Child Health Research Centre - University of Queensland

The Children’s Burns and Trauma Research Group was established in 1999 by burns surgeon, Professor Roy Kimble and is now part of the UQ Child Health Research Centre. Our goal is to prevent children from sustaining traumatic injuries such as burns and to provide the best evidence-base for their treatment.

Our research aims to:

identify ways to decrease the number of children with burns and traumatic injuries, and to implement these changes;
provide scientific evidence for existing treatments and develop novel wound healing treatments for better care of children suffering from burns; and
improve the lives of all children suffering from burns or trauma.

Staff and postdoctoral researchers

Professor Roy Kimble

Leader, Children's Burns and Trauma Research Group & ATH - Professor

Child Health Research Centre
ATH - Professor

Children's Health Queensland Clinical Unit
Dr Belinda Wallis

Honorary Research Fellow

Child Health Research Centre
Dr Alexandra De Young

Service Evaluation Research Coordinator

Queensland Centre for Perinatal and Infant Mental Health
Dr Zephanie Tyack

Honorary Associate Professor

Child Health Research Centre
Dr Bronwyn Griffin
Dr Emma Hartshorn

Industry Fellow

Child Health Research Centre

RCT studying three donor site dressings in children (three arms, Sorbact, Cuticerin & Algisite)

Investigator: Dr Craig McBride, PhD Student

Split-thickness skin grafting (SSG) is integral to the management of deep burn injury. SSG involves taking a thin layer of skin from an area of non-injured skin creating a secondary wound (donor site). Patients often report greater discomfort from donor sites than the primary burn injury. There are a number of favourable donor site dressing qualities, as reported by patients and health professionals with pain (including ease of dressing removal), healing time, scar and itch being the most commonly reported.

There is currently no gold standard donor site dressing. Alginates are used extensively as dressings for donor sites. Whilst good in the initial phases, as the wound heals the dressing tends to dry out, adhering to the wound bed, making removal difficult and painful. The optimal donor site dressing should maintain a moist environment and promote rapid healing without adhering to the wound bed.

To compare the effect of Cuticerin (acetate gauze currently used as donor site dressing at RCH, Brisbane), Sorbact (antimicrobial gauze) and Kaltostat (alginate).

CT studying the effect of negative pressure wound therapy (NPWT) in the management of acute paediatric partial thickness burns (two arms, standard dressings with NPWT & standard dressings only)

Investigators: Kristen Storey (Burns Clinical Nurse Consultant) and Dr Bronwyn Griffin

At the Consensus Meeting in Hamburg in 2010 the recommendation of the international Expert Panel that NPWT be applied in the early post-burn phase to halt or limit progression of tissue injury was rejected as only 66% of participants agreed during the consultative phase, as it was felt that the current evidence was not sufficiently robust to make a firm recommendation.

This trial is testing the hypothesis that NPWT by reducing inflammation & oedema will cause a decrease in pain, reduction in time to re-epithelialisation & reduction in scar management requirements.

RCT studying the effect of a hydrogel as an adjunct to cold running water first aid in acute paediatric burns (two arm trial, Burnaid & standard practice)

Investigator: Demi Bertoni, MPhil Student

Ambulance services are using the product frequently with anecdotes to suggest it provides additional analgesia post cold running water (CRW). The product provides additional benefits with its application and ease of transportation to hospital 5. BurnaidTM hydro-gel dressings are sterile open foamed polyester urethane foam that is impregnated with 90% purified water. Following the recognised standard of first aid treatment for acute burns injury CRW for twenty minutes – BurnaidTM is recognised as secondary first aid treatment for acute burns injury; known for its cooling, anti-inflammatory and anaesthetic properties.

RCT on the use of medical hypnosis for paediatric burns dressings (Two arms, medical hypnosis and standard practice)

Investigator: Stephen Chester, PhD Student

Results showed significant decreases in pain and anxiety levels in hypnosis arm children. Children over the age of three respond to medical hypnosis . Hypnosis has been shown to alleviate acute pain associated with a number of painful pediatric medical procedures. Additionally, use of hypnosis has demonstrated a reduction in pain and anxiety associated with venipuncture, bone marrow aspiration, and lumbar puncture in children aged 3 to 8 years. Results have showed significant decreases in pain and anxiety levels in hypnosis arm children. Several members of burn centre due to undergo medical hypnosis training & certification for clinical use.

