scholarly journals Coping in Pediatric Burn Survivors and Its Relation to Social Functioning and Self-Concept

2021 ◽  
Vol 12 ◽  
Author(s):  
Mira D. H. Snider ◽  
Sarah Young ◽  
Paul T. Enlow ◽  
Corrine Ahrabi-Nejad ◽  
Ariel M. Aballay ◽  
...  
Keyword(s):  
Coping Strategies ◽  
Social Functioning ◽  
Psychosocial Adjustment ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Active Coping ◽  
Self Concept ◽  
Increased Risk ◽  
Burn Survivors ◽  
Social Concerns

Pediatric burn survivors experience increased risk for bullying, stigmatization, body image concerns, and problematic social functioning. Although coping behaviors are associated with engagement in social supports and positive self-concept in multiple pediatric illness populations, their relation has not been examined in pediatric burns. This study examined coping in relation to social functioning and self-concept in 51 pediatric burn survivors aged 7–17years (M=12.54; SD=2.65). Survivors and their caregivers completed the Child Coping Strategies Checklist (CCSC; youth report); the Burn Injury Social Questionnaire (BISQ; parent and youth report); and the Piers-Harris Children’s Self-Concept Scale-2 (PH-2; youth report). Associations between coping, social functioning, self-concept, demographic features, and burn injury characteristics were examined via bivariate correlations. Hierarchical linear regressions examined whether coping strategies predicted social functioning and youth self-concept beyond burn injury and demographic variables. Social functioning concerns were positively correlated with total body surface area (TBSA; r=0.63 and 0.40, respectively). TBSA was the only significant predictor of parent-reported social concerns (β=0.65, p<0.001). Greater distraction coping predicted fewer youth-reported social concerns (β=−0.39, p=0.01). Greater active coping (B=0.67, p=0.002) and lower avoidance coping (B=−0.36, p=0.03) predicted better youth-reported self-concept. This study advances our understanding of coping as potentially protective for psychosocial adjustment. Clinicians working with child burn survivors should incorporate active coping interventions into treatment. Further research including larger and more diverse samples is needed to understand the role of coping approaches on psychological adjustment during burn healing.

96 Relation of Coping Strategies to Social Functioning and Self-Concept in Pediatric Burn Survivors

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S66-S66
Author(s):  
Mira Snider ◽  
Sarah Young ◽  
Paul Enlow ◽  
Corrine Ahrabi-Nejad ◽  
Linda Leonard ◽  
...  
Keyword(s):  
Coping Strategies ◽  
Social Functioning ◽  
Regression Models ◽  
Family Income ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Parent Report ◽  
Self Concept ◽  
Injury Characteristics ◽  
Burn Survivors

Abstract Introduction Burn survivors can experience challenges in social functioning (e.g., bullying, stigmatization) and self-concept (e.g., body image concerns). Use of coping strategies is associated with engagement in social supports and positive self-concept in pediatric oncology and physical injury populations; however, their relation has not been examined in pediatric burn survivors. This study aims to explore coping as it relates to social functioning and self-concept in these youth. Methods Fifty-one pediatric burn survivors aged 7–17 years (M=12.53; SD=2.68), and their primary caregiver participated. Youth and caregivers completed questionnaires, including the Child Coping Strategies Checklist (CCSC; youth report); the Burn Injury Social Questionnaire (BISQ; parent & youth report; higher scores = more social problems); and the Piers-Harris Children’s Self-Concept Scale-2 (PH-2; youth report). Associations between the BISQ, coping strategies (Active, Avoidance, Distraction, Support), self-concept, yearly family income, and burn injury characteristics (e.g., total body surface area; TBSA, participant grafting) were examined via bivariate correlations. Hierarchical linear regression was used to examine whether coping strategies (with significant bivariate correlations) predicted BISQ and PH-2 scores above and beyond burn injury and demographic variables. Three hierarchical regression models were run, one each for parent- and youth-report BISQ and youth-report PH-2 scores. Results Our sample is predominantly male (62.7%) and Caucasian (82.4%) with average TBSA of 8.74% (SD=11.02). Parent- and youth-reports on the BISQ were positively correlated with TBSA (r=.61 and .37, respectively) and negatively correlated with family income (r=-.37 and -.36, respectively). Parents of youth who had a skin graft reported higher BISQ scores (rho=.34). Distraction coping was significantly associated with youth-reported BISQ scores (r=-.31); no coping strategies were correlated with parent-report BISQ scores. In regression models, TBSA significantly predicted of parent-report BISQ (B=.27, p< .001). Higher family income (B=-.40, p=.04) and greater distraction coping (B=-3.41, p=.004) significantly predicted better youth-report BISQ scores. Greater active coping significantly predicted better self-concept (B=6.21, p=.01). Conclusions Results suggest that use of positive coping strategies relates to better youth-reported social functioning and youth-reported self-concept after burn injury in addition to injury characteristics and socioeconomic variables.

