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Recovery Curves for Pediatric Burn Survivors: Advances in Patient-Oriented Outcomes
Lewis E Kazis1, Austin F Lee2, Mary Rose3
1Department of Health Law, Policy and Management, Center for the Assessment of Pharmaceutical Practices, Boston University School of Public Health, Boston, Massachusetts.
Insights
Patient-reported outcomes for pediatric burn survivors are crucial for recovery benchmarks. This study establishes recovery curves for children under 5, aiding in tailored patient management and identifying deviations from expected progress.
Area of Science:
- Pediatric Burn Recovery
- Patient-Reported Outcomes
- Longitudinal Cohort Studies
Background:
- Lack of established benchmarks for pediatric burn survivor recovery.
- Need for new approaches to monitor recovery using statistical models.
- Importance of patient-reported outcomes for early management.
Purpose of the Study:
- To describe multidimensional patient-reported outcomes in pediatric burn survivors younger than 5 years.
- To establish recovery benchmarks using recovery curve methods.
- To identify expected recovery trajectories for pediatric burn survivors.
Main Methods:
- Prospective cohort study of 336 pediatric burn survivors (<5 years) and 285 controls.
- Utilized the Burn Outcomes Questionnaire for children aged 0 to 5 years (BOQ0-5).
- Employed mixed models to generate 48-month recovery curves for 10 BOQ0-5 domains.
Main Results:
- Recovery scores improved over time in 5 domains: play, language, gross motor skills, pain/itching, and worry/concern.
- Pediatric burn survivors showed higher scores in language, emotional behavior, and family functioning compared to controls in later months.
- Significant deficits were observed in multiple functional domains among pediatric burn survivors.
Conclusions:
- Recovery curves can identify deviations from expected recovery trajectories.
- Findings highlight significant functional deficits in pediatric burn survivors.
- Tailored care can be provided to pediatric burn survivors based on identified needs and recovery patterns.
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 5 years 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 each of the 10 BOQ0-5 domains. The study was conducted between January 1999 and December 2008.
Main Outcomes And 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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