INTRODUCTION:The optimal timing of inguinal hernia repair (IHR) in premature infants remains unclear. Our study aims to compare recurrence rates between IHRs performed before and at/after 55 weeks postmenstrual age (PMA). METHODS:A multicenter retrospective cohort study was conducted of premature infants who underwent IHR at ≤1 year of age between 1/2017-12/2019. The primary outcome was inguinal hernia recurrence, defined as recurrence requiring surgical re-repair. Demographic, clinical, perioperative and postoperative variables were analyzed. Multivariable logistic regression was performed to identify factors associated with recurrence. RESULTS:A total of 2,412 premature infants underwent 3,808 IHRs: 3,292 (86.4%) hernias were repaired early (before 55 weeks PMA), and 516 (13.6%) were repaired late (after 55 weeks PMA). Incarceration rates were similar between the groups (9.4% vs. 8.2%, p=0.422), as were the proportion of repairs performed laparoscopically (30.0% vs. 31.2%, p=0.594). Patients undergoing early repair were more frequently admitted postoperatively (81.2% vs. 27.2%, p<0.001). There were no significant differences in hernia recurrence (1.2% vs. 0.8%, p=0.358) or time to recurrence (3 months [IQR 2.0, 9.0] vs. 9 months [IQR 4.3, 11.5], p=0.218) between early and late repair groups. On multivariable regression, laparoscopic repair (OR 1.910 [95% CI 1.018, 3.581], p=0.044) and concurrent procedure (OR 2.046 [95% CI 1.034, 4.047], p=0.040) were independently associated with a higher risk of recurrence, while late repair was not (OR 0.749 [95% CI 0.259, 2.165], p=0.593). CONCLUSION:Time of repair was not an independent predictor of hernia recurrence. Therefore, recurrence risk alone should not drive the decision for early repair; rather timing should be individualized based on patient physiology, anesthetic considerations, and reliability of follow-up.

Burn injuries affect over half a million people in the United States annually, with 40 000 requiring hospitalization. Burn patients often experience significant psychological distress, with high rates of posttraumatic stress disorder (PTSD) and depression. Undetected or untreated psychiatric symptoms can complicate recovery, prolong hospital stays, and increase risk of long-term problems and readmissions. Although burn centers are well positioned to provide mental health services on both an inpatient and outpatient basis, few US burn centers have robust programs to meet these needs—despite psychological screening and intervention being a requirement for American Burn Association verification. This study describes the development of and early data from the Burn Behavioral Health (BBH) program, a burn center–based, technology-enhanced stepped-care model of delivering mental health services across the inpatient to outpatient continuum. BBH includes four steps: (1) initial screening, education, and early intervention; (2) symptom self-monitoring and self-help resources; (3) 30-day follow-up screening; and (4) provision of best-practice treatment via in-person or telehealth care, including individual and group therapy. Between February 2021 and October 2024, 1203 eligible patients were identified (Mage = 46.08, SDage = 18.04; 67% male; 53% White; 38% Black); 919 (84%) completed the initial screening. Nearly half (44%) screened positive for PTSD/depression risk and 95% of them received early intervention. The program reached 62% of patients for the 30-day follow-up, with 21% screening positive for PTSD/depression and 23% being interested in mental health services. These findings provide preliminary support for the BBH program, demonstrating its sustainability and capacity to engage a high proportion of burn patients across care settings, ultimately improving both access to and the quality of mental health care.