664 Risk Factors for the Development of Transaminitis in Pediatric Burn Patients Treated with Oxandrolone

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S177-S177
Author(s):  
Kate Pape ◽  
Sarah Zavala ◽  
Rita Gayed ◽  
Melissa Reger ◽  
Kendrea Jones ◽  
...  
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Pediatric Patients ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Future Research ◽  
Burn Patients ◽  
Thermal Burn ◽  
Increased Risk ◽  
Significant Difference

Abstract Introduction Oxandrolone is an anabolic steroid that is the standard of care for burn patients experiencing hypermetabolism. Previous studies have demonstrated the benefits of oxandrolone, including increased body mass and improved wound healing. One of the common side effects of oxandrolone is transaminitis, occurring in 5–15% of patients, but little is known about associated risk factors with the development of transaminitis. A recent multicenter study in adults found that younger age and those receiving concurrent intravenous vasopressors or amiodarone were more likely to develop transaminitis while on oxandrolone. The purpose of this study was to determine the incidence and identify risk factors for the development of transaminitis in pediatric burn patients receiving oxandrolone therapy. Methods This was a multicenter, retrospective risk factor analysis that included pediatric patients with thermal burn injury (total body surface area [TBSA] > 10%) who received oxandrolone over a 5-year time period. The primary outcome of the study was the development of transaminitis while on oxandrolone therapy, which was defined as aspartate aminotransferase (AST) or alanine aminotransferase (ALT) >100 mg/dL. Secondary outcomes included mortality, length of stay, and change from baseline ALT/AST. Results A total of 55 pediatric patients from 5 burn centers met inclusion criteria. Of those, 13 (23.6%) developed transaminitis, and the mean time to development of transaminitis was 17 days. Patients who developed transaminitis were older (12 vs 6.4 years, p = 0.01) and had a larger mean %TBSA (45.9 vs 34.1, p = 0.03). The odds of developing transaminitis increased by 23% for each 1 year increase in age (OR 1.23, CI 1.06–1.44). The use of other concurrent medications was not associated with an increased risk of developing transaminitis. Renal function and hepatic function was not associated with the development of transaminitis. There was no significant difference in length of stay and mortality. Conclusions Transaminitis occurred in 23.6% of our study population and was associated with patients who were older and had a larger mean %TBSA burn. Older pediatric patients with larger burns who are receiving oxandrolone should be closely monitored for the development of transaminitis. Applicability of Research to Practice Future research is needed to identify appropriate monitoring and management of transaminitis in oxandrolone-treated pediatric burn patients.

scholarly journals Early abnormal fibrinolysis and mortality in patients with thermal injury: a prospective cohort study

BJS Open ◽  
2021 ◽  
Vol 5 (2) ◽  
Author(s):  
A E Pusateri ◽  
T D Le ◽  
J W Keyloun ◽  
L T Moffatt ◽  
T Orfeo ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Odds Ratio ◽  
Thermal Injury ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Burn Patients ◽  
Clot Strength ◽  
Increased Risk

