The Experts below are selected from a list of 2049 Experts worldwide ranked by ideXlab platform
Robert L Sheridan - One of the best experts on this subject based on the ideXlab platform.
-
reconstruction of the upper extremity high voltage electrical injury a Pediatric Burn hospital s 13 year experience
Journal of Burn Care & Research, 2021Co-Authors: Robert L Sheridan, Matthew A Depamphilis, Ryan Cauley, Farzin Sadeq, Martha Lydon, Jonathan M WinogradAbstract:High-voltage electrical injury is a rare yet destructive class of Burn injury that persists as a serious public health issue. High-voltage exposure is commonly associated with complex wounds to the upper extremities, which can be a significant challenge for Burn and plastic surgeons to reconstruct. This intensive and multistage reconstructive process is especially difficult in the growing child. Maximizing upper extremity function is a top priority, as it can have a significant impact on a patient's quality of life. Therefore, this retrospective review describes lessons learned during a 13-year experience at a specialized Pediatric Burn hospital with reconstruction of the upper extremity after severe high-voltage injury in 37 children. We found that adherence to the following principles can help promote meaningful functional recovery. These include: (1) frequent assessment during early acute care for the evolving need of decompression or amputation, (2) serial surgical debridement that follows a tissue-sparing technique, (3) wound closure by skin grafting or use of flaps (particularly groin or abdominal pedicled flaps) when deep musculoskeletal structures are involved, (4) early multidisciplinary intervention for contracture prevention and management including physical and occupational therapy, splinting, and fixation, (5) secondary reconstruction that focuses on the simplest possible techniques to repair chronic skin defects such as laser therapy, local tissue rearrangements, and skin grafting, (6) complex secondary reconstruction to address deeper tissue contractures or tendon and peripheral nerve deficits, and (7) amputation with preservation of growth plates, soft tissue transfer, and long-term prosthetic management when limb salvage is unlikely.
-
development of clinical process measures for Pediatric Burn care understanding variation in practice patterns
Journal of Trauma-injury Infection and Critical Care, 2017Co-Authors: Lewis E Kazis, Robert L Sheridan, Gabriel D Shapiro, Austin F Lee, Matthew H Liang, Colleen M Ryan, Jeffrey C Schneider, M Lydon, Marina Soleybori, Lily A SonisAbstract:BACKGROUND There has been little systematic examination of variation in Pediatric Burn care clinical practices and its effect on outcomes. As a first step, current clinical care processes need to be operationally defined. The highly specialized Burn care units of the Shriners Hospitals for Children system present an opportunity to describe the processes of care. The aim of this study was to develop a set of process-based measures for Pediatric Burn care and examine adherence to them by providers in a cohort of Pediatric Burn patients. METHODS We conducted a systematic literature review to compile a set of process-based indicators. These measures were refined by an expert panel of Burn care providers, yielding 36 process-based indicators in four clinical areas: initial evaluation and resuscitation, acute excisional surgery and critical care, psychosocial and pain control, and reconstruction and aftercare. We assessed variability in adherence to the indicators in a cohort of 1,076 children with Burns at four regional Pediatric Burn programs in the Shriners Hospital system. The percentages of the cohort at each of the four sites were as follows: Boston, 20.8%; Cincinnati, 21.1%; Galveston, 36.0%; and Sacramento, 22.1%. The cohort included children who received care between 2006 and 2010. RESULTS Adherence to the process indicators varied both across sites and by clinical area. Adherence was lowest for the clinical areas of acute excisional surgery and critical care, with a range of 35% to 48% across sites, followed by initial evaluation and resuscitation (range, 34%-60%). In contrast, the clinical areas of psychosocial and pain control and reconstruction and aftercare had relatively high adherence across sites, with ranges of 62% to 93% and 71% to 87%, respectively. Of the 36 process indicators, 89% differed significantly in adherence between clinical sites (p < 0.05). Acute excisional surgery and critical care exhibited the most variability. CONCLUSION The development of this set of process-based measures represents an important step in the assessment of clinical practice in Pediatric Burn care. Substantial variation was observed in practices of Pediatric Burn care. However, further research is needed to link these process-based measures to clinical outcomes. LEVEL OF EVIDENCE Therapeutic/care management, level IV.