Nonadherence to follow-up after bariatric surgery is associated with lower long-term weight loss. Yet limited data exists on the youngest bariatric population, adolescents and young adults (AYA), who experience life changes in social, psychological, and behavioral domains that can interrupt follow-up. To better understand how age groups affected health outcomes in these populations, this study compared bariatric clinic follow-up adherence between AYA and assessed the impact of follow-up interruption on weight loss. Using an institutional registry, we retrospectively reviewed adolescents (age 14–18) and young adults (YA) (age ≥19–26) who underwent sleeve gastrectomy between January 2018 and May 2023. Primary outcome was follow-up compliance (1, 3, 6, 12, 18, 24 months). Secondary outcomes included median total weight loss percentage (

PURPOSE:This study aimed to investigate effect of surgeon annual case volume on pediatric inguinal hernia recurrence rates. METHODS:Surgeons' individual annual case volumes were calculated from a retrospectively collected data set of pediatric inguinal hernia repairs including 21 hospitals from 2017 to 2019. Quartiles were defined based on surgeons' annual case volumes for each year: Lower Volume = Q1-3 and Higher Volume = Q4. Descriptive statistics and bivariate regression were utilized for analysis. RESULTS:For all repair techniques, there were 207 surgeons accounting for 548 surgeon-years with 8519 operations. For all repairs, Higher Volume was defined as > 22 operations per year. On regression analysis, presence of a ventriculoperitoneal shunt, peritoneal dialysis, laparoscopic technique, and surgery performed by a lower volume surgeon were associated with recurrence risk. For open repairs, there were 193 surgeons, 465 surgeon-years, and 5726 operations. Higher Volume was defined as >18 operations per year. On regression analysis, history of an omphalocele, a connective tissue disorder, and tracheostomy dependence contributed to recurrence risk, while surgeon volume did not. For laparoscopic repairs, there were 136 surgeons, 306 surgeon-years, and 2793 operations. High Volume was defined as >14 operations per year. On regression analysis, presence of a ventriculoperitoneal shunt and surgeon laparoscopic volume was associated with recurrence risk. CONCLUSIONS:Annual surgical volume is an important determinant of recurrence following laparoscopic inguinal hernia repair. As surgeons integrate both laparoscopic and open techniques in their practice, caution should be taken to maintain adequate volume and proficiency in each technique. IRB APPROVAL:This study was IRB reviewed and approved (IRB 22-350). LEVEL OF EVIDENCE:III.

ImportanceInguinal hernia repair in preterm infants is common and is associated with considerable morbidity. Whether the inguinal hernia should be repaired prior to or after discharge from the neonatal intensive care unit is controversial.ObjectiveTo evaluate the safety of early vs late surgical repair for preterm infants with an inguinal hernia.Design, Setting, and ParticipantsA multicenter randomized clinical trial including preterm infants with inguinal hernia diagnosed during initial hospitalization was conducted between September 2013 and April 2021 at 39 US hospitals. Follow-up was completed on January 3, 2023.InterventionsIn the early repair strategy, infants underwent inguinal hernia repair before neonatal intensive care unit discharge. In the late repair strategy, hernia repair was planned after discharge from the neonatal intensive care unit and when the infants were older than 55 weeks’ postmenstrual age.Main Outcomes and MeasuresThe primary outcome was occurrence of any prespecified serious adverse event during the 10-month observation period (determined by a blinded adjudication committee). The secondary outcomes included the total number of days in the hospital during the 10-month observation period.ResultsAmong the 338 randomized infants (172 in the early repair group and 166 in the late repair group), 320 underwent operative repair (86% were male; 2% were Asian, 30% were Black, 16% were Hispanic, 59% were White, and race and ethnicity were unknown in 9% and 4%, respectively; the mean gestational age at birth was 26.6 weeks [SD, 2.8 weeks]; the mean postnatal age at enrollment was 12 weeks [SD, 5 weeks]). Among 308 infants (91%) with complete data (159 in the early repair group and 149 in the late repair group), 44 (28%) in the early repair group vs 27 (18%) in the late repair group had at least 1 serious adverse event (risk difference, −7.9% [95% credible interval, −16.9% to 0%]; 97% bayesian posterior probability of benefit with late repair). The median number of days in the hospital during the 10-month observation period was 19.0 days (IQR, 9.8 to 35.0 days) in the early repair group vs 16.0 days (IQR, 7.0 to 38.0 days) in the late repair group (82% posterior probability of benefit with late repair). In the prespecified subgroup analyses, the probability that late repair reduced the number of infants with at least 1 serious adverse event was higher in infants with a gestational age younger than 28 weeks and in those with bronchopulmonary dysplasia (99% probability of benefit in each subgroup).Conclusions and RelevanceAmong preterm infants with inguinal hernia, the late repair strategy resulted in fewer infants having at least 1 serious adverse event. These findings support delaying inguinal hernia repair until after initial discharge from the neonatal intensive care unit.Trial RegistrationClinicalTrials.gov Identifier: NCT01678638