Abstract Introduction Abnormal fibrinolysis early after injury has been associated with increased mortality in trauma patients, but no studies have addressed patients with burn injury. This prospective cohort study aimed to characterize fibrinolytic phenotypes in burn patients and to see if they were associated with mortality. Methods Patients presenting to a regional burn centre within 4 h of thermal injury were included. Blood was collected for sequential viscoelastic measurements using thromboelastography (RapidTEG™) over 12 h. The percentage decrease in clot strength 30 min after the time of maximal clot strength (LY30) was used to categorize patients into hypofibrinolytic/fibrinolytic shutdown (SD), physiological (PHYS) and hyperfibrinolytic (HF) phenotypes. Injury characteristics, demographics and outcomes were compared. Results Of 115 included patients, just over two thirds were male. Overall median age was 40 (i.q.r. 28–57) years and median total body surface area (TBSA) burn was 13 (i.q.r. 6–30) per cent. Some 42 (36.5 per cent) patients had severe burns affecting over 20 per cent TBSA. Overall mortality was 18.3 per cent. At admission 60.0 per cent were PHYS, 30.4 per cent were SD and 9.6 per cent HF. HF was associated with increased risk of mortality on admission (odds ratio 12.61 (95 per cent c.i. 1.12 to 142.57); P = 0.041) but not later during the admission when its incidence also decreased. Admission SD was not associated with mortality, but incidence increased and by 4 h and beyond, SD was associated with increased mortality, compared with PHYS (odds ratio 8.27 (95 per cent c.i. 1.16 to 58.95); P = 0.034). Discussion Early abnormal fibrinolytic function is associated with mortality in burn patients.

10 A Multi-center Study Analyzing Association of Vitamin D Deficiency and Replacement with Infectious Outcomes in Patients with Burn Injuries

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S12-S13
Author(s):  
Katelyn Garner ◽  
Sarah Zavala ◽  
Kate Pape ◽  
Todd A Walroth ◽  
Melissa A Reger ◽  
...  
Keyword(s):  
Vitamin D ◽  
Burn Injury ◽  
Graft Loss ◽  
Total Body Surface Area ◽  
Inhalation Injury ◽  
Control Group ◽  
Comfort Care ◽  
Increased Risk ◽  
Multi Center Study ◽  
Center Study

Abstract Introduction Vitamin D (25OHD) deficiency has been associated with poor outcomes in intensive care populations. A recent single-center, burn study found a high incidence of 25OHD deficiency. A difference was noted in infectious complications, but was underpowered. The primary objective of this multi-center study was to determine if 25OHD deficiency is associated with infectious outcomes in adult burn patients. Methods Adult patients were eligible for inclusion in this 7 center, retrospective study if admitted January 1, 2016 - July 25, 2019 and had a 25OHD concentration drawn within the first 7 days of admission. Patients were excluded if admitted for a non-burn injury, had total body surface area (TBSA) burned of less than 5%, a readmission, pregnant, incarcerated, or made comfort care or expired within 48 hours of admission. Expecting a 3:1 enrollment, goal was at least 250 total patients to be appropriately powered (β = 0.2; α = 0.05) to detect a 33% difference in composite infectious outcome (bacteremia, pneumonia, urinary tract infection, wound infection, graft loss, or death) between patients with 25OHD deficiency (< 20 ng/mL) and control (≥ 20 ng/mL). Generalized linear mixed modelling was used to control for center effect, % TBSA, age, and presence of inhalation injury and find the most predictive model. Results A total of 1147 patients were initially included. After exclusions, 234 (56.8%) in the deficient and 178 in the control group remained. Patients in the control group had their concentration drawn earlier (p < 0.001), were more likely to be male (p = 0.006), Caucasian (p < 0.001), lower body mass index (p = 0.009), lower % TBSA burn (p = 0.002), and taking a 25OHD supplement prior to admission (p < 0.001). Deficient patients were more likely to have an infectious outcome (52.1% vs 36.0%, p = 0.002), acute kidney injury requiring renal replacement therapy (p = 0.009), less ventilator free days in the first 28 days (p < 0.001), and more days requiring vasopressors (p = 0.008). After controlling for center, % TBSA, age, and inhalation injury the best model also included presence of deficiency (odds ratio = 2.425 [1.035 - 1.252]), days until 25OHD supplement initiation (1.139 [1.035 - 1.252]), and choice of cholecalciferol over ergocalciferol 2.112 [1.151 - 3.877]). Conclusions Dilution concerns were controlled by including %TBSA in the regression model. Even if low 25OHD concentrations were an acute reaction to burn injury and not representative of true deficiency, low concentrations and delay in supplementation were independently associated with increased risk of an infectious outcome.

