Health-related quality of life in children after burn injuries: A systematic review

BACKGROUND: Through improved survival of burns, more children have to deal with consequences of burns. Health-related quality of life (HRQL) measurement is important to qualify the perceived burden of burns in children. No systematic study of this outcome in children exists. Therefore, our objective was to review study designs, instruments, methodological quality, outcomes, and predictors of HRQL in children after burns. METHODS: A systematic literature search was conducted in CINAHL, Embase, Google Scholar, Medline, The Cochrane library, and Web of science (PROSPERO ID, CRD42016048065). Studies examining HRQL in pediatric burn patients were included. The risk of bias was assessed using the Quality in Prognostic Studies (QUIPS) tool. RESULTS: Twenty-seven studies using 12 HRQL instruments were included. The Burns Outcome Questionnaire aged 0 to 4 and 5 to 18 years were most often applied. All longitudinal studies showed improvement of HRQL over time. However, problems were reported on the longer term on the domains "(parental) concern" and "appearance." Parental proxy scores were in general comparable to children's self-ratings. Severity of burns, facial burns, hand burns, comorbidity, and short time since burn predicted an impaired HRQL. The risk of bias of the studies was, in general, moderate. CONCLUSION: Health-related quality of life in children after burns increases over time. Domains and patient groups that require special attention are identified. However, due to lack of comparability of studies, the available information could not be used optimally. To further improve our understanding of HRQL, consensus on design, data-analysis, and data presentation are needed. LEVEL OF EVIDENCE: Systematic review, level III.

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