BackgroundAt present, parents lack objective methods to evaluate their child’s postoperative recovery following discharge from the hospital. As a result, clinicians are dependent upon a parent’s subjective assessment of the child’s health status and the child’s ability to communicate their symptoms. This subjective nature of home monitoring contributes to unnecessary emergency department (ED) use as well as delays in treatment. However, the integration of data remotely collected using a consumer wearable device has the potential to provide clinicians with objective metrics for postoperative patients to facilitate informed longitudinal, remote assessment. ObjectiveThis multi-institutional study aimed to evaluate the impact of adding actual and simulated objective recovery data that were collected remotely using a consumer wearable device to simulated postoperative telephone encounters on clinicians’ management. MethodsIn total, 3 simulated telephone scenarios of patients after an appendectomy were presented to clinicians at 5 children’s hospitals. Each scenario was then supplemented with wearable data concerning or reassuring against a postoperative complication. Clinicians rated their likelihood of ED referral before and after the addition of wearable data to evaluate if it changed their recommendation. Clinicians reported confidence in their decision-making. ResultsIn total, 34 clinicians participated. Compared with the scenario alone, the addition of reassuring wearable data resulted in a decreased likelihood of ED referral for all 3 scenarios (P<.01). When presented with concerning wearable data, there was an increased likelihood of ED referral for 1 of 3 scenarios (P=.72, P=.17, and P<.001). At the institutional level, there was no difference between the 5 institutions in how the wearable data changed the likelihood of ED referral for all 3 scenarios. With the addition of wearable data, 76% (19/25) to 88% (21/24 and 22/25) of clinicians reported increased confidence in their recommendations. ConclusionsThe addition of wearable data to simulated telephone scenarios for postdischarge patients who underwent pediatric surgery impacted clinicians’ remote patient management at 5 pediatric institutions and increased clinician confidence. Wearable devices are capable of providing real-time measures of recovery, which can be used as a postoperative monitoring tool to reduce delays in care and avoidable health care use.

Approximately 120,000 children in the United States are evaluated in the emergency department annually due to burn injuries. Studies have consistently documented that pediatric burns are among the most stressful events for caregivers, resulting in a wide range of emotions, including guilt, anxiety, grief, depression, and posttraumatic stress symptoms, as well as positive psychological changes, a phenomenon known as posttraumatic growth. The present pilot study aimed to explore the prevalence of elevated perceived stress as well as posttraumatic growth among caregivers of pediatric burn patients receiving outpatient burn care and using an mHealth burn platform to administer burn treatment. Our results demonstrated that, on average, caregivers endorsed similar or lower levels of perceived stress over the past 30 days compared to the general population of 30–44-year-old adults and only a third of caregivers reported elevated levels of perceived stress in the past 30 days. However, during the treatment phase, two-thirds of caregivers reported elevated levels of stress. Further, approximately half of the caregiver sample reported moderate to high levels of posttraumatic growth following their child’s burn injury. This pilot study clarifies the level of the perceived stress that caregivers of burn-injured children experience, particularly during the treatment phase when they are responsible for their children’s outpatient burn care (e.g., dressing changes). Additionally, the results shed light on the high prevalence of moderate to high posttraumatic growth in caregivers, with a prevalence rate similar to other trauma survivors.

