinson, Glenn Warden, Kim Stubbs, Patricia Blakeney, Walter Meyer, Robert McCauley, David Herndon, Tina Palmieri, Kate Mooney, David Wood, Frank Pidcock & 7 others Debra Reilly, Marc Cullen, Catherine Calvert, Colleen M. Ryan, Jeffrey C. Schneider, Marina Soley-Bori, Ronald G. Tompkins

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

IMPORTANCE: Patient-reported outcomes serving as benchmarks for recovery of pediatric burn survivors are lacking, and new approaches using longitudinal cohorts for monitoring their expected recovery based on statistical models are needed for patient management during the early years following the burn. OBJECTIVE: To describe multidimensional patient-reported outcomes among pediatric burn survivors younger than 5 years to establish benchmarks using recovery curve methods. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study of pediatric burn survivors younger than 5years at 12 burn centers. Age-matched nonburned reference groups were studied to define expected results in normal growth and development. The Burn Outcomes Questionnaire for children aged 0 to 5 years (BOQ0-5) was administered to parents of children who had burns and were younger than 5 years. Mixed models were used to generate 48-month recovery curves for eachof the 10 BOQ0-5 domains. The study was conducted between January1999 and December 2008. MAINOUTCOMESAND MEASURES: The 10 BOQ0-5 domains including play, language, fine motor skills, gross motor skills, emotional behavior, family functioning, pain/itching, appearance, satisfaction with care, and worry/concern up to 48 months after burn injury. RESULTS: A total of 336 pediatric burn survivors younger than 5 years (mean [SD] age, 2.0 [1.2] years; 58.4% male; 60.2% white, 18.6% black, and 12.0% Hispanic) and 285 age-matched nonburned controls (mean [SD] age, 2.4 [1.3] years; 51.1% male; 67.1% white, 8.9% black, and 15.0% Hispanic) completed the study. Predicted scores improved exponentially over time for 5 of the BOQ0-5 domains (predicted scores at 1 month vs 24 months: play, 48.6 vs 52.1 [P =.03]; language, 49.2 vs 54.4 [P <.001]; gross motor skills, 48.7 vs 53.0 [P =.002]; pain/itching, 15.8 vs 33.5 [P <.001]; and worry/concern, 31.6 vs 44.9 [P <.001]). Pediatric burn survivors had higher scores in language, emotional behavior, and family functioning domains compared with healthy children in later months. CONCLUSIONS AND RELEVANCE: This study demonstrates significant deficits in multiple functional domains across pediatric burn survivors compared with controls. Recovery curves can be used to recognize deviation from the expected course and tailor care to patient needs.

Original languageEnglish (US)
Pages (from-to)534-542
Number of pages9
JournalJAMA Pediatrics
Volume170
Issue number6
DOIs
StatePublished - Jun 1 2016

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Survivors
Pediatrics
Motor Skills
Benchmarking
Language
Pruritus
Hispanic Americans
Burn Units
Pain
Statistical Models
Burns
Growth and Development
Patient Care
Cohort Studies
Parents
Prospective Studies
Wounds and Injuries
Patient Reported Outcome Measures
hydroquinone

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Kazis, L. E., Lee, A. F., Rose, M., Liang, M. H., Li, N. C., Ren, X. S., ... Tompkins, R. G. (2016). Recovery curves for pediatric burn survivors advances in patient-oriented outcomes. JAMA Pediatrics, 170(6), 534-542. https://doi.org/10.1001/jamapediatrics.2015.4722

Recovery curves for pediatric burn survivors advances in patient-oriented outcomes. / Kazis, Lewis E.; Lee, Austin F.; Rose, Mary; Liang, Matthew H.; Li, Nien Chen; Ren, Xinhua S.; Sheridan, Robert; Gilroy-Lewis, Janet; Stoddard, Fred; Hinson, Michelle; Warden, Glenn; Stubbs, Kim; Blakeney, Patricia; Meyer, Walter; McCauley, Robert; Herndon, David; Palmieri, Tina; Mooney, Kate; Wood, David; Pidcock, Frank; Reilly, Debra; Cullen, Marc; Calvert, Catherine; Ryan, Colleen M.; Schneider, Jeffrey C.; Soley-Bori, Marina; Tompkins, Ronald G.

In: JAMA Pediatrics, Vol. 170, No. 6, 01.06.2016, p. 534-542.

Research output: Contribution to journalArticle

Kazis, LE, Lee, AF, Rose, M, Liang, MH, Li, NC, Ren, XS, Sheridan, R, Gilroy-Lewis, J, Stoddard, F, Hinson, M, Warden, G, Stubbs, K, Blakeney, P, Meyer, W, McCauley, R, Herndon, D, Palmieri, T, Mooney, K, Wood, D, Pidcock, F, Reilly, D, Cullen, M, Calvert, C, Ryan, CM, Schneider, JC, Soley-Bori, M & Tompkins, RG 2016, 'Recovery curves for pediatric burn survivors advances in patient-oriented outcomes', JAMA Pediatrics, vol. 170, no. 6, pp. 534-542. https://doi.org/10.1001/jamapediatrics.2015.4722
Kazis, Lewis E. ; Lee, Austin F. ; Rose, Mary ; Liang, Matthew H. ; Li, Nien Chen ; Ren, Xinhua S. ; Sheridan, Robert ; Gilroy-Lewis, Janet ; Stoddard, Fred ; Hinson, Michelle ; Warden, Glenn ; Stubbs, Kim ; Blakeney, Patricia ; Meyer, Walter ; McCauley, Robert ; Herndon, David ; Palmieri, Tina ; Mooney, Kate ; Wood, David ; Pidcock, Frank ; Reilly, Debra ; Cullen, Marc ; Calvert, Catherine ; Ryan, Colleen M. ; Schneider, Jeffrey C. ; Soley-Bori, Marina ; Tompkins, Ronald G. / Recovery curves for pediatric burn survivors advances in patient-oriented outcomes. In: JAMA Pediatrics. 2016 ; Vol. 170, No. 6. pp. 534-542.
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T1 - Recovery curves for pediatric burn survivors advances in patient-oriented outcomes

AU - Kazis, Lewis E.

