title: Long-term posttraumatic stress symptoms vary inversely with early opiate dosing in children recovering from serious burns: effects durable at 4 years.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  Prognostic/epidemiologic study, level II.
authors.affiliation: 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.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Sheridan
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Stoddard
authors.forename: Lewis E
authors.initials: LE
authors.lastname: Kazis
authors.forename: Austin
authors.initials: A
authors.lastname: Lee
authors.forename: Nien-Chen
authors.initials: NC
authors.lastname: Li
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Kagan
authors.forename: Tina L
authors.initials: TL
authors.lastname: Palmieri
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Meyer
authors.forename: Marc
authors.initials: M
authors.lastname: Nicolai
authors.forename: Teresa K
authors.initials: TK
authors.lastname: Stubbs
authors.forename: Grace
authors.initials: G
authors.lastname: Chan
authors.forename: Michelle I
authors.initials: MI
authors.lastname: Hinson
authors.forename: David N
authors.initials: DN
authors.lastname: Herndon
authors.forename: Ronald G
authors.initials: RG
authors.lastname: Tompkins
mesh_terms: D000293:Adolescent; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D002056:Burns / Q000150:complications* / Q000523:psychology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D059408:Pain Management; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology*; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid