Are burns a chronic condition? Examining patient reported... : Journal of Trauma and Acute Care Surgery (original) (raw)

INDEPENDENT SUBMISSIONS

Are burns a chronic condition? Examining patient reported outcomes up to 20 years after burn injury—A Burn Model System National Database investigation

Abouzeid, Cailin A. BA; Wolfe, Audrey E. MPH; Ni, Pengsheng PhD; Carrougher, Gretchen J. MN, RN; Gibran, Nicole S. MD; Hammond, Flora M. MD; Holavanahalli, Radha PhD; McMullen, Kara A. MPH; Roaten, Kimberly PhD; Suman, Oscar PhD; Stewart, Barclay T. MD; Wolf, Steven MD; Zafonte, Ross DO; Kazis, Lewis E. ScD; Ryan, Colleen M. MD; Schneider, Jeffrey C. MD

From the Department of Physical Medicine and Rehabilitation (C.A.A., A.E.W., R.Z., L.E.K., J.C.S.), Spaulding Rehabilitation Hospital, Boston, Massachusetts; Department of Surgery (G.J.C., N.S.G., B.T.S.), University of Washington, Seattle, Washington; Department of Rehabilitation Medicine (K.A.M), University of Washington, Seattle, Washington; Harborview Injury Prevention and Research Center (B.T.S.), University of Washington, Seattle, Washington; Department of Physical Medicine and Rehabilitation (R.H.), University of Texas South Western Medical Center, Dallas, Texas; Department of Psychiatry (K.R.), University of Texas South Western Medical Center, Dallas, Texas; Department of Physical Medicine and Rehabilitation (F.M.H.), Indiana University School of Medicine, Indianapolis, Indiana; Rehabilitation Hospital of Indiana (F.M.H.), Indianapolis, Indiana; Department of Health Law, Policy, and Management (P.N., L.E.K.), Boston University School of Public Health, Boston, Massachusetts; Department of Surgery (O.S., S.W.), University of Texas Medical Branch, Galveston, Texas; Department of Surgery (O.S., S.W.), Shriners Hospitals for Children Galveston, Galveston, Texas; Department of Physical Medicine and Rehabilitation (R.Z.), Massachusetts General Hospital, Boston, Massachusetts; Department of Surgery (C.M.R.), Massachusetts General Hospital, Boston, Massachusetts; Department of Surgery (C.M.R.), Shriners Hospitals for Children Boston, Boston, Massachusetts; Harvard Medical School (R.Z., L.E.K., C.M.R., J.C.S.), Boston, Massachusetts; and Department of Physical Medicine and Rehabilitation (R.Z., L.E.K., J.C.S.), Spaulding Research Institute, Boston, Massachusetts.

Submitted: November 18, 2021, Revised: January 6, 2022, Accepted: January 10, 2022, Published online: January 25, 2022.

Presented at the 2021 American Burn Association annual meeting in the top six abstract plenary.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.jtrauma.com).

Address for reprints: Jeffrey C. Schneider, MD, 300 First Ave, Boston, MA 02114; email: [email protected].

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BACKGROUND

People living with burn injury often face long-term physical and psychological sequelae associated with their injuries. Few studies have examined the impacts of burn injuries on long-term health and function, life satisfaction, and community integration beyond 5 years postinjury. The purpose of this study was to examine these outcomes up to 20 years after burn injury.

METHODS

Data from the Burn Model System National Longitudinal Database (1993–2020) were analyzed. Patient-reported outcome measures were collected at discharge (preinjury status recall) and 5 years, 10 years, 15 years, and 20 years after injury. Outcomes examined were the SF-12/VR-12 Physical Component Summary and Mental Component Summary, Satisfaction with Life Scale, and Community Integration Questionnaire. Trajectories were developed using linear mixed models with repeated measures of outcome scores over time, controlling for demographic and clinical variables.

RESULTS

The study population included 421 adult burn survivors with a mean age of 42.4 years. Lower Physical Component Summary scores (worse health) were associated with longer length of hospital stay, older age at injury and greater time since injury. Similarly, lower Mental Component Summary scores were associated with longer length of hospital stay, female sex, and greater time since injury. Satisfaction with Life Scale scores decrease negatively over time. Lower Community Integration Questionnaire scores were associated with burn size and Hispanic/Latino ethnicity.

CONCLUSION

Burn survivors' physical and mental health and satisfaction with life worsened over time up to 20 years after injury. Results strongly suggest that future studies should focus on long-term follow-up where clinical interventions may be necessary.

LEVEL OF EVIDENCE

Prognostic and Epidemiologic; Level III.