State-wide RCT on an app based intervention for reducing hot drink scalds (two arms, specific hot beverage scald prevention messages & general injury prevention messages)

RCT studying the use of silicone and pressure garments in children at high risk of burn scars (three arms, silicone gel, pressure garments & both silicone gel and pressure garments)

Validating the relationship between burn temperature, duration of contact and tissue injury depth (laboratory based research with burn models)

Investigator: Christine Andrews, PhD student

Globally, scalds are the most commonly treated paediatric burn injury. However the heat dose (temperature + duration) required to cause a severe deep partial thickness scald injury is unknown. Using modelling, the tissue damage from a burn injury is assessed for scald injury conditions including; immersion and spill/splash scalds. This research will provide valid up to date scientific evidence to inform medicolegal opinions and to guide future scald burn prevention strategies and legislation.

Two RCTs on an early intervention programme for preventing traumatic stress reactions in high risk young injured children (two arms, PTSD intervention program & standard care control)

The psychosocial impact and support needs of Australian young people living with an altered appearance: YP Face IT, an online intervention to promote psychosocial adjustment

Investigator: Caroline Gee, PhD Student

Utilising a mixed-methods design, this study is an Australian first. Semi-structured qualitative interviews will explore the psychosocial impact and support needs of Australian young people who have an altered appearance and the perspectives of health professionals who care for them. The interviews also aim to identify gaps and barriers in service provision and explore attitudes about online interventions. Through an international collaboration with the University of West of England, Bristol, a new online psychosocial intervention called Young People’s Face IT (YP Face IT) will undergo its first empirical testing outside of Europe. Developed by the Centre for Appearance Research (UK), YP Face IT (https://www.ypfaceit.co.uk/index.aspx) is a seven week online intervention, combining cognitive behavioural therapy and social skills training. Designed specifically for 12 to 17 year olds, YP Face IT provides support to young people who worry or are distressed because they have an unusual appearance. The interactive program teaches young people new skills and provide tips to feel more confident about looking “different”, manage difficult social situations, improve self-esteem and reduce appearance anxiety. An acceptability study will determine how culturally suitable YP Face IT is for Australian young people which will inform further feasibility and efficacy testing of YP Face IT in Australia. Findings from this research aim to inform future psychosocial care practices, assist in the development of appearance-related psychosocial resources and support early intervention.

Learn more about this project.

Validating the Brisbane Burn Scar Impact Profile

Investigator: Dr Zephanie Tyack

The Brisbane Burn Scar Impact Profile was developed in 2013 to assess health-related quality of life in people with burn scars. Four separate versions were developed: one for adults, one for children aged 8 to 18 years, one for caregivers of children aged less than 8 years, and one for caregivers of children aged 8 years or older. Preliminary testing has supported the content validity of the Brisbane Burn Scar Impact Profile. However, psychometric testing is ongoing.

Learn more about the Brisbane Burn Scar Impact Profile.

Observations from the paediatric outpatients unit: Parent emotions, behaviour and child distress

Investigator: Erin Brown, PhD Student

Young children are the highest risk age group for incurring burn injuries. A burn injury and the following medical procedures are painful and potentially traumatic, for child and parent alike. Child and parent psychological functioning post-injury is related (De Young et al. 2014), which suggests family dynamics during dressing changes may influence recovery.This research aimed to evaluate the role of parent emotions (i.e. anxiety, depression, posttraumatic stress, guilt) on parenting coping-promoting (e.g. engaging the child in play) and distress-promoting (e.g. restraining the child) behaviours during a dressing change, and the subsequent impact on child distress, pain, and anxiety.

The burden of burns, access to care and functional outcomes in Aboriginal and Torres Strait Islander children in Australia

Although Aboriginal and Torres Strait Islander children in Australia have higher risk of burns compared with non-Aboriginal children, their access to burn care, particularly post-discharge care, is poorly understood, including the impact of care on functional outcomes. The objective of this study is to describe the burden of burns, access to care and functional outcomes in Aboriginal and Torres Strait Islander children in Australia, and develop appropriate models of care.

RCT of three silver based burns dressings on children with partial thickness burns (three arms, Acticoat, Acticoat with Mepitel interphase & Mepilex Ag)

Investigator: Dr Emma Gee Kee

Despite the large number of burns dressings available on the market, very few high level trials have been conducted in children or adults. It is paramount that these trials be performed to facilitate evidence based practice. To determine the effect of various silver and silicone containing burns dressings for the treatment of partial thickness burns in children.

Result changed the previous acute paediatric burns dressing protocol to a new decision making algorithm. This has resulted in a state wide change in practice, and had been adopted by other major burn services worldwide.

