Predictors of health status and health-related quality of life 12 months after severe burn

Introduction

Sustaining a moderate to severe burn injury is associated with the potential for substantial impairments to long-term physical and psychosocial health, including health related quality of life (HRQoL). The objective of this study was to identify clinical and patient characteristics which predict HRQoL 12-months after injury.

Methods

A total of 125 patients were recruited over the study period, although only 99 were included in the final analysis representing all those who completed both the pre-burn and 12-months after burn injury Short Form 36 Medical Outcomes Survey (SF-36v2). These patients also completed the Burn Specific Health Scale-Brief (BSHS-B). Patient demographics and burn injury characteristics and treatment factors were collected to identify which factors predict 12-month health status outcomes. Multiple linear regression analyses were conducted to identify important predictors of outcomes. The SF36v2 models were adjusted for pre-injury measurements.

Results

Older age (regression coefficient −0.26, 95% confidence interval (95% CI) −0.38, −0.13), female gender (−8.08, 95% CI −12.8, −3.34) and increased percentage of full-thickness burns per body surface area (−0.51; 95% CI −0.88, −0.13) were important predictors of poorer physical health status at 12 months. Older age (−0.15, 95% CI −0.26, −0.04) and increased percentage of full-thickness burns per body surface area (−0.36, 95% CI −0.69, −0.03) were important predictors of poorer mental health status at 12 months. Older age (−0.38; 95%CI −0.66, −0.11) and female gender (−12.17; 95% CI −22.76, −1.57) were important predictors of poorer BSHS-B total score at 12 months after injury.

Conclusions

Given the complexity of burn care rehabilitation, physical and psychosocial screening and assessment within the first weeks after a burn injury along with adequate monitoring after discharge should be undertaken in burn injured patients. In this context, patients of specific demographics, such as female patients and older patients, and patients with a higher percentage of full thickness surface area burns are of greater risk for poorer physical and psychological outcomes and may benefit from additional monitoring and rehabilitation.     

Predictors of functional recovery for hip fractured elders during 12 months following hospital discharge: a prospective study on a Taiwanese sample

To examine the longitudinal changes in overall and individual physical activities of daily living (PADLs) and instrumental activities of daily living (IADLs), at 1, 3, 6, and 12 months after hospital discharge in elderly subjects, 110 hip fractured elders (mean±SD age, 79.4±7.5; 60.9% females) were enrolled in a prospective study. At 12 months following hospital discharge, 56.1% subjects had recovered their overall PADLs, 37.9% had recovered their overall IADLs, and 74.2% could walk independently or with the aide of a cane. When analyzed by generalized estimating equations (GEE), for individual PADL, bathing and climbing stairs had consistently improved at every time point throughout the 1-year follow-up period, while transferring, toileting, and walking ability only improved significantly in the first 3 months after discharge. For individual IADL, the proportion of recovery for mobility appeared to increase significantly during the first 6 months post-discharge, and the remaining IADLs appeared to be stable. These results indicated that the recovery rate is varied for performance of different activities according to the complexity and the involvement of the lower extremities. We also found that less concomitant diseases, and a shorter hospital stay could predict a better recovery trend of overall and of most individual PADLs. These findings may be applicable to other countries with Chinese populations, and could provide a reference for health care providers to develop specific interventions for Chinese hip fractured elders.     

Health outcomes of adults 3 months after injury

BACKGROUND: Injury is a leading cause of preventable mortality and morbidity in Australia and the world. Despite this there is little research examining the health related quality of life of adults following general trauma. METHODS: A prospective cohort design was used to study adults who presented to hospital following injury. Data regarding injury and demographic details was collected through the routine operation of the Queensland Trauma Registry (QTR). In addition, the short form 36 (SF-36) was mailed to patients approximately 3 months following injury. RESULTS: Participants included 339 injured patients who were hospitalised for >or=24h in March-June 2003. A secondary group of 145 patients completed the SF-36, but did not have QTR data collected due to hospitalisation being <24h. Both groups of participants reported significantly lower scores on all subscales of the SF-36 when compared to Australian norms. CONCLUSIONS: Health related quality of life of injured survivors is markedly reduced 3 months after injury. Ongoing treatment and support is necessary to improve these health outcomes.     

