Exploring 'Return to Productivity' Among People Living with Burn Injury: a Burn Model System National Database Report

Global, regional and national burden of injuries caused by fire, heat, and hot substances from 1990 to 2021

BACKGROUND

Burn injuries, which are caused by fire, heat, and hot substances, are considered a chronic condition due to their long-term effects on the health of affected individuals. Moreover, burn injuries constitute a significant public health issue that cannot be overlooked within the global healthcare system.

MATERIALS AND METHODS

This study comprehensively analyzed the burden of burn injuries, focusing on variations by Socio-Demographic Index (SDI) levels and Global Burden of Disease (GBD) regions, sex-based disparities, Frontier analysis, and future trend forecasting using the Bayesian Age-Period-Cohort (BAPC) model.

RESULTS

Compared to 1990, the global burden of burn injuries decreased in most regions worldwide in 2021. The majority of regions showed a negative Estimated Annual Percentage Change (EAPC), indicating a continuous decline in Age-Standardized Rate (ASR) annually. And the ASR decreased with the increasing SDI. Moreover, the forecasted trend from 2021 to 2030, indicates a continued decline with a well-fitted projection model.

CONCLUSIONS

Despite the observed and projected decline in global ASR of burn, the burden of burn remains a significant concern that should not be underestimated.

Quality of life and return to work rates in the first two years following major burn injury

BACKGROUND

A better understanding of how major burns patients recover following injury is vital in assessing trauma care and informing healthcare and rehabilitation provision. We aimed to describe the longer-term health and return to work status of major burns patients and identify factors associated with positive outcomes i.e., reporting no problems with health-related quality of life, returning to work).

METHODS

This registry-based cohort study included adult (≥ 16 years) patients with a burn injury affecting ≥ 20 % total body surface area registered by the Victorian State Trauma Registry with a date of injury from July 1 2009 to June 30 2022. Patients were followed-up at six, 12, and 24 months post-injury, completing the 3-level or 5-level EuroQoL 5 dimensions questionnaire (depending on their date of injury) and return to work-related questions at each time point. Mixed effect regression models were used to predict factors associated with quality of life outcomes. Modified binary Poisson models were used to model the probability of experiencing no problems in each of the quality of life domains, and mixed effects linear regression was used to model the overall utility score.

RESULTS

Two hundred and eighty-seven patients were included; 63 (21.9 %) did not die but were completely lost to follow-up. The prevalence of reporting no problems at 24 months post-injury was 70.2 % for mobility, 77.8 % for self-care, 48.0 % for usual activities, 49.7 % for pain or discomfort, and 51.5 % for anxiety or depression. The predicted probability of reporting no problems in each of the EQ-5D health states was lowest at six-months and increased over time.

CONCLUSIONS

The prevalence of ongoing problems - particularly with usual activities, pain, and anxiety/depression - at 24 months post-injury is high, confirming that major burns are often an ongoing disorder. Greater investment in interventions designed to reduce these problems is needed.

Association between community distress and return to work after burn injury

INTRODUCTION

Community-level disadvantage is associated with reduced quality of life after burn injury. We evaluated the association between community-level disadvantage and return to work after burn injury.

METHODS

A multicenter burn injury database was queried from 1998-2021. Participants 18-65 years old with documented employment status and ZIP codes were included. Exposures were community distress (Distressed Communities Index, DCI), patient demographics, and burn characteristics. The primary outcome was odds of employment 6 months after burn injury using stepwise logistic regression models, first with patient-level variables, then DCI. An interaction term was included to evaluate the modification of DCI and post-injury employment by race.

RESULTS

1960 participants were included, with a median age of 39.2 years (IQR 29.2, 49.3); 81 % were White, 75 % male, and 74 % were working at the time of injury. Participants unemployed 6 months post-injury were more often older, female, non-White, and unemployed at injury, with larger burn sizes and longer hospitalizations. 59 % of participants unemployed at 6 months were employed at the time of injury. Residence in the highest distress ZIP codes was associated with 2.21 (95 % CI 1.39-3.52) odds of 6 month unemployment. Older age, larger burn size, more operations, Black race, and pre-injury unemployment were associated with the greatest odds of unemployment. The interaction between race and DCI was not statistically significant.

CONCLUSION

Patients from the highest distress communities have twice the odds of unemployment 6 months after injury. This association did not vary by race. Screening for DCI by ZIP code may be a useful tool to focus vocational rehabilitation resources.

Recovery of functional independence following major burn: A systematic review

BACKGROUND

Major burn injury, despite advancements in care and prevention, can have a profound impact on long-term morbidity, affecting quality of life and socioeconomic standing. We aim to explore factors predicting recovery of independence, the expected rate and time in majorly burned patients, and the measures of progress used.