The optimal first aid for burns: First-aid with cold running water is important in decreasing the depth of a burn

Investigators: Dr Leila Cuttle and Ms Margit Kempf

Dr Leila Cuttle, Professor Kimble and Ms Margit Kempf have undertaken a series of studies, conducted in parallel with studies performed by Dr John Harvey’s team in Westmead, Sydney to produce evidence for optimal first-aid in burns. This research has been internationally recognised and has had an impact globally. Outcome: The research and first-aid recommendations have been adopted by the Australia & New Zealand Burns Association, British Burn Association, American Burn association, Australian Resuscitation Council, St John Ambulance and State Ambulance Services.

Burns & Trauma Prevention Projects

Our team is also focused on burns and trauma prevention, with a particular focus on drowning, low speed vehicle run over, cycling, ATV and motorbike injury, equestrian and wheeled recreational devices to name a few. Professor Kimble, Dr Belinda Wallis, Dr Bronwyn Griffin and the team have previously shown that the incidence of paediatric trauma can be decreased by surveillance, collaboration & targeted campaigns. Data is the most powerful tool for legislative change, and since the group’s first prevention paper in 2001 they have published a further 25, each of which has been followed by a targeted prevention campaign.

Working with organisations such as Kidsafe, Queensland Injury Prevention Council and The Queensland Trauma Network (which Prof Kimble holds a position on the Boards), the team will continue to be strong advocates for paediatric burn and trauma prevention.

Outcome: Improved community awareness of cause of burn & other injuries. Decrease in incidence of injuries.

Telemedicine for Paediatric Burns

Investigators: Professor Kimble, Professor Richard Woorton and Associate Professor Anthony Smith

An evidence-based telemedicine service was established for the post-acute care of burns patients. This service is now one of the largest in the world, & recognised internationally as an important model of care. The service has treated over 2000 children & saved patient travel the equivalent distance of travelling from the earth to the moon six times over. This work has been published in a series of seven papers & a book chapter. Outcome: The success of this service has recently facilitated the creation of similar telemedicine clinics for general paediatric surgery & for children with vascular anomalies.

Development and Studying the use of an Electronic Interactive Hand Held Device to Deliver Procedural Preparation and Distraction Therapy to Children undergoing Medical Procedures

Investigators: Professor Kimble, and his team in collaboration with Queensland University of Technology and latterly Diversionary Technologies Ltd

This study enabled the development of a hand held deviceto provide discipline and age specific pre-procedural preparation and distraction for children undergoing painful or distressing procedures. The “Ditto” device has completed nine randomised controlled trials (RCT) including one international multicentre RCT. These have shown that “Ditto” consistently reduces pain and anxiety compared to a standard distraction control (including commercial hand held electronic games) in hospital areas such as Burns, Orthopaedics, Emergency Medicine and Operating Theatre. In 2011 this device went onto the market to benefit children worldwide. The research has gained international recognition and has won numerous awards. Outcome: Three roll-outs of Ditto devices have occurred in Queensland Health, and are now in many children’s hospitals world-wide.

Evaluation & development of new tools in paediatric burns

We have studied & validated the modalities of 3D digital photography, laser Doppler, Ultrasound & Visitrak (a tool to measure burn surface area) in children. These tools have been incorporated into everyday burn assessment improving accuracy and allowing treatment decisions to be made earlier. The use of these tools in trials has allowed for accurate patient comparisons and reliable quantitative data.
The Study of Microskin Camouflage for Mature Scarring: Microskin is a computer colour matched spray-on skin camouflage which is durable, lasting for up to five days after application. The team in collaboration with Professor Graham Martin from UQ Dept of Psychiatry have studied this locally developed product to determine whether it offers lasting psychosocial benefit to paediatric burns patients. Two RCTs have been completed, the second involving all major paediatric burn centres in Australia and New Zealand. This was the first multicentre burns RCT ever to be performed in Australasia. This award winning research indicates that Microskin improves psychosocial functioning in paediatric burn patients and is well-tolerated and acceptable. Further trials are planned studying the effects in the adult burns population, children and adults with vascular malformations, and as an agent which can be used for scar management in immature scars.
The pathogenesis of hypertrophic scarring: Appropriate models are vital to the development of new burns treatments. For several years Professor Kimble and his team have been studying the pathogenesis of hypertrophic scarring, and have successfully created a burns model which heals with true hypertrophic scaring. This internationally acclaimed model has featured in 24 of his papers to date in various studies to develop novel burns treatments and has been adopted by key groups around the world.

Children's Burns and Trauma Research Group