From the Shriners Hospitals for Children (R.L.S., F.J.S., M.I.H., R.G.T.); Massachusetts General Hospital (R.L.S., F.J.S., A.L., R.G.T.); and Center for the Assessment of Pharmaceutical Practices (CAPP) (L.E.K.), Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Children (D.N.H., W.J.M., M.N.), Galveston, Texas; Shriners Hospitals for Children (R.J.K., T.K.S.), Cincinnati, Ohio; Shriners Hospitals for Children (Northern California) (T.L.P., G.C.), Sacramento, California.
J Trauma Acute Care Surg. 2014 Mar;76(3):828-32. doi: 10.1097/TA.0b013e3182ab111c.
Children surviving serious burns are at risk for developing posttraumatic stress disorder (PTSD) as a function both of the injury and of its treatment. Short-term studies in such children have demonstrated reduced PTSD symptoms with intensive early pain control. However, the long-term impact of early pain control strategies on posttraumatic stress symptoms in children recovering from serious burn injuries has not been examined.
This was a retrospective review of a multiple time point data collection involving a cohort of 147 infants, children, and teenagers with 4 years of follow-up after serious burns conducted at 4 pediatric burn centers to examine the impact of early opiate dosing on long-term posttraumatic stress symptoms. The main outcome measure was the nine-item Short Form Child Stress Disorders Checklist, which is an established and validated assessment. The impact of total opiate dosing during the first 7 days on these scores was assessed.
Subjects had an average age of 11 years and average injury size of 22% total body surface area burned (%TBS). The correlation between opiate units (OUs) and %TBS was 0.46 at baseline, OU increasing with increasing %TBS. OUs were strongly predictive of Child Stress Disorders Checklist scores up to 4 years, with higher OU (10 units vs. 6 and 2 units) remaining constantly different up to 4 years in predicting lower stress scores for both smaller and larger burns.
Early opiate management of pain associated with acute burn wounds and burn treatment predicts the development and resolution rate of PTSD symptoms in a large multicenter sample of children hospitalized for serious burns. The effect seems to be dose related and durable at least up to 4 years in a range of burn sizes.
Prognostic/epidemiologic study, level II.
儿童在严重烧伤后发生创伤后应激障碍（PTSD）的风险与损伤及其治疗有关。对这些儿童的短期研究表明，通过早期强化疼痛控制，可以减轻 PTSD 症状。然而，早期疼痛控制策略对严重烧伤后儿童创伤后应激症状的长期影响尚未得到检验。
这是一项回顾性研究，涉及四个儿科烧伤中心的 147 名婴儿、儿童和青少年队列，在严重烧伤后进行了 4 年的随访，以检查早期阿片类药物剂量对长期创伤后应激症状的影响。主要结局指标是九项儿童应激障碍清单短表，这是一种已建立和验证的评估方法。评估了前 7 天内总阿片类药物剂量对这些评分的影响。
研究对象的平均年龄为 11 岁，平均烧伤面积为 22%总体表面积（%TBS）。基线时阿片类药物单位（OU）与 %TBS 的相关性为 0.46，OU 随 %TBS 的增加而增加。OU 与儿童应激障碍清单评分高度相关，高达 4 年，较高的 OU（10 单位比 6 单位和 2 单位）在预测较小和较大烧伤的应激评分时，在 4 年内一直保持不同。
急性烧伤伤口和烧伤治疗相关疼痛的早期阿片类药物管理预测了大量多中心严重烧伤住院儿童 PTSD 症状的发生和缓解率。这种效应似乎与剂量有关，在一定范围内的烧伤大小下，至少在 4 年内具有持久效应。
预后/流行病学研究，II 级。