-
current concepts in the medical management of the Pediatric Burn patient
Current Trauma Reports, 2016Co-Authors: Robert L Sheridan, Carlos DuranAbstract:Management of the Pediatric Burn patient involves a careful, multi-faceted approach in order to meet treatment goals. Due to advances in surgical and medical care, mortality and morbidities can be minimized. This chapter seeks to address current advances which allow practitioners to provide excellent systemic care. Judicious fluid management of children with severe Burn injury can improve the respiratory outcome measures of these children. A multi-modal approach to pain and sedation can improve the neurologic status of severely Burned children. Children with significant Burn injury can have the most favorable outcomes when the principles of skillful critical care are applied. Systemic critical care based on the best evidence available not only improves survival rates but also improves quality of life for these delicate patients.
-
recovery curves for Pediatric Burn survivors advances in patient oriented outcomes
JAMA Pediatrics, 2016Co-Authors: Lewis E Kazis, Robert L Sheridan, Matthew H Liang, Mary Rose, Nien Chen Li, Janet Gilroylewis, Frederick J Stoddard, Michelle I Hinson, Glenn D Warden, Kim StubbsAbstract: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 RESULTS: = .03]; language, 49.2 vs 54.4 [P RESULTS: 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. Language: en
-
Recovery Curves for Pediatric Burn Survivors: Advances in Patient-Oriented Outcomes
JAMA pediatrics, 2016Co-Authors: Lewis E Kazis, Robert L Sheridan, Austin F Lee, Matthew H Liang, Mary Rose, Frederick J Stoddard, Xinhua S. Ren, Janet Gilroy-lewis, Michelle I HinsonAbstract: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 RESULTS: = .03]; language, 49.2 vs 54.4 [P RESULTS: 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. Language: en
David N. Herndon - One of the best experts on this subject based on the ideXlab platform.
-
contracture severity at hospital discharge in children a Burn model system database study
Journal of Burn Care & Research, 2020Co-Authors: Miranda Yelvington, David N. Herndon, Matthew Godleski, Austin F Lee, Karen J. Kowalske, Jeremy Goverman, Ingrid Parry, O E Suman, R HolavanahalliAbstract:Contractures can complicate Burn recovery. There are limited studies examining the prevalence of contractures following Burns in Pediatrics. This study investigates contracture outcomes by location, injury, severity, length of stay, and developmental stage. Data were obtained from the Burn Model System between 1994 and 2003. All patients younger than the age of 18 with at least one joint contracture at hospital discharge were included. Sixteen areas of impaired movement from the shoulder, elbow, wrist, hand, hip, knee, and ankle joints were examined. Analysis of variance was used to assess the association between contracture severity, Burn size, and length of stay. Age groupings were evaluated for developmental patterns. A P value of less than .05 was considered statistically significant. Data from 225 patients yielded 1597 contractures (758 in the hand) with a mean of 7.1 contractures (median 4) per patient. Mean contracture severity ranged from 17% (elbow extension) to 41% (ankle plantarflexion) loss of movement. Statistically significant associations were found between active range of motion loss and Burn size, length of stay, and age groupings. The data illustrate quantitative assessment of Burn contractures in Pediatric patients at discharge in a multicenter database. Size of injury correlates with range of motion loss for many joint motions, reflecting the anticipated morbidity of contracture for Pediatric Burn survivors. These results serve as a potential reference for range of motion outcomes in the Pediatric Burn population, which could serve as a comparison for local practices, quality improvement measures, and future research.
