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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.
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.