Female patients display poorer burn-specific quality of life 12 months after a burn injury

IntroductionAlthough gender differences in morbidity and mortality have been measured in patients with moderate to severe burn injury, little attention has been directed at gender effects on health-related quality of life (HRQoL) following burn injury. The current study was therefore conducted to prospectively measure changes in HRQoL for males and females in a sample of burn patients.MethodsA total of 114 adults who received treatment at a statewide burns service for a sustained burns injury participated in this study. Instruments measuring generic health status (Short Form 36 Medical Outcomes Survey version 2), burn-specific HRQoL (Burns Specific Health Scale-Brief), psychological distress (Kessler Psychological Distress Scale) and alcohol use (Alcohol Use Disorders Identification Tool) were prospectively measured at 3, 6 and 12 months post-burn.ResultsIn the 12 months post-injury, female patients showed overall poorer physical (p = 0.01) and mental health status (p < 0.001), greater psychological distress (p < 0.001), and greater difficulty with aspects of burn-specific HRQoL: body image (p < 0.001), affect (p < 0.001), interpersonal functioning (p = 0.005), heat sensitivity (p = 0.01) and treatment regime (p = 0.01). While significant interaction effects suggested that female patients had more improvement in difficulties with treatment regime (p = 0.007), female patients continued to report greater difficulty with multiple aspects of physical and psychosocial health status 12 months post-injury.ConclusionEven though demographic variables, injury characteristics and burn care interventions were similar across genders, following burn injury female patients reported greater impairments in generic and burn-specific HRQoL along with psychological morbidity, when compared to male patients. Urgent clinical and research attention utilising an evidence-based research framework, which incorporates the use of larger sample sizes, the use of validated instruments to measure appropriate outcomes, and a commitment to monitoring long-term care, can only improve burn-care.     

Coping strategies, injury characteristics and long-term outcome after burn injury

Coping consists of cognitive and behavioural strategies aimed at enhancing adaptation, and the use of certain coping strategies is proposed to be beneficial for health. The relationship between coping strategies and burn injury characteristics, sociodemographics and long-term outcome was evaluated in 161 previous victims of severe burn injury. Functional and psychosocial restrictions were measured with the burn specific health scale-brief (BSHS-B) and related to coping strategies measured by the coping with burns questionnaire (CBQ). Patients were on average 47.7 years at measurement of health status and they were assessed 9.2 (S.D. = 4.8) years after injury. The mean area burned was 24.0 and 7.2% was full thickness injury. There was no relation between coping strategies and injury characteristics except in individuals with a full thickness burn exceeding 10%, who exhibited more Revaluation/adjustment. An Avoidant coping strategy was related to work status, marital status and living conditions, and this was the strategy most clearly related to "Bad outcome" in all scales of the BSHS-B. Emotional support was the most beneficial strategy and was mainly associated with the psychosocial scales of the BSHS-B.     

Patterns of burn injury in the preambulatory infant

Introduction

This study was undertaken after an increasing trend in young babies presenting with severe burns was observed in Princess Margaret Hospital (PMH) in Perth, Western Australia. The aim was to explore the patterns of these injuries with a view to identifying whether they could be prevented with better parent education.

Method

Inclusion criteria was infants under 6 months of age who sustained a burns injury requiring admission or out-patient treatment in the Burns Unit of PMH between July 2005 and September 2007.

Results

Immobile infants are at significant risk of burns. In infants who are not yet mobile, environmental factors are commonly implicated, with the vast majority of burns sustained in the home. The mechanisms of injuries were scalds (43%), contact burns (39%), sunburn (11%) and TPN burns in premature infants in NICU (7%). TBSA ranged from <0.5% to 30%.

Conclusion

Infants less than 6-month-old are at significant risk of burn; at this age the injury is usually caused by hazards in the home environment. These infants are vulnerable to inadequate first aid and require a large amount of follow-up care. Better parental education may help reduce the number of injuries we see in this age group.     