-
skeletal muscle protein breakdown remains elevated in Pediatric Burn survivors up to one year post injury
Shock, 2015Co-Authors: Tony Chao, David N. Herndon, Craig Porter, Maria Chondronikola, Anastasia Chaidemenou, Doaa Reda Abdelrahman, Fredrick J Bohanon, Clark R AndersenAbstract:Acute alterations in skeletal muscle protein metabolism are a well-established event associated with the stress response to Burns. Nevertheless, the long-lasting effects of Burn injury on skeletal muscle protein turnover are incompletely understood. This study was undertaken to investigate fractional synthesis (FSR) and breakdown (FBR) rates in skeletal muscle of Pediatric Burn patients (n = 42, >30% total body surface area Burns) for up to 1 year after injury. Skeletal muscle protein kinetics were measured in the postprandial state following bolus injections of C6 and N phenylalanine stable isotopes. Plasma and muscle phenylalanine enrichments were quantified using gas chromatography-mass spectrometry. We found that the FSR in Burn patients was 2- to 3-fold higher than values from healthy men previously reported in the literature (P ≤ 0.05). The FBR was 4- to 6-fold higher than healthy values (P Language: en
-
pruritus in Pediatric Burn survivors defining the clinical course
Journal of Burn Care & Research, 2015Co-Authors: Gretchen J. Carrougher, David N. Herndon, Jeffrey C Schneider, Karen J. Kowalske, Deborah Nadler, Katie Matthews, Shelley A Wiechman, Nicole S Gibran, Walter J MeyerAbstract:Pruritus is a frequent and severe symptom and a significant cause of distress for adult Burn patients. Its effects in children are largely unstudied. The aim of this study is to characterize postBurn itch in the Pediatric population. This is a retrospective review from 2006 to 2013 for Pediatric Burn survivors who were enrolled in a longitudinal multicenter outcomes study. Demographic data, injury characteristics, associated symptoms (skin-related problems, pain, and sleep), and incidence and intensity (Numerical Rating Scale) of itch were examined. Measures were completed at hospital discharge and at 6, 12, and 24 months after injury. Spearman's correlations were used to examine the correlation between itch intensity and associated symptoms. Multivariate regression analyses examined the impact of associated symptoms on itch intensity. There were 430 Pediatric Burn survivors with a mean age of 7.8 years and a mean TBSA of 40.8%. Pruritus is present in most children (93%) and is of moderate intensity (5.7 ± 3.1) at discharge. The frequency and intensity of pruritus decreases over time; a majority of children continue to report symptoms at 2 years (63%). Itch was significantly correlated with associated symptoms. Regression analyses showed a correlation between itch intensity and pain at each time point. There was no association between itch intensity and Burn etiology, age, gender, or Burn size. Pruritus is a frequent complication that lasts for at least 2 years after injury in a majority of Pediatric Burn survivors. This information will enable better tracking of outcomes and will serve as a baseline for assessing interventions.