Keeping it all inside: Shyness, internalizing coping strategies and socio-emotional adjustment in middle childhood

2009 ◽  
Vol 33 (1) ◽  
pp. 47-54 ◽  
Author(s):  
Leanne C. Findlay ◽  
Robert J. Coplan ◽  
Anne Bowker
Keyword(s):  
Coping Strategies ◽  
Social Functioning ◽  
Middle Childhood ◽  
Emotional Adjustment ◽  
Well Being ◽  
Self Concept ◽  
Positive And Negative Affect ◽  
Potential Mediator ◽  
Internalizing Difficulties ◽  
And Coping

Despite growing research results indicating that shyness is a risk factor for psychosocial maladjustment in childhood, less is known about the conceptual mechanisms that may underlie these associations. The purpose of the current study was to explore links between self-reported shyness, coping strategies and social functioning in middle childhood. As well, we sought to examine the reliance on internalizing coping strategies as a potential mediator of the link between shyness and social functioning. Participants were 355 children aged 9 to 11 years who completed measures of shyness, loneliness, positive and negative affect, social anxiety, self-concept, well-being, and coping strategies. Results indicated that shyness was associated with greater internalizing difficulties and lower well-being. Moreover, internalizing coping was found to partially mediate the relation between shyness and certain indices of internalizing problems. These results suggest a conceptual pathway, where an over-reliance on internalizing coping may partially explain why shy children experience internalizing difficulties in middle childhood.

scholarly journals Testosterone receptor blockade restores cellular immunity in male mice after burn injury

2001 ◽  
Vol 169 (2) ◽  
pp. 299-308 ◽  
Author(s):  
KA Messingham ◽  
KA Messingham ◽  
M Shirazi ◽  
LA Duffner ◽  
LA Duffner ◽  
...  
Keyword(s):  
Cellular Immunity ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Receptor Activation ◽  
Delayed Type Hypersensitivity ◽  
Splenocyte Proliferation ◽  
Septic Complications ◽  
Partial Restoration ◽  
Increased Risk

Males are known to have increased risk for septic complications after traumatic injury, which appears to be mediated by the inhibitory effects of testosterone on immune function. The role of testosterone in immunity after burn injury, however, remains unclear. Herein, we examined the effects of a testosterone receptor antagonist, flutamide, on delayed type hypersensitivity response (DTH), splenocyte proliferation, interleukin (IL)-2 secretion, and IL-2 receptor (IL-2R) expression in male BALB/c mice subjected to a 15% total body surface area burn or sham injury. Burn- or sham-injured mice were given flutamide s.c. at 30 min and 24 h after injury. At 48 h, burn injury caused a 48% (P<0.001) decrease in DTH response; however, mice that received flutamide treatment did not demonstrate significant suppression of DTH. Likewise, splenocyte proliferation and IL-2 production were depressed in burned animals in comparison with sham-injured controls, and flutamide treatment resulted in a partial restoration of these responses. In vitro studies indicated that splenocytes from sham- and burn-injured mice were equally sensitive to the suppressive effects of 5alpha-dihydrotestosterone in regard to proliferation and IL-2 production. Further evaluation revealed a decrease in IL-2R expression on splenocytes from burned mice and a partial restoration of this expression with flutamide treatment. Thus blocking testosterone receptor activation improves the cellular immunity in thermally injured mice, possibly through restoration of IL-2 production and IL-2R expression. It remains to be determined whether the effects of testosterone in this injury model are direct or indirect.