Insulin resistance, secretion and breakdown are increased 9 months following severe burn injury

Insulin resistance in the acute burn period has been well described, however, it is unknown if alterations in glucose metabolism persist beyond discharge from the acute injury. To measure the duration of insulin resistance following recovery from the acute burn injury, we performed a prospective cross-sectional study with a standard 2-h oral glucose tolerance test in 46 severely burned children at 6, 9 or 12 months following initial injury. Glucose uptake and insulin secretion were assessed following the glucose load. Results were compared to those previously published in healthy children. At 6 months after burn, the 2-h glucose concentration was significantly (P<0.001) greater than controls, and the area under the curve (AUC) of glucose was significantly higher compared to 12 months and to healthy children (P=0.027 and P<0.001, respectively). The 9-month AUC glucose was higher than controls (P<0.01). The 6-month 2-h insulin was significantly higher than controls, as was the AUC of insulin in all time points post-burn. The AUC of C-peptide was significantly greater at 6 months after injury compared to 9 and 12 months (P<0.01 for both). Increased 2h and AUC glucose and insulin indicate that glucose metabolism is still affected at 6 and 9 months after injury, and coincides with previously documented defects in bone and muscle metabolism at these time points. Insulin breakdown is also still increased in this population. Further study of this population is warranted to determine if specific treatment is needed.     

Exercise training to improve health related quality of life in long term survivors of major burn injury: A matched controlled study

Objective

Patients often experience reduced health-related quality of life (HRQOL) following burn injury. Exercise training has been demonstrated to improve HRQOL in a number of clinical populations, yet it is unknown whether exercise can improve HRQOL in burns patients.

Procedures

Nine burn-injured participants (42 ± 18.38%TBSA: 6.56 ± 3.68 years after injury) and 9 matched controls participated in a 12-week exercise programme. HRQOL was assessed via the Burn Specific Health Scale-Brief (BSHS-B) and the Medical Outcomes Study 36-Item Short Form (SF-36). Activity limitation was measured using the quick Disabilities of the Arm, Shoulder and Hand (QuickDASH).

Results

The burns group had decreased HRQOL compared to the controls at baseline, as reported by the BSHS-B (t (16) = 3.51, p = 0.003) and some domains of the SF-36 including role physical (t (16) = 3.79, p = 0.002). Burned participants reported decreased activity levels compared to the controls as measured by the QuickDASH (t (16) = 2.19, p = 0.044). Exercise training improved SF-36 scores in both burn (t (8) = 3.77, p = 0.005) and control groups (t (8) = 2.71, p = 0.027). Following training there was no difference between the groups on the SF-36 or QuickDASH.

Conclusion

Exercise training improves HRQOL and activity limitations in burn-injured patients to a level that is equivalent to that of their uninjured counterparts.     

Practical guidelines for nutritional management of burn injury and recovery

Nutrition practice in burn injury requires a multifaceted approach aimed at providing metabolic support during a heightened inflammatory state, while accommodating surgical and medical needs of the patient. Nutritional assessment and determination of nutrient requirements is challenging, particularly given the metabolic disarray that frequently accompanies inflammation. Nutritional therapy requires careful decision making, regarding the safe use of enteral or parenteral nutrition and the aggressiveness of nutrient delivery given the severity of the patient's illness and response to treatment. With the discovery that specific nutrients can actually alter the course of disease, the role of nutrition support in critical illness has shifted from one of preventing malnutrition to one of disease modulation. Today the use of glutamine, arginine, essential fatty acids, and other nutritional factors for their effects on immunity and cell regulation is becoming more common, although the evidence is often lagging. An exciting dichotomy exits, forcing nutrition support specialists to make responsible choices while remaining open to new potential helpful therapeutic options.     

Assessment of the health status in Brazilian burn victims five to seven months after hospital discharge

Purpose

To evaluate health status, impact of event, anxiety, and depression in burn victims at five-to-seven months after hospital discharge, and to explore the association between those variables with age, body surface area burn (BSA), sex, and marital status.

Methods

Cross-sectional study involving 73 adults who were interviewed for general health status (BSHS-R), impact of event (IES), and anxiety and depression (HADS).

Results

Participants were mostly men (68.5%), with mean age 38.4 years (SD = 14.5), and mean hospital length of stay (LOS) 24.5 days (SD = 25.3). Mean scores were: 128.1 (SD = 18.9) for BSHS-R, 62.1(SD = 35.8) for IES, 5.5 (SD = 4.1) for anxiety, and 3.9 (SD = 3.9) for depression. Health status was highly and inversely correlated with impact of event, depression, anxiety, LOS, number of surgeries, and BSA. Men and women differed in the BSHS-R affect and body image domains, and depression. Individuals with larger BSA reported worse scores for BSHS-R (work domain).