-
early rehabilitative exercise training in the recovery from Pediatric Burn
Medicine and Science in Sports and Exercise, 2014Co-Authors: Justin P Hardee, David N. Herndon, Craig Porter, Elisabet Borsheim, Labros S Sidossis, James A Carson, Oscar E SumanAbstract:AB Purpose: The purpose of this study was to determine the effects of early outpatient exercise on muscle mass, function, and fractional synthetic rate in severely Burned children. Methods: Forty-seven children with >=40% total body surface area Burn performed a 12-wk standard of care rehabilitation (SOC, n = 23) or rehabilitative exercise training (RET, n = 24) immediately after hospital discharge. Dual-energy x-ray absorptiometry was used to assess lean body mass (LBM) at discharge, posttreatment, and 12 months post-Burn. Muscle function was evaluated with a Biodex Isokinetic Dynamometer, and peak aerobic fitness (V[spacing dot above]O2peak) was measured using a modified Bruce treadmill protocol posttreatment. Stable isotope infusion studies were performed in a subset of patients (SOC, n = 13; RET, n = 11) at discharge and posttreatment to determine mixed-muscle fractional synthetic rate. Results: Relative peak torque (RET, 138 +/- 9 N[middle dot]m[middle dot]kg-1, vs SOC, 106 +/- 9 N[middle dot]m[middle dot]kg-1) and V[spacing dot above]O2peak (RET, 32 +/- 1 mL[middle dot]kg-1[middle dot]min-1, vs SOC, 28 +/- 1 mL[middle dot]kg-1[middle dot]min-1) were greater at posttreatment with RET compared with those with SOC. In addition, RET increased whole-body (9% +/- 2%) and leg (17% +/- 3%) LBM compared with SOC. Furthermore, the percentage change in whole-body (18% +/- 3%) and leg (31% +/- 4%) LBM from discharge to 12 months post-Burn was greater with RET compared to SOC. Muscle fractional synthetic rate decreased from discharge to posttreatment in both groups (6.9% +/- 1.1% per day vs 3.4 +/- 0.4% per day); however, no differences were observed between treatment groups at each time point. Conclusions: Early outpatient exercise training implemented at hospital discharge represents an effective intervention to improve muscle mass and function after severe Burn injury.
-
pamidronate attenuates muscle loss after Pediatric Burn injury
Journal of Bone and Mineral Research, 2014Co-Authors: David N. Herndon, Elisabet Borsheim, Hal K Hawkins, Oscar E Suman, Matthew Cotter, Gordon L KleinAbstract:Children who are Burned >40% total body surface area lose significant quantities of both bone and muscle mass because of acute bone resorption, inflammation, and endogenous glucocorticoid production, which result in negative nitrogen balance. Because administration of the bisphosphonate pamidronate within 10 days of the Burn injury completely prevents the bone loss, we asked whether muscle protein balance was altered by the preservation of bone. We reviewed the results from 17 Burned Pediatric subjects previously enrolled in a double-blind randomized controlled study of pamidronate in the prevention of post-Burn bone loss and who were concurrently evaluated for muscle protein synthesis and breakdown by stable isotope infusion studies during the acute hospitalization. We found a significantly lower fractional protein synthesis rate (FSR) in the pamidronate group and a correspondingly lower rate of appearance of the amino acid tracer in venous blood, suggesting lower muscle protein turnover. Moreover, net protein balance (synthesis minus breakdown) was positive in the subjects receiving pamidronate and negative in those receiving placebo. Muscle fiber diameter was significantly greater in the pamidronate subjects and leg strength at 9 months post-Burn was not different between subjects who received pamidronate and normal physically fit age-matched children studied in our lab. Leg strength in Burned subjects who served as controls tended to be weaker, although not significantly so. If substantiated by a larger study, these results suggest that bone may have a paracrine mechanism to preserve muscle and this finding may have implications for the treatment of sarcopenia in the elderly.
Lewis E Kazis - One of the best experts on this subject based on the ideXlab platform.
-
agreement between proxy and self report scores on promis health related quality of life domains in Pediatric Burn survivors a national institute on disability independent living and rehabilitation research Burn model system study
Quality of Life Research, 2021Co-Authors: Alyssa M Bamer, Lewis E Kazis, Steven E Wolf, Kara Mcmullen, Barclay T Stewart, Camerin A Rencken, Dagmar AmtmannAbstract:To examine agreement between Pediatric Burn survivor self- and caregiver proxy-report on multiple PROMIS domains and examine factors associated with differences between self- and proxy-reports. Children 8–17 years of age and their caregivers completed PROMIS measures (physical function, depression, peer relationships, pain interference, and anger) between 6 months and 15 years after injury. Self- and proxy-report scores were compared using Wilcoxon sign rank test, Cohen’s effect size, and intraclass correlation coefficients (ICC) and by agreement across severity of symptoms based on recommended cutoffs. Ordinary least squares regression analyses examined child- (self-report score, age, gender, and ethnicity) and proxy-related (relationship to child) factors associated with score differences. Two hundred and seventy four child-caregiver pairs completed the PROMIS measures. Mean child age was 13.0 (SD:3) years. Caregivers reported significantly worse scores than the child on physical function, pain, and anger (all p ≤ 0.01). The effect sizes were small across all domains except physical function. Similarly, ICCs were all of moderate agreement. The percentage of dyads in agreement by severity groups was high with only 5%-9% of pairs discordant. Only higher self-report score was associated (all p < 0.05) with greater differences across all domains in regression analyses. This study supports the use of Pediatric proxy PROMIS depression, physical function, peer relationships, pain interference, and anger scales in Pediatric Burn patients. Although agreement was moderate to good, assessing proxy-report alone as a surrogate should only be considered when self-report is not possible or practical. Caregivers typically report slightly worse severity of symptoms than children across all domains.