AU - Lee, Austin F.

AU - Rose, Mary

AU - Liang, Matthew H.

AU - Li, Nien Chen

AU - Ren, Xinhua S.

AU - Sheridan, Robert

AU - Gilroy-Lewis, Janet

AU - Stoddard, Fred

AU - Hinson, Michelle

AU - Warden, Glenn

AU - Stubbs, Kim

AU - Blakeney, Patricia

AU - Meyer, Walter

AU - McCauley, Robert

AU - Herndon, David

AU - Palmieri, Tina

AU - Mooney, Kate

AU - Wood, David

AU - Pidcock, Frank

AU - Reilly, Debra

AU - Cullen, Marc

AU - Calvert, Catherine

AU - Ryan, Colleen M.

AU - Schneider, Jeffrey C.

AU - Soley-Bori, Marina

AU - Tompkins, Ronald G.

PY - 2016/6/1

Y1 - 2016/6/1

N2 - IMPORTANCE: Patient-reported outcomes serving as benchmarks for recovery of pediatric burn survivors are lacking, and new approaches using longitudinal cohorts for monitoring their expected recovery based on statistical models are needed for patient management during the early years following the burn. OBJECTIVE: To describe multidimensional patient-reported outcomes among pediatric burn survivors younger than 5 years to establish benchmarks using recovery curve methods. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study of pediatric burn survivors younger than 5years at 12 burn centers. Age-matched nonburned reference groups were studied to define expected results in normal growth and development. The Burn Outcomes Questionnaire for children aged 0 to 5 years (BOQ0-5) was administered to parents of children who had burns and were younger than 5 years. Mixed models were used to generate 48-month recovery curves for eachof the 10 BOQ0-5 domains. The study was conducted between January1999 and December 2008. MAINOUTCOMESAND MEASURES: The 10 BOQ0-5 domains including play, language, fine motor skills, gross motor skills, emotional behavior, family functioning, pain/itching, appearance, satisfaction with care, and worry/concern up to 48 months after burn injury. RESULTS: A total of 336 pediatric burn survivors younger than 5 years (mean [SD] age, 2.0 [1.2] years; 58.4% male; 60.2% white, 18.6% black, and 12.0% Hispanic) and 285 age-matched nonburned controls (mean [SD] age, 2.4 [1.3] years; 51.1% male; 67.1% white, 8.9% black, and 15.0% Hispanic) completed the study. Predicted scores improved exponentially over time for 5 of the BOQ0-5 domains (predicted scores at 1 month vs 24 months: play, 48.6 vs 52.1 [P =.03]; language, 49.2 vs 54.4 [P <.001]; gross motor skills, 48.7 vs 53.0 [P =.002]; pain/itching, 15.8 vs 33.5 [P <.001]; and worry/concern, 31.6 vs 44.9 [P <.001]). Pediatric burn survivors had higher scores in language, emotional behavior, and family functioning domains compared with healthy children in later months. CONCLUSIONS AND RELEVANCE: This study demonstrates significant deficits in multiple functional domains across pediatric burn survivors compared with controls. Recovery curves can be used to recognize deviation from the expected course and tailor care to patient needs.

AB - IMPORTANCE: Patient-reported outcomes serving as benchmarks for recovery of pediatric burn survivors are lacking, and new approaches using longitudinal cohorts for monitoring their expected recovery based on statistical models are needed for patient management during the early years following the burn. OBJECTIVE: To describe multidimensional patient-reported outcomes among pediatric burn survivors younger than 5 years to establish benchmarks using recovery curve methods. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study of pediatric burn survivors younger than 5years at 12 burn centers. Age-matched nonburned reference groups were studied to define expected results in normal growth and development. The Burn Outcomes Questionnaire for children aged 0 to 5 years (BOQ0-5) was administered to parents of children who had burns and were younger than 5 years. Mixed models were used to generate 48-month recovery curves for eachof the 10 BOQ0-5 domains. The study was conducted between January1999 and December 2008. MAINOUTCOMESAND MEASURES: The 10 BOQ0-5 domains including play, language, fine motor skills, gross motor skills, emotional behavior, family functioning, pain/itching, appearance, satisfaction with care, and worry/concern up to 48 months after burn injury. RESULTS: A total of 336 pediatric burn survivors younger than 5 years (mean [SD] age, 2.0 [1.2] years; 58.4% male; 60.2% white, 18.6% black, and 12.0% Hispanic) and 285 age-matched nonburned controls (mean [SD] age, 2.4 [1.3] years; 51.1% male; 67.1% white, 8.9% black, and 15.0% Hispanic) completed the study. Predicted scores improved exponentially over time for 5 of the BOQ0-5 domains (predicted scores at 1 month vs 24 months: play, 48.6 vs 52.1 [P =.03]; language, 49.2 vs 54.4 [P <.001]; gross motor skills, 48.7 vs 53.0 [P =.002]; pain/itching, 15.8 vs 33.5 [P <.001]; and worry/concern, 31.6 vs 44.9 [P <.001]). Pediatric burn survivors had higher scores in language, emotional behavior, and family functioning domains compared with healthy children in later months. CONCLUSIONS AND RELEVANCE: This study demonstrates significant deficits in multiple functional domains across pediatric burn survivors compared with controls. Recovery curves can be used to recognize deviation from the expected course and tailor care to patient needs.

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