Long-term posttraumatic stress symptoms vary inversely with early opiate dosing in children recovering from serious burns: Effects durable at 4 years

Robert L. Sheridan, Frederick J. Stoddard, Lewis E. Kazis, Austin Lee, Nien Chen Li, Richard J. Kagan, Tina L. Palmieri, Walter J. Meyer, Marc Nicolai, Teresa K. Stubbs, Grace Chan, Michelle I. Hinson, David N. Herndon, Ronald G. Tompkins

Research output: Contribution to journalArticlepeer-review

33 Scopus citations


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. CONCLUSION: 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.

Original languageEnglish (US)
Pages (from-to)828-832
Number of pages5
JournalJournal of Trauma and Acute Care Surgery
Issue number3
StatePublished - Mar 2014


  • Burns
  • Outcomes
  • Pain control
  • Pediatric
  • Posttraumatic stress

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine


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