Biological markers of stress in pediatric acute burn injury


Autoria(s): Brown, Nadia J.; Kimble, Roy M.; Rodger, Sylvia; Ware, Robert S.; McWhinney, Brett C.; Ungerer, Jacobus P.J.; Cuttle, Leila
Data(s)

2014

Resumo

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. AIM 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 50.2U/ml higher (p<0.001) at 10min 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 0.54nmol/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). CONCLUSION 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.

Identificador

http://eprints.qut.edu.au/67191/

Publicador

Elsevier

Relação

DOI:10.1016/j.burns.2013.12.001

Brown, Nadia J., Kimble, Roy M., Rodger, Sylvia, Ware, Robert S., McWhinney, Brett C., Ungerer, Jacobus P.J., & Cuttle, Leila (2014) Biological markers of stress in pediatric acute burn injury. Burns, 40(5), pp. 887-895.

Direitos

Copyright 2014 Elsevier

This is the author’s version of a work that was accepted for publication in Burns. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Burns, [VOL 40, ISSUE 5, (2014)] DOI: 10.1016/j.burns.2013.12.001

Fonte

School of Biomedical Sciences; Faculty of Health; Institute of Health and Biomedical Innovation

Palavras-Chave #Burns #Child #Salivary alpha-amylase #Salivary cortisol #Stress
Tipo

Journal Article