Conclusion

Burn victims reported good health status on average, which was negatively correlated with reported depression, anxiety, impact of event, LOS, number of operations, and BSA. These findings suggest that general health might be improved by interventions that target modifiable behavioral factors, such as support groups and cognitive behavioral therapies.     

Health-related quality of life in Swedish pediatric burn patients and associations with burn and family characteristics

Although many children with burns recover well and have a satisfying quality of life after the burn, some children do not adjust as well. Health-related quality of life (HRQoL) focuses on the impact health status has on quality of life. The aim of this study was to assess HRQoL with the American Burn Association/Shriners Hospitals for Children Burn Outcomes Questionnaire (BOQ) in a nationwide Swedish sample of children with burns 0.3–9.0 years after injury. Participants were parents (n = 109) of children aged up to 18 years at the time of investigation who were treated at the Linköping or Uppsala Burn Center between 2000 and 2008. The majority of children did not have limitations in physical function and they did not seem to experience much pain. However, there were indications of psychosocial problems. Parents of preschool children reported most problems with the children's behavior and family disruption, whereas parents of children aged 5–18 years reported most problems with appearance and emotional health. There were mainly burn-related variables associated with suboptimal HRQoL in children aged 5–18 years, while family-related variables did not contribute as much.     

Health utilities in burn injury survivors: A systematic review

BackgroundAn estimated 11 million burn injuries with medical attention occur every year worldwide. Although potentially deadly, burn injuries are now considered a chronic disease with multiple lifetime physical and psychological sequelae. However, it remains unclear how these events affect patients’ utility scores. We aimed to conduct a systematic review to summarize the utility scores of burn injury survivors.MethodsWe conducted on March 18^th, 2020 a systematic review of the published literature using a search strategy designed in collaboration with a research librarian. Our search strategy aimed to identify studies that provided burn injury survivors’ utility scores via a standardized indirect instrument.ResultsWe identified 15 studies that reported burn injury survivors’ utility scores. Most studies used the EQ-5D instruments to assess patients’ utility scores. Results varied substantially between studies, ranging from a low of 0.06 to a high of 0.972. Our review identified two key trends. First, utility scores seem to be negatively correlated with the severity of the burn injury. Second, utility scores in adults tend to increase in function of the time since injury.ConclusionUnfortunately, due to differences in study design and settings, patient populations and instruments used to assess patients’ utility scores, we were unable to combine all study results into a single value. In spite of this limit, results we identified support previous trends identified by others regarding the relationship between utility scores and the burn injury severity and/or the time since injury.     

伤后即行切痂对烧伤大鼠心肌损伤的防治作用

目的探讨早期一次性切痂对烧伤后心肌损伤的防治作用。方法建立30% TBSAⅢ度烧伤大鼠立即切痂模型,动物随机分为正常对照组、未切痂组和切痂组,于伤后1,3,6,12和24h 检测血浆肌钙蛋白 T(TnT)和肿瘤坏死因子(TNF)等指际。结果烧伤后3h 血浆 TnT 即显著升高,伤后6h 血浆 TNF 显著高于伤前,心肌组织中 TNF 也在伤后12h 显著升高。未切痂组与切痂组比较,伤后1～3h 未切痂组 TnT、TNF 略低于切痴组,烧伤6h后,未切痂组 TnT 显著高于切痂组,烧伤12h 后,未切痂组 TNF 显著高于切痂组。TNF 与 TnT 存在显著正相关关系。结论 TNF是引起烧伤后心肌损伤的重要因素,且与心肌损伤程度密切相关。伤后即行一次性切痂可以减少炎症介质的生成和释放,这可能是其对烧伤后并发心肌损伤具有防治作用的机理之一。     

Managing the relationship between quality and cost-effective burn care

In the modern era of fiscal prudence, managing the relationship between quality health care and cost reduction is a complex and challenging task for policy makers and health care providers. Health economics is an applied field that aids in assessing the feasibility of incorporating new interventions in a certain field. Applying these tools when allocating funds for burn care is even more complicated due to the lack of clinical data regarding the cost effectiveness of different aspects in burn care. Herein we review the existing literature and summarize different approaches for achieving cost effective health care in general and in burn care specifically. Special considerations to funds allocation in burn care are also discussed.     