Abstract Introduction Annually, nearly half a million people in the U.S. receive medical treatment for burns, 40,000 of whom are hospitalized. Burn patients experience significant psychological burden during acute burn treatment. Long-term psychiatric problems are highly prevalent compared to patients with other injuries. Undetected or untreated psychiatric symptoms can complicate recovery, increase length of stay, and cause long-term problems and readmission. Burn centers are ideally suited to provide these services to burn patients on an inpatient and outpatient basis; however, few burn centers in the U.S. have mental health programs to address patients’ needs. This presentation will describe the Burn Behavioral Health (BBH) program, a burn center-based technology-enhanced stepped-care model of delivering mental health services for burn survivors, spanning the inpatient to outpatient continuum. This model was adapted from the Trauma Resilience and Recovery Program which has been successful in meeting the needs of traumatic injury patients. Methods Data were collected as part of clinical care. BBH includes 4 main steps: (1) initial screening, education, and early intervention; (2) symptom self-monitoring and self-help resources; (3) follow-up screening 30 days post-injury; and (4) provision of best-practice mental health treatment for patients who need it, using both in-person and telehealth modalities, including individual and skill-based group therapy. Results Between February 2021 and September 2022, 384 patients were identified as eligible for BBH services. Of these, 342 (90%) were enrolled in BBH and completed initial screening. 50% of patients screened positive for depression/PTSD risk or symptoms and were offered brief intervention. 54% of enrolled survivors received brief intervention, 21% of whom completed more than one session. We reached 84% of patients for the 30-day follow-up, 20% of whom screened positive for depression/PTSD and 29% were connected to mental health services. Conclusions This study provides preliminary support demonstrating that BBH is sustainable and capable of reaching and engaging a large proportion of burn patients across the inpatient to outpatient continuum. In the U.S., only 25% of burn centers have structured screening in place for inpatient and 11% for outpatient burn survivors. Data from the traumatic injury population (which includes burns) suggest only 10% of patients received intervention after a positive screen and 42% did not know how or where to get help. Psychological recovery is an essential component of a comprehensive burn program and availability of psychological screening and intervention is a requirement for the ABA verification. Applicability of Research to Practice BBH shows promise in increasing access and quality of mental health care to address the unique needs of burn survivors.

The umbilical pilonidal sinus (UPS) is an uncommon clinical entity and, as such, is not easily diagnosed unless there is a high index of suspicion. Though pilonidal sinuses are most frequently seen around the gluteal cleft in adolescence, these lesions can occasionally be observed on other areas of the body, including the breast, spaces between the fingers, axilla, and umbilicus. UPS accounts for approximately .6% of all pilonidal disease1 and is one of the rarest subtypes. Known risk factors for UPS are similar to those for gluteal cleft pilonidal cysts and include young age, male, obesity, hirsuteness, and poor skin hygiene. We discuss a case of umbilical pilonidal sinus in a teenage male, which initially presented as an umbilical granuloma. After imaging was inconclusive, operative exploration revealed a hair-containing umbilical pilonidal sinus. An increased awareness of UPS among general pediatric surgeons may expedite clinical diagnosis and treatment and help to avoid low yield imaging tests.

Abstract Introduction In 2020 a large academic hospital with an existing pediatric burn program expanded its services to take adults. Prior to opening the comprehensive center, training and education for the nursing staff was designed and implemented, in amalgamation with the existing pediatric education program. This study describes and evaluates the implementation and efficacy of a novel burn nursing education program, established using the American Burn Association’s (ABA) nursing competencies and Kolb’s Experiential Learning Model. Methods For the purpose of this study Cohort 1 (C1) is defined as 83 nurses hired prior to 2021 and Cohort 2 (C2) is defined as 304 nurses hired after 2022. Didactic and simulated education sessions were created and presented in tandem for both initial and ongoing competency. Didactic sessions were evaluated in two cohorts because the program content was redesigned after 2021. C1 was evaluated using a pre-posttest, whereas, C2 was evaluated using only a post-test. Simulated content was evaluated using the verification in practice method with a check off sheet created using institutional wound care guidelines. Course efficacy was evaluated by attendees using a 1-5 Likert scale. Test scores from 2020-2022 were compared using a T-test with a p-value of < 0.05 considered significant. Results To date 387 nurses have completed a written exam, been validated in practice, and if in C1, completed an annual ongoing burn competency activity. In 2020, C1 showed a statistically significant increase in pre and posttest scores from 66.87%±9.36 to 88.26%±7.90, p=0.000015. When C1 was retested in 2021 using the same posttest, the scores were 80%±1.73 in 2020 to 84.33%±3.84 in 2022, p=0.36. The mean score for posttests for C2 in 2022 was 88%. Course evaluations returned by 155 nurses (77%) in 2020 indicated the course was too long, and some of the information was exorbitant for nursing practice. Therefore, in 2021 the course was redesigned. An additional 251 (65%) nurses have taken the course since, and have reported a mean of 4.5/5 for course efficacy and 4.9/5 for an increase in nursing confidence to care for the burn patient population. Conclusions The education program resulted in significantly higher posttest scores in C1 during the 2020-2021 period showcasing an increase in initial burn knowledge. Although the scores for C1 in 2022 were not statistically significant, the increase in mean scores shows the nurses not only retained the initial information, but built on it throughout the year with the addition of clinical practice. Nurses in C1 continue to practice at high levels and train nurses in C2 who reported the course was critical to their understanding of burn care. Nurses in both C1 and C2 will be required to complete an annual burn competency module to ensure ongoing competency in burn care. Applicability of Research to Practice Nursing Education

Abstract Introduction Previous literature has shown that pediatric burn camps provide numerous benefits to childhood burn survivors. Unfortunately, the COVID-19 pandemic resulted in the inability to host camp for fear of viral transmission to burn survivors and camp personnel alike. A comprehensive burn center, with assistance from the firefighter community, hosted its first burn camp since the onset of the COVID pandemic in August of 2022. A camp staff of 54 volunteers modified the previous camp processes to ensure camp was safe, fun and accessible to 20 pediatric burn survivors. Methods This is an academic short report that reviews the process changes necessary to host a safe pediatric burn camp in the midst of the COVID pandemic. All attendees and staff were required to show a negative PCR test result 48 hours prior to arrival at camp. COVID vaccination was encouraged in all participants, however, staff and patients were not required to be vaccinated. Daily symptom tracking was implemented immediately upon arrival to camp. All participants were assigned a thermometer, and daily temperatures and symptom monitoring was performed by the camp director. Masks were mandated when indoors or within close proximity or group activities. There was a quarantine plan in place in the case a camper or staff member became symptomatic, or tested positive for COVID. Lastly, the number of people per cabin decreased from 12 to 8. Results In the early planning phase of camp, it was discovered that some of the participants and staff were unable to obtain a PCR test prior to camp. Therefore, onsite testing was implemented to allow testing as the participants and camp staff arrived to camp. The onsite testing facility was available for the entirety of camp in the case anyone became symptomatic. Implementation of additional camp processes resulted in a successful and safe camp. There were no reported cases of COVID during or after camp. Conclusions As the Public Health Emergency from COVID-19 continues, group activities, such as summer burn camps, with medically vulnerable populations must be altered to protect all stakeholders. We described the steps taken by one burn-center-run camp that enabled children and firefighter volunteers to participate in the full burn camp experience. Plans for the 2023 burn camp are already in process, and the processes implemented in 2022 will be implemented in all upcoming camps to ensure the children and staff are safe from the transmission of COVID. Applicability of Research to Practice N/A