-
development of clinical process measures for Pediatric Burn care understanding variation in practice patterns
Journal of Trauma-injury Infection and Critical Care, 2017Co-Authors: Lewis E Kazis, Robert L Sheridan, Gabriel D Shapiro, Austin F Lee, Matthew H Liang, Colleen M Ryan, Jeffrey C Schneider, M Lydon, Marina Soleybori, Lily A SonisAbstract:BACKGROUND There has been little systematic examination of variation in Pediatric Burn care clinical practices and its effect on outcomes. As a first step, current clinical care processes need to be operationally defined. The highly specialized Burn care units of the Shriners Hospitals for Children system present an opportunity to describe the processes of care. The aim of this study was to develop a set of process-based measures for Pediatric Burn care and examine adherence to them by providers in a cohort of Pediatric Burn patients. METHODS We conducted a systematic literature review to compile a set of process-based indicators. These measures were refined by an expert panel of Burn care providers, yielding 36 process-based indicators in four clinical areas: initial evaluation and resuscitation, acute excisional surgery and critical care, psychosocial and pain control, and reconstruction and aftercare. We assessed variability in adherence to the indicators in a cohort of 1,076 children with Burns at four regional Pediatric Burn programs in the Shriners Hospital system. The percentages of the cohort at each of the four sites were as follows: Boston, 20.8%; Cincinnati, 21.1%; Galveston, 36.0%; and Sacramento, 22.1%. The cohort included children who received care between 2006 and 2010. RESULTS Adherence to the process indicators varied both across sites and by clinical area. Adherence was lowest for the clinical areas of acute excisional surgery and critical care, with a range of 35% to 48% across sites, followed by initial evaluation and resuscitation (range, 34%-60%). In contrast, the clinical areas of psychosocial and pain control and reconstruction and aftercare had relatively high adherence across sites, with ranges of 62% to 93% and 71% to 87%, respectively. Of the 36 process indicators, 89% differed significantly in adherence between clinical sites (p < 0.05). Acute excisional surgery and critical care exhibited the most variability. CONCLUSION The development of this set of process-based measures represents an important step in the assessment of clinical practice in Pediatric Burn care. Substantial variation was observed in practices of Pediatric Burn care. However, further research is needed to link these process-based measures to clinical outcomes. LEVEL OF EVIDENCE Therapeutic/care management, level IV.
-
recovery curves for Pediatric Burn survivors advances in patient oriented outcomes
JAMA Pediatrics, 2016Co-Authors: Lewis E Kazis, Robert L Sheridan, Matthew H Liang, Mary Rose, Nien Chen Li, Janet Gilroylewis, Frederick J Stoddard, Michelle I Hinson, Glenn D Warden, Kim StubbsAbstract: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 RESULTS: = .03]; language, 49.2 vs 54.4 [P RESULTS: 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. Language: en
-
Recovery Curves for Pediatric Burn Survivors: Advances in Patient-Oriented Outcomes
JAMA pediatrics, 2016Co-Authors: Lewis E Kazis, Robert L Sheridan, Austin F Lee, Matthew H Liang, Mary Rose, Frederick J Stoddard, Xinhua S. Ren, Janet Gilroy-lewis, Michelle I HinsonAbstract: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 RESULTS: = .03]; language, 49.2 vs 54.4 [P RESULTS: 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. Language: en
Kevin P Yakuboff - One of the best experts on this subject based on the ideXlab platform.