严重烧伤早期肠道营养对肠道脂肪吸收的影响

将健康雄性贵州小型香猪12只,致体表面积Ⅲ度30％烧伤后,分为早期及延迟喂养两组。分别于伤前及伤后4、7及10天进行门静脉血流量测定及吸收功能测定。结果表明,烧伤后肠道吸收功能随门静脉血流量而变化,而肠道本身的吸收功能并没有大幅度减少。早期肠道营养能明显增加脂肪的吸收量。结果提示,如果能及时而有效地改善门静脉系血循环状况,肠道吸收功能可明显改善,而早期肠道营养则是达到此目的的一个有效手段。     

How self-inflicted injury and gender impacted the outcome following a severe burn

BackgroundA high prevalence of self-inflicted burn injury is noted in severe burn injury. It remains unclear as to whether gender and past psychiatric history impact upon whether injury is self-inflicted and the outcomes.AimsReview the psychiatric history of patients treated in a statewide burn service following severe burn injury and determine whether psychiatric history, extent of burn and mortality are impacted by gender and whether the injury was self-inflicted.MethodA data linkage study was performed with psychiatric history and mental health service contact data matched to patients’ data collected via a previous retrospective file audit. Unadjusted and adjusted logistic regression modelling measured interactions between gender and self-inflicted burn status, and other study outcomes.ResultsIn total, 298 patients (47 with a self-inflicted burn) were admitted following a severe burn. Patients with self-inflicted burns were significantly more likely to have total body surface area burn of at least 50% (OR = 9.3; 95%CI: 4.7–18.5) and die within 24 h of admission (OR = 10.5; 95%CI:4.7–23.2). They were significantly more likely to have a past psychiatric diagnosis and public mental health service contact in the month pre-injury (OR = 18.9; 95%CI: 7.5–47.2). Male patients had significantly lower rates of a psychiatric diagnosis and recent mental health service contact. Males with self-inflicted injury are far more likely to die than males with a non-self-inflicted injury.ConclusionsPsychiatric clinicians should assertively screen the psychiatric history of patients with severe burn injury, and participate in the acute and longer-term management of persons admitted with a self-inflicted burn.     

The influence of advancing age on quality of life and rate of recovery after treatment for burn

Background

With an ageing population the prevalence of burns in the elderly is increasing. The influence of increasing age on post-burn quality of life (QoL) is unquantified.

Aim

To examine the effect of ageing on QoL recovery after burn.

Methods

The Burn Specific Health Scale-Brief (BSHS-B) and Short Form Health Outcomes (SF-36), collected up to 24 months post-injury, for patients treated by the Royal Perth Hospital Burn Service were analysed. Multivariable analysis was adjusted for demographic and injury factors. The impact of ageing on rate of recovery was examined using BSHS-B normative data.

Results

The cohort (n = 1051) was 79.6% male with mean TBSA of 8% and age of 37.3 years. The SF-36 showed advancing age predicted poorer outcomes in physical function, role physical, vitality and role emotional domains but reduced bodily pain. The BSHS-B was affected by injury factors, not ageing. The standardised rate of recovery after burn improved with advancing age. The provision of surgery positively affected most outcomes assessed.

Conclusion

This study quantified the impact of ageing on post-burn QoL recovery and confirmed that physical function suffered to the greatest degree. The results emphasise the importance of pro-active burn surgery and physical rehabilitation strategies with older patients.     

严重烧伤早期肠道营养对肠道脂肪吸收的影响

将健康雄性贵州小型香猪１２只，致体表面积Ⅲ度３０％烧伤后，分为早期及延迟喂养两组。分别于伤前及伤后４、７及１０天进行门静脉血流量测定及吸收功能测定。结果表明，烧伤后肠道吸收功能随门静脉血流量而变化，而肠道本身的吸收功能并没有大幅度减少。早期肠道营养能明显增加脂肪的吸收量。结果提示，如果能及时而有效地改善门静脉系血循环状况，肠道吸收功能可明显改善，而早期肠道营养则是达到此目的的一个有效手段。