Annual Report 2023-2024

Study finds patient variables that impact the standard for opioid dosing Shriners Children’s patients face some of the most complex conditions and injuries, many which result in significant pain for our young patients. From acute injuries to surgical interventions, appropriate and effective pain management is of primary concern.

Since 2016, Dr. Ryan has been the principal investigator on multiple funded studies focused on long-term outcomes, with the hope that the rehabilitation and recovery process for child burn survivors can be made easier

for patients and their families. Dr. Ryan is now in the first year of a three-year grant for two studies. Preschool Life Impact Burn Recovery Evaluation Profile (LIBRE) focuses on how children, ages 1-5, deal with the consequences of burns and the impact on their development. The instrument explores their behavior, sleep, interpersonal interactions, and their physical, emotional, and psychosocial health. The hope is that this data will help clinicians optimize treatments, assist parents and clinicians in identifying areas that need attention and measure whether interventions are having an appropriate effect. Measuring Health Outcomes for Teenagers With Burns looks at the challenges associated with some of the current measures used to capture data, including an outcomes questionnaire and self-reported health information. The aim is to develop a conceptual framework, test these items on a large group of teens with burns, and, using modern scientific techniques, create a new burn-specific measure. The Teen-Aged LIBRE Profile will measure the often blunt physical and psychosocial impact of such an injury during this fragile and emotionally stressful period in a person’s life where the teen is developing their sense of self. “The thought is that if we can measure it, we can improve it,” Dr. Ryan said. With the ability to track and monitor recovery, clinicians can determine how, when and which therapies would be most effective. Dr. Ryan is the recipient of the 2024 Harvey Stuart Allen Distinguished Service Award from the American Burn Association. This distinction is awarded to an outstanding North American scientist for their contribution in the burn field.

Tina Palmieri, M.D., chief of burns at Shriners Children’s Northern California, teamed up with Kristin Grimsrud, Ph.D., Shriners Children’s scientific staff and University of California Davis medical school faculty member with expertise in pharmacology

and toxicology. Together they explored the use of opioids (fentanyl) for pain management and measured effectiveness based on several variables. Their three-year study centered on the premise that opioids provide relief for severe pain but that there can be barriers to their effective use. These include the development of tolerance that necessitates escalating doses, the risk of addiction with chronic use, and the accumulation of toxic levels due to the variability of a person’s metabolism. This variability in the drug metabolism can be particularly prevalent in special populations, such as children and those with organ impairment or severe burns, making “one size fits all” dosing inappropriate. Their study sought to measure these variations to enable more precise therapeutic dosing, leading to decreased pain and improved outcomes. Although Drs. Palmieri and Grimsrud concluded their study in December 2023, analysis of the complex genomic and pharmacokinetic data continues. They identified significant variability in fentanyl blood levels among patients following clinical administration of fentanyl. They also identified genetic variants that are thought to have an impact on drug function. These results help explain why each patient reacts differently

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