Two-year follow-up of outcomes related to scarring and distress in children with severe burns.
We assessed the perception of scarring and distress by pediatric burn survivors with burns covering more than one-third of total body surface area (TBSA) for up to 2 years post-burn.



Children with severe burns were admitted to our hospital between 2004 and 2012, and consented to this IRB-approved-study. Subjects completed at least one Scars Problems and/or Distress questionnaire between discharge and 24 months post burn. Outcomes were modeled with generalized estimating equations or using mixed linear models. Significance was accepted at p < 0.01.



Responses of 167 children with a mean age of 7 ± 5 years and burns covering an average 54 ± 14% of TBSA were analyzed. Significant improvements over the 2-year period were seen in reduction of pain, itching, sleeping disturbance, tightness, range of motion, and strength (p < 0.01). There was a significantly increased persistent desire to hide the scarred body areas over time (p < 0.01). The perception of mouth scarring, inability to portray accurate facial expressions, and skin coloration did not improve over the follow-up period.



According to self-assessment questionnaires, severely burned children exhibit significant improvements in their overall perception of scarring and distress. However, these patients remain self-conscious with respect to their body image even 2 years after burn injury. Implications for Rehabilitation According to self-assessment questionnaires, severely burned children perceive significant improvements in scarring and distress during the first 2 years post burn. Significant improvements were seen in reduction of pain, itching, sleeping disturbances, tightness, range of motion, and strength (p < 0.01). Burn care providers should improve the treatment of burns surrounding the mouth that with result in scarring, and develop strategies to prevent skin discoloration. Careful evaluation of pain and sleeping disorders during the first year post burn are warranted to improve the patient rehabilitation. Overall, significantly more female patients expressed a persistent desire to hide their scarred body areas. The rehabilitation team should provide access to wigs or other aids to pediatric burn survivors to address these needs.
a Department of Surgery , University of Texas Medical Branch Galveston , Galveston , TX , USA.|b Shriners Hospitals for Children , Galveston , TX , USA.|c Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery , Medical University of Graz , Graz , Austria.
Paul
P
Wurzer
d School of Medicine , University of Texas Medical Branch Galveston , Galveston , TX , USA.
Abigail A
AA
Forbes
b Shriners Hospitals for Children , Galveston , TX , USA.
Gabriel
G
Hundeshagen
a Department of Surgery , University of Texas Medical Branch Galveston , Galveston , TX , USA.|b Shriners Hospitals for Children , Galveston , TX , USA.
Clark R
CR
Andersen
a Department of Surgery , University of Texas Medical Branch Galveston , Galveston , TX , USA.|b Shriners Hospitals for Children , Galveston , TX , USA.
Kathryn M
KM
Epperson
a Department of Surgery , University of Texas Medical Branch Galveston , Galveston , TX , USA.|b Shriners Hospitals for Children , Galveston , TX , USA.
Walter J
WJ
Meyer
c Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery , Medical University of Graz , Graz , Austria.
Lars P
LP
Kamolz
a Department of Surgery , University of Texas Medical Branch Galveston , Galveston , TX , USA.|b Shriners Hospitals for Children , Galveston , TX , USA.|c Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery , Medical University of Graz , Graz , Austria.
Ludwik K
LK
Branski
a Department of Surgery , University of Texas Medical Branch Galveston , Galveston , TX , USA.|b Shriners Hospitals for Children , Galveston , TX , USA.
Oscar E
OE
Suman
a Department of Surgery , University of Texas Medical Branch Galveston , Galveston , TX , USA.|b Shriners Hospitals for Children , Galveston , TX , USA.
David N
DN
Herndon
a Department of Surgery , University of Texas Medical Branch Galveston , Galveston , TX , USA.|b Shriners Hospitals for Children , Galveston , TX , USA.|e Institute of Translational Sciences, University of Texas Medical Branch and Shriners Hospitals for Children , Galveston , TX , USA.
Celeste C
CC
Finnerty
D000293:Adolescent; D001828:Body Image / Q000523:psychology; D002056:Burns / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D010146:Pain; D011537:Pruritus; D016059:Range of Motion, Articular; D012649:Self Concept; D012647:Self-Assessment; D013315:Stress, Psychological / Q000534:rehabilitation*; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D013781:Texas; D055815:Young Adult
Itch; burns; children; pain; self-perception
J Burn Care Res. 2013 Jan-Feb;34(1):94-101
23079565
J Burn Care Res. 2013 Nov-Dec;34(6):e318-25
23702860
Psychosom Med. 2007 May;69(4):377-82
17510292
Exerc Sport Sci Rev. 2015 Jan;43(1):34-40
25390300
Arch Phys Med Rehabil. 2007 Dec;88(12 Suppl 2):S36-42
18036980
QJM. 2003 Jan;96(1):7-26
12509645
J Burn Care Rehabil. 1991 Jul-Aug;12(4):330-3
1682327
J Burn Care Res. 2015 Mar-Apr;36(2):266-71
24722664
Psychiatr Clin North Am. 2015 Mar;38(1):105-20
25725572
J Burn Care Rehabil. 1994 Nov-Dec;15(6):486-92
7852451
Lancet. 2014 Mar 29;383(9923):1168-78
24034453
J Craniofac Surg. 2008 Jul;19(4):951-9
18650717
Burns. 2015 Aug;41(5):1107-13
25591949
Burns. 2011 Sep;37(6):930-8
21724334
Burns. 2015 Dec;41(8):1839-46
26480870
Rehabil Psychol. 2009 May;54(2):211-6
19469612
J Am Coll Surg. 2006 Mar;202(3):536-48
16500259
Ann Burns Fire Disasters. 2010 Sep 30;23(3):137-43
21991213
Burns. 2015 Sep;41(6):1186-92
26088146