Introduction: Anterior (Morgagni) congenital diaphragmatic hernia and congenital pericardial agenesis in the absence of other defects has yet to be described in a neonate. Case presentation: The patient was a female infant born at term to a mother with delayed prenatal care. Fetal magnetic resonance imaging at 35 weeks gestation showed a cystic lesion in the left lung base that was thought to be a variant of a congenital pulmonary airway malformation. Patient was treated with continuous positive airway pressure at birth but was stable on room air within an hour of life. Patient was asymptomatic and discharged on day 2 of life. Patient remained asymptomatic through multiple follow-ups with pediatric surgery, and imaging consistently showed a cystic mass in the lower left chest. Surgery was performed to resect the pulmonary cystic lesion 6 months after birth. Upon thoracoscopic visualization of the chest, the heart without pericardium was seen herniated into the left pleural space, and a Morgagni hernia with a cystic sac was visualized. The Morgagni hernia was repaired primarily by pediatric surgery, and pediatric cardiothoracic surgery used a Gore-Tex patch to construct the absent left pericardium. Hospital course was uneventful, and the patient was discharged on postoperative day 6. On follow-up 2 weeks after discharge, the patient was asymptomatic, but new elevation of the left hemidiaphragm was seen. Further follow-up is scheduled. Conclusion: The combination of defects seen in this patient has not been previously described, and further follow-up of the hemidiaphragm elevation will be necessary. Long-term complications are not expected.

Burn injury is one of the most common traumatic injuries in childhood. Fortunately, 90% of pediatric burns may be treated in the outpatient setting after appropriate burn triage. Patients with burns face significant geographic disparities in accessing expert burn care due to regionalized care. To aid patients and their families during acute outpatient burn recovery, we developed a smartphone app, Telemedicine Optimized Burn Intervention (TOBI). With this app, we aimed to increase access to care by allowing secure, streamlined communication between patients and burn providers, including messaging and wound image transfer. The purpose of this study was to systematically evaluate user feedback to optimize the patient and provider experience. TOBI was evaluated using a convergent mixed-methods approach consisting of qualitative semi-structured interviews and quantitative measurements of app usability via the mHealth App Usability Questionnaire. Participants included 15 caregivers of pediatric patients with burns who used TOBI during treatment and ten burn providers. Users found TOBI to be a highly usable application in terms of usefulness, ease of use, satisfaction, and functionality. Qualitative data provided insight into user experience, satisfaction and preferences, difficulty navigating, usability and acceptability, and potential improvements. Although most users were highly satisfied, improvements were needed to optimize the burn app. We systematically made these improvements before we released TOBI for routine patient use. This study uncovered helpful recommendations for app improvements that can be generalized to other mobile health apps to increase their appeal and adoption.

Whalen, Allison1; Zivick, Elizabeth2; Cardona, Monika1; Lesher, Aaron3; Hudspeth, Michelle3 Author Information

Burn-injured patients must frequently travel long distances to regional burn centers, creating a burden on families and impairing clinical outcomes. Recent federal policies in response to the coronavirus pandemic have relaxed major barriers to conducting synchronous videoconference visits in the home. However, the efficacy and benefits of virtual visits relative to in-person visits remained unclear for burn patients. Accordingly, a clinical quality assurance database maintained during the coronavirus pandemic (3/3/2020 to 9/8/2020) for virtual and/or in-person visits at a comprehensive adult and pediatric burn center was queried for demographics, burn severity, visit quality, and distance data. A total of 143 patients were included in this study with 317 total outpatient encounters (61 virtual and 256 in-person). The savings associated with the average virtual visit were 130 ± 125 miles (mean ± standard deviation), 164 ± 134 travel minutes, $104 ± 99 driving costs, and $81 ± 66 foregone wage earnings. Virtual visit technical issues were experienced by 23% of patients and were significantly lower in pediatric (5%) than in adult patients (44%; P = .006). This study is the first to assess the efficacy of synchronous videoconference visits in the home setting for outpatient burn care. The findings demonstrate major financial and temporal benefits for burn patients and their families. Technical issues remain an important barrier, particularly for the adult population. A clear understanding of these and other barriers may inform future studies as healthcare systems and payors move toward improving access to burn care through remote healthcare delivery services.

