title: Biological markers of stress in pediatric acute burn injury.
abstract: BACKGROUND
  Burns and their associated wound care procedures evoke significant stress and anxiety, particularly for children. Little is known about the body's physiological stress reactions throughout the stages of re-epithelialization following an acute burn injury. Previously, serum and urinary cortisol have been used to measure stress in burn patients, however these measures are not suitable for a pediatric burn outpatient setting.
  
  
  OBJECTIVE
  To assess the sensitivity of salivary cortisol and sAA in detecting stress during acute burn wound care procedures and to investigate the body's physiological stress reactions throughout burn re-epithelialization.
  
  
  METHODS
  Seventy-seven participants aged four to thirteen years who presented with an acute burn injury to the burn center at the Royal Children's Hospital, Brisbane, Australia, were recruited between August 2011 and August 2012.
  
  
  RESULTS
  Both biomarkers were responsive to the stress of burn wound care procedures. sAA levels were on average 50.2 U/ml higher (p<0.001) at 10 min post-dressing removal compared to baseline levels. Salivary cortisol levels showed a blunted effect with average levels at ten minutes post dressing removal decreasing by 0.54 nmol/L (p<0.001) compared to baseline levels. sAA levels were associated with pain (p=0.021), no medication (p=0.047) and Child Trauma Screening Questionnaire scores at three months post re-epithelialization (p=0.008). Similarly, salivary cortisol was associated with no medication (p<0.001), pain scores (p=0.045) and total body surface area of the burn (p=0.010).
  
  
  CONCLUSIONS
  Factors which support the use of sAA over salivary cortisol to assess stress during morning acute burn wound care procedures include; sensitivity, morning clinic times relative to cortisol's diurnal peaks, and relative cost.
authors.affiliation: Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, and the School of Medicine, The University of Queensland, Royal Children's Hospital, Brisbane, Australia. Electronic address: nadia.brown@uqconnect.edu.au.
authors.forename: Nadia J
authors.initials: NJ
authors.lastname: Brown
authors.affiliation: Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, Department of Paediatrics and Child Health, The University of Queensland, Royal Children's Hospital, Brisbane, Australia.
authors.forename: Roy M
authors.initials: RM
authors.lastname: Kimble
authors.affiliation: The University of Queensland, School of Health & Rehabilitation Sciences, Division of Occupational Therapy, Brisbane, Australia.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Rodger
authors.affiliation: The University of Queensland, School of Population Health and Queensland Children's Medical Research Institute, Brisbane, Australia; Queensland Children's Medical Research Institute, The University of Queensland, Australia.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Ware
authors.affiliation: Department of Chemical Pathology, Pathology Queensland, Royal Brisbane and Women's Hospital, QLD, Australia.
authors.forename: Brett C
authors.initials: BC
authors.lastname: McWhinney
authors.affiliation: Department of Chemical Pathology, Pathology Queensland, Royal Brisbane and Women's Hospital, QLD, Australia.
authors.forename: Jacobus P J
authors.initials: JP
authors.lastname: Ungerer
authors.affiliation: Centre for Children's Burns & Trauma Research, Queensland Children's Medical Research Institute, and University of Queensland, Australia; Tissue Repair and Regeneration Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia.
authors.forename: Leila
authors.initials: L
authors.lastname: Cuttle
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001458:Bandages; D015415:Biomarkers / Q000378:metabolism; D002056:Burns / Q000523:psychology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008297:Male; D010146:Pain / Q000378:metabolism* / Q000523:psychology; D062326:Re-Epithelialization; D012463:Saliva / Q000378:metabolism*; D055291:Salivary alpha-Amylases / Q000378:metabolism*; D012680:Sensitivity and Specificity; D013315:Stress, Psychological / Q000175:diagnosis / Q000378:metabolism* / Q000523:psychology
chemical_list: D015415:Biomarkers; D055291:Salivary alpha-Amylases; D006854:Hydrocortisone
keywords: Burns; Child; Salivary alpha-amylase; Salivary cortisol; Stress