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Pediatric Contractures in Burn Injury: A Burn Model System National Database Study
Jeremy Goverman1, Katie Mathews, Richard Goldstein
1From the *Division of Burns, Department of Surgery, Sumner Redstone Burn Center, Surgical Services, Massachusetts General Hospital, Boston; †Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts; ‡Harvard Medical School, Boston, Massachusetts; §Shriners Hospitals for Children, Boston, Massachusetts; ‖Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas; ¶Department of Surgery, University of Washington Medicine Regional Burn Center, University of Washington, Seattle; and #University of Texas Medical Branch, Shriners Hospitals for Children, Galveston.
Insights
Approximately 23% of pediatric burn survivors develop contractures at hospital discharge. Key risk factors include age and intensive care unit (ICU) stay, highlighting the need for improved prevention strategies for pediatric burn contractures.
Area of Science:
- Pediatric burn care
- Rehabilitation medicine
- Epidemiology of injuries
Background:
- Joint contractures are a significant cause of morbidity and functional impairment following burns.
- Limited data exists on the incidence and risk factors of postburn contractures in children.
Purpose of the Study:
- To determine the incidence and severity of contractures in a large pediatric burn population.
- To identify risk factors associated with the development and severity of postburn contractures in children.
Main Methods:
- Analysis of data from the National Institute on Disability and Rehabilitation Research Burn Model System database (1994-2003).
- Inclusion of pediatric burn survivors (under 18 years) with collected demographic and medical data.
- Regression analysis to identify predictors of contracture presence, severity, and number.
Main Results:
- 23% of 1031 pediatric patients developed at least one contracture at hospital discharge.
- Shoulder, elbow, and wrist were the most frequently affected joints; most contractures were mild to moderate.
- Age and intensive care unit (ICU) length of stay were significant predictors of contracture development and severity.
Conclusions:
- This study provides the first epidemiological data on postburn contractures in pediatric patients.
- Contractures develop in a significant portion of children despite early interventions, necessitating novel prevention strategies.
- Risk factors like age, ICU stay, amputation, and race influence contracture development and severity, guiding future research and clinical practice.
Abstract:
Joint contractures are a major cause of morbidity and functional deficit. The incidence of postburn contractures and their associated risk factors in the pediatric population has not yet been reported. This study examines the incidence and severity of contractures in a large, multicenter, pediatric burn population. Associated risk factors for the development of contractures are determined. Data from the National Institute on Disability and Rehabilitation Research Burn Model System database, for pediatric (younger than 18 years) burn survivors from 1994 to 2003, were analyzed. Demographic and medical data were collected on each subject. The primary outcome measures included the presence of contractures, number of contractures per patient, and severity of contractures at each of nine locations (shoulder, elbow, hip, knee, ankle, wrist, neck, lumbar, and thoracic) at time of hospital discharge. Regression analysis was performed to determine predictors of the presence, severity, and numbers of contractures, with P < .05 used for statistical significance. Of the 1031 study patients, 237 (23%) developed at least 1 contracture at hospital discharge. Among those with at least one contracture, the mean was three (3.3) contractures per person. The shoulder was the most frequently contracted joint (27.9%), followed by the elbow (17.6%), wrist (14.2%), knee (13.3%), and ankle (11.9%). Most contractures were mild (38.5%) or moderate (36.3%) in severity. The statistically significant predictors of contracture development were age and intensive care unit (ICU) length of stay. The statistically significant predictors of severity of contracture were age, ICU length of stay, presence of amputation, and black race. Predictors of the number of contractures included total age, length of stay, length of ICU stay, presence of amputation, TBSA burned, and TBSA grafted. This is the first study to report the epidemiology of postburn contractures in the pediatric population. Approximately one quarter of children with a major burn injury developed a contracture at hospital discharge, and this could potentially increase as the child grows. Contractures develop despite early therapeutic interventions such as positioning and splinting; therefore, it is essential that we identify novel and more effective prevention strategies.