618 Clinical and Humanistic Burdens of Pediatric Burns: A Systematic Literature Review

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S163-S164
Author(s):  
Helen Hahn ◽  
Tzy-Chyi Yu ◽  
Randi L Rutan ◽  
David L Salyer
Keyword(s):  
Peer Relationships ◽  
Burn Injury ◽  
Donor Site ◽  
Total Body Surface Area ◽  
Burn Injuries ◽  
Burn Care ◽  
Increased Risk ◽  
Patient Reported ◽  
Pediatric Burns ◽  
Over Time

Abstract Introduction Children face long-term clinical and psychological sequelae from burn injuries. This review summarizes the scientific literature on the clinical and humanistic burdens of pediatric burns. Methods A systematic review of literature published between Jan 2015 and Jun 2020 was conducted based on PRISMA guidelines in Embase, Biosis, and MEDLINE to identify publications examining the clinical, humanistic, economic, and/or epidemiologic burdens of illness associated with pediatric burns in the US. Results Of 2,286 unique articles identified, 28 met eligibility criteria. This analysis focused on studies relating to the clinical (n=8) and humanistic (n=9) burdens of pediatric burns. Across all studies, flame and scald were the most common burn etiologies. Among the 8 clinical studies, several evaluated outcomes (n=2) or treatments (n=3) in predominantly graft recipients. One study found that 64% of pediatric split-thickness autograft recipients exhibited hypertrophic scarring (HTS) at the donor site. Other variables (time to re-epithelialization, donor-site harvest depth, harvest in an acute burn care setting, thigh donor-site location) were associated with increased risk of HTS. An increase in percentage total body surface area (%TBSA) burned corresponded to increased number of autograft procedures, risk for HTS, and viral infection risk. Other reported outcomes included infections (eg, healthcare-associated, wound, viral), pain, inhalation injury, and sepsis. One study found that while the frequency and intensity of pruritis decreased over time, 63% of children continued to report symptoms at 2 years after injury. Among the 9 humanistic studies, 4 reported larger %TBSA corresponded to worse health-related quality of life assessed by various instruments. In a study of patients under age 5 with burns, Burns Outcomes Questionnaire (0–4) scores improved over time in multiple domains. In youth with a history of burn injuries, patient-reported pain interference with daily living was significantly associated with decreased physical functioning, depression, and impaired peer relationships. Two studies assessed caregiver burden, with one study finding that 19% of caregivers self-reported clinical or at-risk levels of distress following the child’s burn injury. Conclusions Pediatric burns place a substantial clinical and humanistic burden on patients and their caregivers. While outcomes appeared to improve over time, clinical and humanistic consequences of pediatric burns endured. More research on novel treatment products and procedures is needed to reduce the burden of burns for this population.

810 Routine Psychosocial Screening and Follow-up of Adult Burn Patients in an Outpatient Clinic

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S243-S244
Author(s):  
Alaina Tiani ◽  
Desiree N Williford ◽  
Carrie B Jackson ◽  
Kristine Durkin ◽  
Ariana Langholz ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Burn Injury ◽  
Psychological Services ◽  
Post Traumatic Stress ◽  
Increased Risk ◽  
Burn Survivors ◽  
Clinically Significant ◽  
At Home