-
tissue expander complications in the Pediatric Burn patient a 10 year follow up
Annals of Plastic Surgery, 2014Co-Authors: Parit A Patel, Haithem M Elhadi, W J Kitzmiller, David A Billmire, Kevin P YakuboffAbstract:Background This study is a 10-year follow-up to our previous publication reviewing the complication rates of tissue expansion in the Pediatric Burn population. The purpose of this study was to determine if our institutional experience with tissue expanders had remained stable during the subsequent 10 years. Methods There were 240 patients who were identified at a major Pediatric Burn center who underwent reconstruction with a tissue expander (256 tissue expanders) from 1996 to 2006. Data were obtained retrospectively by reviewing patient medical records. Complications were categorized into absolute and relative complications. Results Absolute complications occurred in 36 (14.1%) of 256 expanders placed and relative complications occurred in 26 (10.2%) of 256 expanders placed. There was no statistical difference between this study and our previous study for overall complication rates and complications for all sites. The highest complication rate occurred when the scalp was a surgical site. Betadine skin preparation was associated with a 10% reduction in infection-related complications compared to other skin preparations. The operating surgeon or age of patient was not found to be associated with increased complication rates. Conclusions After changing our tissue expander protocol, the complication rates at our institution have remained stable during the 10-year follow-up period. Tissue expansion in the Pediatric Burn population continues to be a safe and effective reconstructive option with acceptable complication rates.
-
treatment outcomes for keloid scar management in the Pediatric Burn population
Burns, 2012Co-Authors: Parit A Patel, Kevin P Yakuboff, J K BaileyAbstract:Abstract Introduction Keloids scars are challenging problems facing many reconstructive surgeons and have proven to be resistant to many treatments. This is evident by the broad range of treatments available and implemented with inconsistent results. We reviewed our experience to better define the disorder and to evaluate the impact of specific treatment options as related to our patient population. Methods After obtaining Institutional Review Board approval, we examined the medical records of Pediatric patients who were evaluated at our Pediatric Burn center between 2000 to 2008. All study subjects were identified as having keloid scars confirmed by clinical evaluation (raised scar extending beyond the margins of the original wound [1] , [2] ). Treatments included excision and grafting [split thickness autograft (STAG) or full thickness autograft (FTAG)], excision and grafting with steroid injection, excision and primary closure, or excision and primary closure with steroid injection. Patients were included only if there was follow-up of 12 months or greater. Results One hundred and ten subjects with a diagnosis of a keloid scar were identified. Twenty-six were treated with excision and skin grafting and 8 were treated with a steroid and surgery regimen. Of the patients treated with surgery and steroids, the treatment varied from an intra-operative injection to post-operative injections at 6-week intervals. The number of injections was determined by the administering surgeon and varied from one to three. Clinical end points were determined by the administering surgeon and included: (1) no further improvement in scar maturation or (2) absence of improvement. Recurrence was defined as return of a raised scar consistent with a keloid scar. The recurrence rate was 87.5% for patients treated with surgery and steroids and 80.0% for surgery only. This difference was not statistically significant. Conclusions Our data demonstrate that steroids do not significantly decrease recurrence in Pediatric Burn related keloids as compared to previously published series involving non-Burn related keloids [3] , [5] . This further emphasizes that Burn related keloids respond differently to conventional treatments that have proven successful in keloid scars from other mechanisms of injury. A consistent and effective treatment algorithm should be implemented in treating keloid scars from Burn wounds.
Renata Fabia - One of the best experts on this subject based on the ideXlab platform.
