The Impact of Adverse Childhood Experiences on Burn Outcomes in Adult Burn Patients

Abstract

Adverse childhood experiences (ACEs), including child maltreatment and household dysfunction, define adverse events that occur before 18 years of age. National and state data show that between 12.5 and 14.5% of the adult population report ≥4 ACEs (HIGH-ACE), respectively. HIGH-ACEs are associated with more chronic health problems. To date, the interaction between ACEs and burn injuries has not been studied. Herein, we sought to define the ACE exposure in our burn patients and its impact on early outcomes. Inpatient and outpatient adult burn survivors (≥18 years of age) were enrolled. Subjects completed surveys assessing adverse experiences (ACEs-18), needs, strengths, and resiliency at consent, and pain, depression, post-traumatic stress disorder (PTSD), and social participation surveys at 2 weeks to 3 months postinjury. Demographics, burn, and hospital course data were also collected. Chi-square and student’s t-tests were used for descriptive analysis and to compare the groups (HIGH-ACE vs LOW-ACE). The HIGH-ACE group (n = 24; 45.3%) reported more depressive symptoms (P < .04) than the LOW-ACE group (n = 29, 54.7%). HIGH-ACE patients were less resilient when facing stressful events (P ≤ .02) and more likely to screen positive for probable PTSD (P = .01) and to score lower on the Life Impact Burn Recovery Evaluation Profile (LIBRE Profile), which assesses for social participation, in the domain of Family and Friends (P = .015). Our exploratory study suggests that ACE screening may help detect burn patients at risk for a more complicated recovery, thereby promoting personalized assistance in recovery.

Nationwide efforts for trauma-informed care implementation and workforce development in healthcare and related fields: a systematic review

“…Many healthcare organizations view TIC as a priority, and numerous studies have reported on the screening of patients for ACEs over the last decade although progress continues to be slow considering the vast healthcare network. [60][61][62][63][64] Healthcare organizations' commitment to TIC varies substantially and is influenced by different factors at the organizational and individual level. 65,66 Organizations and communities that have most successfully implemented TIC have reviewed and amended TIC procedures and policies, provided training to all staff and aligning staff hires with TIC training, followed recommended guidelines, and adopted refinements in TIC, such as service user involvement and ongoing staff training using system-level approaches.…”

“…Researchers stress the importance of the colocalization of behavioral health and primary care providers, supported with an adequate number of social workers, to better address the needs of patients with a history of childhood trauma; these practices have led to substantial benefits for patients. [61][62][63][65][66][67][93][94][95][96][97][98] One prime example of this integrated behavioral health in primary care practice is the Montefiore Hospital Pediatric primary care clinics, which we will review in more detail in a later section. 95,96 Implementation of TIC has resulted in changes in healthcare practice.…”

“…61 The same model was implemented in the Emergency Department and the burn unit of the same institution, which increased the recognition of families and patients suffering from multiple trauma, dramatically. 62,63…”

“…138,139 The need to be understood by their provider is a repetitive theme in this population. 62,140 Kottenstette et al 61 and Fassel et al 62 reported that their twogenerational screening models for childhood trauma, family resiliency, and healthcare needs was well-received by clients; 98% and 75% of patients reported this model "could help their providers provide better healthcare" to them.…”

The association between adverse childhood experiences and common mental disorders and suicidality: an umbrella review of systematic reviews and meta-analyses

“…Adverse childhood experiences (ACEs) are stressful and potentially traumatic events occurring in childhood or adolescence (0-18 years) that can negatively impact health and well-being. [22,47] ACEs include exposure to childhood maltreatment, parental mental illness, family dysfunction, violence and socio-economic adversity. [22,47] ACEs are common across low-, middle-and high-income countries, with two in every five adults having at least one ACE [48,65] A nationally representative study from the USA found that three in five adults reported at least one ACE, and a quarter of adults had at least three such experiences.…”