BACKGROUND:Recent evidence demonstrates that earlier feeding may be beneficial after non-surgical necrotizing enterocolitis (NEC). We aimed to decrease time to reach full enteral feeds by 20% post-NEC by standardizing time to reinitiate feeds.METHODS:We implemented a consensus-based guideline for earlier feeding post-NEC. Outcome measures included days to initiate enteral feeds and reach full enteral feeds. Central venous line days and length of stay were also evaluated. Balancing measures were NEC recurrence and post-NEC stricture. Statistical analysis used process control methodology and standard comparison statistical testing.RESULTS:Average days infants with Stage II NEC began feeding decreased from 9.4 to 5.1 days and average days to reach full feeds was decreased by 35% from 24.0 to 15.7 days. We observed no change in our balancing measures.CONCLUSION:A multidisciplinary consensus-based NEC earlier feeding guideline decreased time to reach full enteral feeds and reduced central line days without adverse events.

Acute limb ischemia is a rare but potentially devastating event in a critically ill patient. In the pediatric population, limb ischemia is usually related to iatrogenic vascular damage and arterial thrombus formation secondary to arterial catheter placement. Children who have undergone femoral artery cannulation for venoarterial extracorporeal membrane oxygenation (VA-ECMO) are particularly at risk for this complication. In these cases, there have been reports of the successful use of a percutaneous limb reperfusion cannula to prevent or treat limb ischemia. We present a case of an 18 month old female who required VA-ECMO via carotid artery cannulation for viral myocarditis and subsequently developed acute lower limb ischemia related to a thrombus from an indwelling femoral arterial catheter in place for hemodynamic monitoring. This case highlights the usage of a distal reperfusion cannula and extracorporeal membrane oxygenation (ECMO) circuit for a novel purpose, which coupled with near infrared spectroscopy (NIRS) monitoring successfully re-established blood flow to the ischemic limb.

Abstract Introduction Pediatric burn injury remains one of the most common traumatic injuries in childhood. Fortunately, up to 90% of pediatric burns may be treated safely in the outpatient setting after appropriate burn triage. Patients face significant geographic disparities in access to expert burn care due to the regionalization of burn care. To aid patients and their families during acute burn recovery, a smartphone app was developed to improve patient outcomes, increase access to care, and streamline communication. The purpose of this study is to evaluate patient-derived feedback to optimize this burn app prior to subsequent efficacy testing. Methods The burn app was evaluated using a mixed-method approach consisting of qualitative semi-structured interviews and quantitative usability data gathered from caregivers of pediatric burn patients who utilized the app during the treatment phase of their child’s burn injury. Usability data were collected using a psychometrically validated mHealth App Usability Questionnaire (MAUQ). To analyze the interview transcriptions, we followed the Braun and Clark (2006) framework of thematic analysis. The research questions focused on caregiver perceptions of smartphone-enhanced pediatric burn care and potential app improvements, including acceptability, usability, technical preferences, and emotional perceptions. Results 14 caregivers (93% women; M age = 36) completed the study. Overall MAUQ scores (M = 6.46; SD = .62) indicated high app usability. Ease of Use & Satisfaction (M = 6.66; SD = .42), System Information Arrangement (M = 5.93; SD = 1.07), and Usefulness (M = 6.69; SD = .61) subscales indicated an average degree of agreement above “somewhat agree” with usability statements. Furthermore, 13/14 (93%) caregivers reported a positive overall experience and agreed that the app was an acceptable method to monitor burn care. 12/14 (86%) caregivers reported that the app captured important clinical information. 53% preferred app-based burn care, 31% preferred both face-to-face and app-based care, and 15% preferred in-person only. Only 1 person preferred synchronous video-based care to asynchronous text-messaging. All study participants suggested improvements, with the most common being: (1) keeping user logged in, (2) time-stamping photos and messages, (3) consolidating text-messages and pictures, (4) adding push notifications and appointment reminders, and (5) tracking pain level. Conclusions Mobile health technology may be leveraged to improve outpatient burn care. The results from this study (1) demonstrate caregiver experiences using a novel mHealth platform for outpatient pediatric burn care which showed high acceptability and usability and (2) provide systematic data for app optimization.