title: Recovery Curves for Pediatric Burn Survivors: Advances in Patient-Oriented Outcomes.
abstract: 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.
  
  
  
  To describe multidimensional patient-reported outcomes among pediatric burn survivors younger than 5 years to establish benchmarks using recovery curve methods.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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 = .03]; language, 49.2 vs 54.4 [P < .001]; gross motor skills, 48.7 vs 53.0 [P = .002]; pain/itching, 15.8 vs 33.5 [P < .001]; and worry/concern, 31.6 vs 44.9 [P < .001]). Pediatric burn survivors had higher scores in language, emotional behavior, and family functioning domains compared with healthy children in later months.
  
  
  
  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.
authors.affiliation: Department of Health Law, Policy and Management, Center for the Assessment of Pharmaceutical Practices, Boston University School of Public Health, Boston, Massachusetts.
authors.forename: Lewis E
authors.initials: LE
authors.lastname: Kazis
authors.affiliation: Department of Mathematical Sciences, Bentley University, Waltham, Massachusetts3School of Insurance and Economics, University of International Business and Economics, Beijing, China4Department of Surgery, Massachusetts General Hospital, Boston.
authors.forename: Austin F
authors.initials: AF
authors.lastname: Lee
authors.affiliation: Shriners Hospitals for Children, Galveston, Texas.
authors.forename: Mary
authors.initials: M
authors.lastname: Rose
authors.affiliation: Massachusetts Veterans Epidemiology Research and Information Center, Boston.
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Liang
authors.affiliation: Department of Health Law, Policy and Management, Center for the Assessment of Pharmaceutical Practices, Boston University School of Public Health, Boston, Massachusetts.
authors.forename: Nien-Chen
authors.initials: NC
authors.lastname: Li
authors.affiliation: Department of Health Law, Policy and Management, Center for the Assessment of Pharmaceutical Practices, Boston University School of Public Health, Boston, Massachusetts.
authors.forename: Xinhua S
authors.initials: XS
authors.lastname: Ren
authors.affiliation: Shriners Hospitals for Children, Boston, Massachusetts.
authors.forename: Robert
authors.initials: R
authors.lastname: Sheridan
authors.affiliation: Shriners Hospitals for Children, Boston, Massachusetts.
authors.forename: Janet
authors.initials: J
authors.lastname: Gilroy-Lewis
authors.affiliation: Shriners Hospitals for Children, Boston, Massachusetts.
authors.forename: Fred
authors.initials: F
authors.lastname: Stoddard
authors.affiliation: Shriners Hospitals for Children, Boston, Massachusetts.
authors.forename: Michelle
authors.initials: M
authors.lastname: Hinson
authors.affiliation: Shriners Hospitals for Children, Cincinnati, Ohio.
authors.forename: Glenn
authors.initials: G
authors.lastname: Warden
authors.affiliation: Shriners Hospitals for Children, Cincinnati, Ohio.
authors.forename: Kim
authors.initials: K
authors.lastname: Stubbs
authors.affiliation: Shriners Hospitals for Children, Galveston, Texas.
authors.forename: Patricia
authors.initials: P
authors.lastname: Blakeney
authors.affiliation: Shriners Hospitals for Children, Galveston, Texas.
authors.forename: Walter
authors.initials: W
authors.lastname: Meyer
authors.affiliation: Shriners Hospitals for Children, Galveston, Texas.
authors.forename: Robert
authors.initials: R
authors.lastname: McCauley
authors.affiliation: Shriners Hospitals for Children, Galveston, Texas.
authors.forename: David
authors.initials: D
authors.lastname: Herndon
authors.affiliation: Shriners Hospitals for Children, Sacramento, California10Nebraska Medical Center, Omaha.
authors.forename: Tina
authors.initials: T
authors.lastname: Palmieri
authors.affiliation: Shriners Hospitals for Children, Sacramento, California.
authors.forename: Kate
authors.initials: K
authors.lastname: Mooney
authors.affiliation: Department of Pediatrics, College of Medicine-Jacksonville, University of Florida, Jacksonville.
authors.forename: David
authors.initials: D
authors.lastname: Wood
authors.affiliation: Kennedy Krieger Institute, Baltimore, Maryland.
authors.forename: Frank
authors.initials: F
authors.lastname: Pidcock
authors.affiliation: Nebraska Medical Center, Omaha.
authors.forename: Debra
authors.initials: D
authors.lastname: Reilly
authors.affiliation: Children's Hospital of Michigan, Detroit.
authors.forename: Marc
authors.initials: M
authors.lastname: Cullen
authors.affiliation: North Carolina Jaycee Burn Center, Chapel Hill.
authors.forename: Catherine
authors.initials: C
authors.lastname: Calvert
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston7Shriners Hospitals for Children, Boston, Massachusetts15Harvard Medical School, Boston, Massachusetts.
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Ryan
authors.affiliation: Harvard Medical School, Boston, Massachusetts16Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Schneider
authors.affiliation: Department of Health Law, Policy and Management, Center for the Assessment of Pharmaceutical Practices, Boston University School of Public Health, Boston, Massachusetts.
authors.forename: Marina
authors.initials: M
authors.lastname: Soley-Bori
authors.affiliation: Shriners Hospitals for Children, Boston, Massachusetts.
authors.forename: Ronald G
authors.initials: RG
authors.lastname: Tompkins
mesh_terms: D001007:Anxiety / Q000209:etiology; D002053:Burn Units / Q000706:statistics & numerical data; D002056:Burns / Q000473:pathology / Q000534:rehabilitation*; D016022:Case-Control Studies; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007805:Language Development Disorders / Q000209:etiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D019957:Motor Skills Disorders / Q000209:etiology; D000071066:Patient Reported Outcome Measures; D011446:Prospective Studies; D011537:Pruritus / Q000209:etiology; D011594:Psychometrics; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*