Biological markers of stress in pediatric acute burn injury

Brown, Nadia J., Kimble, Roy M., Rodger, Sylvia, Ware, Robert S., McWhinney, Brett C., Ungerer, Jacobus P. J. and Cuttle, Leila (2014) Biological markers of stress in pediatric acute burn injury. Burns, 40 5: 887-895. doi:10.1016/j.burns.2013.12.001

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Author Brown, Nadia J.
Kimble, Roy M.
Rodger, Sylvia
Ware, Robert S.
McWhinney, Brett C.
Ungerer, Jacobus P. J.
Cuttle, Leila
Title Biological markers of stress in pediatric acute burn injury
Journal name Burns   Check publisher's open access policy
ISSN 0305-4179
Publication date 2014-01-14
Sub-type Article (original research)
DOI 10.1016/j.burns.2013.12.001
Volume 40
Issue 5
Start page 887
End page 895
Total pages 9
Place of publication Kidlington, Oxford, United Kingdom
Publisher Pergamon
Language eng
Formatted abstract
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 50.2 U/ml higher (p < 0.001) at 10 min 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 0.54 nmol/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.
Keyword Stress
Salivary cortisol
Salivary alpha-amylase
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Available online 14 January 2014

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Created: Thu, 27 Mar 2014, 01:03:28 EST by Nyree Divitini on behalf of School of Medicine