METHOD

A systematic search of four databases (MEDLINE, EMBASE, COCHRANE, CINAHL) was conducted for studies reporting outcomes pertaining to physical ability indicative of independent function in adult (>15 y) cohorts who had suffered a major burn (>20% TBSA) up to 30 years after treatment in a developed specialised burn service. Data extracted included factors affecting rate of and time to achievement of function in five independence domains, as well as the outcome measures used.

RESULTS

21 eligible studies were included comprising 1298 major burns survivors with a combined mean age of 39.6 y and a mean TBSA of 25.8%. The most significant recurring factors impacting recovery of independent function were older age, female gender, burn severity, prolonged ICU and hospital admission, preceding mental health conditions, and post-acute psychological issues. Exercise-based rehabilitation conferred benefits on major burn patients even over 2 years following injury. Discharge to independent living from hospital occurred in 27% to 97% of patients, while reported return to work rates varied from 52% to 80%. Burns Specific Health Scale-Brief, Functional Independence Measure, and Physical Composite Score (SF-36) were the most widely used outcome scoring systems.

CONCLUSION

Major burn survivors have protracted recovery with potential for persistent chronic impairments, remaining consistently below baseline levels of function. Non-modifiable factors such as age and gender, and disease characteristics such as burn size with associated physical, physiological and psychosocial sequelae are contributory. Further research is required to explore achievement of specific milestones of major burn and polytrauma critical care patients, while early targeted rehabilitation addressing physical, psychological, and vocational needs has promising potential benefit.

Assessing Return to Work Outcomes for Individuals Affected by Burn Injuries: A Comprehensive Study

Background Burn injuries can have long-lasting effects on individuals, including their ability to return to work (RTW). This study aims to comprehensively analyze factors influencing the RTW status of burn patients after their injuries. Methods A dataset containing information on gender, age groups, burn types, discharge status, burn causes, employment status, total body surface area (TBSA) burn, and more were analyzed. The dataset covered the years 2018 to 2020. Chi-square tests were used for categorical data, while Mann-Whitney U tests were used for continuous variables. The participant characteristics, activity impairment, and work results were investigated using descriptive statistics. Results The number of reported burn cases was higher among males than females in 2018, 2019, and 2020. The highest burn cases occurred within the 25-40 age group. Most of the patients were involved in manual labor-intensive work prior to burn injury, unemployed individuals also accounted for a notable proportion of the cases. Most patients analyzed for the study had sustained 20-40% TBSA burn. From a total of 1130 patients, 710 (62.83%) of patients returned to work, and (37.16%) did not RTW. Conclusion Understanding the factors influencing the RTW status of burn patients after one year is crucial for effective occupational rehabilitation. This analysis provides insights into gender differences, age distribution, burn types, discharge outcomes, causes of burn incidents, employment status, TBSA burn, and the relationship between these factors and RTW rates.

Higher Out-of-pocket Expenses are Associated with Worse Health-related Quality of Life in Burn Survivors: A Northwest Regional Burn Model System Investigation

The care required to recover serious burn injuries is costly. In the United States, these costs are often borne by patients. Examining the relationship between out-of-pocket (OOP) costs and health-related quality of life (HRQL) is important to support burn survivors. Financial data from a regional burn center were merged with data in the Burn Model System (BMS) National Database. HRQL outcomes included VA-Rand 12 (VR-12) physical component summary (PCS) and mental component summary (MCS) scores. Participant surveys were conducted at 6-, 12-, and 24-months post-injury. VR-12 scores were evaluated using generalized linear models and adjusted for potential confounders (age, sex, insurance/payer, self-identified race/ethnicity, measures of burn injury severity). 644 participants were included, of which 13% (84) had OOP costs. The percentage of participants with OOP costs was 34% for commercial/private, 22% for Medicare, 8% for other, 4% for self-pay, and 0% for workers' compensation and Medicaid. For participants with OOP expenses, median payments were $875 with an IQR of $368-1728. In addition to markers of burn injury severity, OOP costs were negatively associated with PCS scores at 6-months (coefficient -0.002, P < .001) and 12-months post-injury (coefficient -0.001, P = .004). There were no significant associations with PCS scores at 24 months post-injury or MCS scores at any interval. Participants with commercial/private or Medicare payer had higher financial liability than other payers. Higher OOP expenses were negatively associated with physical HRQL for at least 12 months after injury. Financial toxicity occurs after burn injury and providers should target resources accordingly.

A Narrative Review of Outcomes in Burn Rehabilitation Based on the International Classification of Functioning, Disability, and Health

Burn injury commonly causes long-term physical impairments and psychosocial limitations that impact survivorship. This article uses the World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) framework to summarize burn rehabilitation outcomes related to body functions and structures and how they relate to activities and participation within the social context. This article will contribute to a better understanding of burn recovery, facilitate the identification of specific and meaningful issues common to burn survivorship that may be under-reported in prior investigations and guide future rehabilitation to advance long-term burn outcomes.