-
variation in acute fluid resuscitation among Pediatric Burn centers
Burns, 2021Co-Authors: Courtney Pisano, Dylan Stewart, Sheila Giles, Renata Fabia, Krista K. Wheeler, Junxin Shi, Lisa Puett, Susan ZiegfeldAbstract:Abstract Background Accurate resuscitation of Pediatric patients with large thermal injury is critical to achieving optimal outcomes. The goal of this project was to describe the degree of variability in resuscitation guidelines among Pediatric Burn centers and the impact on fluid estimates. Methods Five Pediatric Burn centers in the Pediatric Injury Quality Improvement Collaborative (PIQIC) contributed data from patients with ≥15% total body surface area (TBSA) Burns treated from 2014 to 2018. Each center's resuscitation guidelines and guidelines from the American Burn Association were used to calculate estimated 24-h fluid requirements and compare these values to the actual fluid received. Results Differences in the TBSA Burn at which fluid resuscitation was initiated, coefficients related to the Parkland formula, criteria to initiate dextrose containing fluids, and urine output goals were observed. Three of the five centers’ resuscitation guidelines produced statistically significant lower mean fluid estimates when compared with the actual mean fluid received for all patients across centers (4.53 versus 6.35 ml/kg/% TBSA, p Conclusions This variation in practice patterns led to statistically significant differences in fluid estimates. One center chose to modify its resuscitation guidelines at the conclusion of this study.
-
defining benchmarks in Pediatric Burn care inception of the Pediatric injury quality improvement collaborative piqic
Journal of Burn Care & Research, 2021Co-Authors: Kelli N Patterson, Carisa Parrish, Susan Ziegfeld, Sheila Giles, Renata Fabia, Sarah N Verlee, Daniel Marx, Pablo Aguayo, Dylan F StewartAbstract:Pediatric Burn care is highly variable nationwide. Standardized quality and performance benchmarks are needed for guiding performance improvement within Pediatric Burn centers. A network of Pediatric Burn centers was established to develop and evaluate Pediatric-specific best practices. A multi-disciplinary team including Pediatric surgeons, nurses, advanced practice providers, Pediatric intensivists, rehabilitation staff, and child psychologists from five Pediatric Burn centers established a collaborative to share and compare performance improvement data, evaluate outcomes, and exchange best care practices. In December 2016, the Pediatric Injury Quality Improvement Collaborative (PIQIC) was established. PIQIC members chose quality improvement indicators, drafted and approved a memorandum of understanding (MOU), data use agreement (DUA) and charter, formalized the multidisciplinary membership, and established a steering committee. Since inception, PIQIC has conducted monthly teleconferences and biannual in-person or virtual group meetings. A centralized data repository has been established where data is collated and analyzed for benchmarking in a blinded fashion. PIQIC has shown the feasibility of multi-institutional data collection, implementation of performance improvement metrics, publication of research, and enhancement of aggregate and institution-specific Pediatric Burn care.
-
u s Pediatric Burn patient 30 day readmissions
Journal of Burn Care & Research, 2017Co-Authors: Krista K. Wheeler, Renata Fabia, Jonathan I. Groner, Junxin Shi, Andrew Nordin, Henry Xiang, Rajan K ThakkarAbstract:The objectives of the study were to determine unscheduled 30-day readmission rates for Pediatric Burn patients and to identify readmission reasons. We used the 2013-2014 National Readmission Database to produce 30-day all-cause unscheduled readmission rates by patient and hospital characteristics. Readmission risk factors were evaluated with multivariable logistic regression. An estimated 11,940 U.S. Pediatric Burn patients were discharged in January through November 2013 and 2014, and 325 had unscheduled readmissions within 30 days (2.7%; 95% confidence interval [CI], 1.5-3.9). This rate is higher than that seen in Pediatric trauma patients (1.7%; P = 0.04]. Higher rates were seen in children with TBSA Burned ≥ 10% (4.1%; 95% CI, 2.3-6.0) and patients with third-degree Burns (5.5%; 95% CI, 1.4-9.6). The majority (86%) had index admissions in hospitals treating 100 or more Burn patients annually, and 98% returned to the same hospital. Over two-thirds had an operating room procedure during their readmission; 15% had infections. The highest adjusted odds of readmission (AOR = 2.7; 95% CI, 1.7-4.2) was for patients with third-degree Burns. When compared with patients with lengths of stay (LOS) of 1 day, those with LOS of 2 to 3 days had a higher odds (AOR = 1.7; 95% CI, 1.03-2.9), but the AOR was not different for those with LOS > 3 days. TBSA, index operating room procedure, and patient residence were associated with readmission. This national dataset enhances our ability to predict patients at risk for unscheduled readmission and to plan for appropriate patient discharge, potentially reducing readmissions.