Abstract Introduction Sustaining a burn injury is associated with increased risk of mental health issues, and common among these are depression, anxiety, post-traumatic stress disorder (PTSD), and substance use. Unfortunately, less than half of these adult burn survivors receive services related to their mental health concerns. Moreover, few studies have examined the routine implementation of a psychosocial screener in an outpatient burn clinic setting, and there is a paucity of research which examines how to proceed when patients endorse symptomology. The aim of the current study is to report on outcomes of a routine psychosocial screener in a sample of adult burn survivors and patient response to brief psychological consultation at initial screen and 1-month follow-up. Methods A psychosocial screener was developed and implemented (October 2016-August 2019) in an outpatient burn clinic to identify patients who endorse clinically significant psychosocial distress. Comprised of very brief, validated scales (and their clinical cut-off scores), the screener assessed for safety at home, suicidal risk, depression, anxiety, and substance use. Adult burn survivors completed the questionnaire at their first outpatient appointment. Patients who endorsed safety concerns at home and/or suicidal ideation/risk were immediately evaluated by a physician or psychology staff. Those who endorsed significant distress, but no suicidal or safety risk, were contacted by psychology staff within one week of the screener date. Those who did not indicate significant clinically significant distress did not require further action. Results Of the 393 patients who completed the screener, 102 individuals (26%) indicated clinically significant mental/behavioral distress. Psychology staff were able to reach 80 patients (78%) for initial brief consultation (i.e., within one week). Of those contacted, 14 (18%) indicated that they were already receiving psychological services, 25 (31%) reported they were not interested in a psychological referral, 20 (25%) accepted a new referral for psychological services, and 19 (24%) endorsed minimal or decreased symptoms. In February 2019, we began to conduct 1-month follow-up. A total of 19 individuals were eligible (had positive screens) and 8 (42%) were reached. Of those reached, 2 (25%) accepted a new psychological referral, 2 (25%) indicated no interest in a referral, and 3 (37%) reported minimal/no psychological symptoms. Conclusions Implementing a psychosocial screener is a feasible way to screen for distress in outpatients. Applicability of Research to Practice A 1-month follow-up contact helps staff to understand whether referrals are utilized or how symptoms may change over time and yields another opportunity to provide referrals to those previously uninterested.

scholarly journals A non-lethal murine flame burn model leads to a transient reduction in host defenses and enhanced susceptibility to lethal Pseudomonas aeruginosa infection

2021 ◽  
Author(s):  
Jerod Brammer ◽  
Myeongjin Choi ◽  
Scott M Baliban ◽  
Adrienne R Kambouris ◽  
Gary Fiskum ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Inflammatory Cytokines ◽  
Burn Injury ◽  
Clinical Symptoms ◽  
Total Body Surface Area ◽  
Serum Levels ◽  
Opportunistic Pathogen ◽  
Increased Risk ◽  
Flame Burn ◽  
Pro Inflammatory Cytokines

Of the 486,000 burn injuries that required medical treatment in the USA in 2016, 40,000 people were hospitalized, with > 3,000 fatalities. After burn injury, humans are at increased risk of sepsis and mortality from infections caused by Pseudomonas aeruginosa (PA), an opportunistic pathogen. We hypothesize that systemic events were initiated from the burn that increased the host’s susceptibility to PA. A non-lethal 10% total body surface area (TBSA), full-thickness flame burn was performed in CD-1 mice without and with subsequent PA (strain M2) infection. The LD 50 for subcutaneous infection with PA M2 at the burn site immediately after the burn decreased by 6-logs with mortality occurring between 18 and 26 hours, compared with PA-infected mice without burn injury. Bacteria in distal organs were detected by 18 hours, concurrent with the onset of clinical symptoms. Serum pro-inflammatory cytokines (IL-6, IL-1β, IFN-γ, and TNF-α) and the anti-inflammatory cytokine, IL-10, were first detected at 12 hours post-burn with infection and continued to increase until death. Directly after burn alone, serum levels of HMGB1, a danger-associated molecular pattern and TLR4 agonist, transiently increased to 50 ng/mL before returning to 20 ng/mL. Burn with PA infection increased serum HMGB1 concentrations >10-fold (250 ng/mL) at the time of death. This HMGB1-rich serum stimulated TLR4-mediated NF-κB activation in a TLR4-reporter cell line. Treatment of infected burned mice with P5779, a peptide inhibitor of HMGB1, increased the mean survival from 23 to 42 hours (P<0.0001). We conclude that the high level of serum HMGB1, which preceded the increase in pro-inflammatory cytokines, is associated with post-burn mortality.

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