Trajectories of physical health-related quality of life among adults living with burn injuries: A burn model system national database investigation to improve early intervention and rehabilitation service delivery

INTRODUCTION

Understanding trajectories of recovery in key domains can be used to guide patients, families, and caregivers. The purpose of this study was to describe common trajectories of physical health over time and to examine predictors of these trajectories.

METHOD

Adults with burn injuries completed self-reported assessments of their health-related quality of life (HRQOL) as measured by the SF-12® Physical Component Summary (PCS) score at distinct time points (preinjury via recall, index hospital discharge, and at 6-, 12-, and 24 months after injury). Growth mixture modeling (GMM) was used to model PCS scores over time. Covariables included burn size, participant characteristics, and scores from the Community Integration Questionnaire (CIQ)/Social Integration portion, Satisfaction With Life Scale (SWLS), and Satisfaction With Appearance Scale (SWAP).

RESULTS

Data from 939 participants were used for complete-case analysis. Participants were 72% male, 64% non-Hispanic White, with an average age of 44 years and an average burn size of 20% of total body surface area (TBSA). The best fitting model suggested three distinct trajectories (Class 1 through 3) for HRQOL. We titled each Class according to the characteristics of their trajectory. Class 1 (recovering; n = 632), Class 2 (static; n = 77), and Class 3 (weakened; n = 205) reported near average HRQOL preinjury, then reported lower scores at discharge, with Class 1 subsequently improving to preinjury levels and Class 3 improving but not reaching their preinjury quality of life. Class 3 experienced the largest decrease in HRQOL. Class 2 reported the lowest preinjury HRQOL and remained low for the next 2 years, showing minimal change in their HRQOL.

CONCLUSIONS

These findings emphasize the importance of early universal screening and sustained intervention for those most at risk for low HRQOL following injury. For Class 2 (static), lower than average HRQOL before their injury is a warning. For Class 3 (weakened), if the scores at 6 months show a large decline, then the person is at risk for not regaining their HRQOL by 24 months and thus needs all available interventions to optimize their outcomes. Results of this study provide guidance for how to identify people with burn injury who would benefit from more intensive rehabilitation to help them achieve or regain better HRQOL. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Impacts of Financial Assistance on Quality of Life Among People Living With Burn Injury: Matched Cohort Analysis of the National Institute on Disability, Independent Living and Rehabilitation Research Burn Model System Database

Disparities in socioeconomic status and minority status affect the risk of burn injury and the severity of that injury, thus affecting the subsequent cost of care. We aimed to characterize the demographic details surrounding receipt of financial assistance due to burn injury and its relationship with health-related quality of life scores. Participants ≥18 from Burn Model System National Longitudinal Database (BMS) with complete demographic data were included (n = 4330). Nonresponders to financial assistance questions were analyzed separately. The remaining sample (n = 1255) was divided into participants who received financial assistance because of burn injury, those who received no financial assistance, and those who received financial assistance before injury and as a result of injury. A demographic and injury-characteristic comparison was conducted. Health-related quality of life metrics (Satisfaction with Life, Short Form-12/Veterans RAND 12-Item Health Survey, Community Integration Questionnaire Social Component, and the Post-Traumatic Growth Inventory) were analyzed preinjury, then 6-months, 1-year, and 2-years postinjury. A matched cohort analysis compared these scores. When compared to their no financial assistance counterparts, participants receiving financial assistance due to burns were more likely to be minorities (19% vs 14%), have more severe injuries (%TBSA burn 21% vs 10%), and receive workers' compensation (24% vs 9%). They also had lower health-related quality of life scores on all metrics except the post-traumatic growth inventory. Financial assistance may aid in combating disparities in posttraumatic growth scores for participants at the greatest risk of financial toxicity but does not improve other health-related quality of life metrics.

Peer Support Groups: Identifying Disparities to Improve Participation

Disparities in psychosocial outcomes after burn injury exist in patients from racial or ethnic minority groups in the United States. Peer support groups can help patients with many psychosocial aspects of recovery from burns; however, access to such support among patients of racial and ethnic minority or low socioeconomic groups are unknown. The present study examined participation rates in outpatient peer support within this patient population. Patients attending outpatient clinic at an urban safety-net hospital and regional burn center with a majority minority patient population were asked about participation in burn survivor group, interest in joining a group, and given validated survey questions about managing emotions and social interactions since injury. Current or past participation in peer support was low (4.2%), and 30.3% of patients not already in support group were interested in joining. Interest in future participation in peer support was highest among Hispanic patients (37.0%) and lowest among Black patients (0%). Logistic regression models demonstrated that increased total body surface area burned, hospital length of stay, and need for surgical intervention were associated with interest in joining or having joined a peer support group. Effectiveness of management of emotions and social interactions were not associated with interest in joining peer support in the future. These findings demonstrate a considerable difference between levels of interest and participation in peer support within this population. Improving access to and education about benefits of peer support in underresourced communities may help to address the variation in psychosocial outcomes of patients across racial or ethnic minority groups recovering from burns.