-
inter facility transfer of Pediatric Burn patients from u s emergency departments
Burns, 2016Co-Authors: Sarah A Johnson, Renata Fabia, Jonathan I. Groner, Junxin Shi, Rajan K ThakkarAbstract:Abstract Purpose To describe the epidemiology of Pediatric Burn patients seen in U.S. emergency departments (EDs) and to determine factors associated with inter-facility transfer. Methods We analyzed data from the 2012 Nationwide Emergency Department Sample. Current American Burn Association (ABA) Guidelines were used to identify children Results In 2012, there were an estimated 126,742 (95% CI: 116,104–137,380) Pediatric Burn ED visits in the U.S. Of the 69,003 (54.4%) meeting referral criteria, 83.2% were in low volume hospitals. Only 8.2% of patients meeting criteria were transferred from low volume hospitals. Of the 52,604 (95% CI: 48,433–56,775) not transferred, 98.3% were treated and released and 1.7% were admitted without transfer; 54.7% of Burns involved hands. Conclusions Over 90% of Pediatric Burn ED patients meet ABA Burn referral criteria but are not transferred from low volume hospitals. Perhaps a portion of the 92% of patients currently receiving definitive care in low volume hospitals are under-referred and would have improved clinical outcomes if transferred at the time of presentation.
-
Evaluation of nurse accuracy in rating procedural pain among Pediatric Burn patients using the Face, Legs, Activity, Cry, Consolability (FLACC) Scale
Burns : journal of the International Society for Burn Injuries, 2016Co-Authors: Jiabin Shen, Sheila Giles, Kelli Kurtovic, Renata Fabia, Gail E. Besner, Krista K. Wheeler, Huiyun Xiang, Jonathan I. GronerAbstract:Abstract Background Accurate pain assessment is essential for proper analgesia during medical procedures in Pediatric patients. The Faces, Legs, Activity, Cry, and Consolability (FLACC) scale has previously been shown to be a valid and reliable tool for assessing Pediatric procedural pain in research labs. However, no study has investigated how rater factors (gender, number of dressing changes performed/week, Burn history, having children, nursing experience, stress at home/work) and patient factors (pain intensity) affect the accuracy of FLACC ratings for procedural pain when implemented by bedside care providers. Method Twenty-four nurses in an ABA verified Pediatric Burn Center watched four videos of dressing changes for Pediatric Burn patients in random order three times and rated the children's procedural pain using the FLACC scale. The four videos had standard FLACC scores established by an interdisciplinary panel. Results Descriptive and mixed modeling analysis was conducted to explore nurse rating accuracy and to evaluate the rater and patient factors that influenced the rating accuracy. The highest accuracy was reached when rating high procedural pain (with a FLACC of 6). Nurses underrated both mild and severe procedural pain. Nurses who had less nursing experience demonstrated significantly higher accuracy than those with more experience. Conclusions The present study is the first study in the literature to systematically examine the factors influencing the accuracy of FLACC rating for Pediatric procedural pain among bedside care providers. The findings suggest that nurse clinical experience and patient pain intensity are two significant contributors to rating accuracy.