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Yelvington M, Godleski M, Lee AF, Goverman J, Parry I, Herndon DN, Suman OE, Kowalske K, Holavanahalli R, Gibran NS, Esselman PC, Ryan CM, Schneider JC. Contracture Severity at Hospital Discharge in Children: A Burn Model System Database Study. J Burn Care Res 2021; 42:425-433. [PMID: 33247583 DOI: 10.1093/jbcr/iraa169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Contractures can complicate burn recovery. There are limited studies examining the prevalence of contractures following burns in pediatrics. This study investigates contracture outcomes by location, injury, severity, length of stay, and developmental stage. Data were obtained from the Burn Model System between 1994 and 2003. All patients younger than the age of 18 with at least one joint contracture at hospital discharge were included. Sixteen areas of impaired movement from the shoulder, elbow, wrist, hand, hip, knee, and ankle joints were examined. Analysis of variance was used to assess the association between contracture severity, burn size, and length of stay. Age groupings were evaluated for developmental patterns. A P value of less than .05 was considered statistically significant. Data from 225 patients yielded 1597 contractures (758 in the hand) with a mean of 7.1 contractures (median 4) per patient. Mean contracture severity ranged from 17% (elbow extension) to 41% (ankle plantarflexion) loss of movement. Statistically significant associations were found between active range of motion loss and burn size, length of stay, and age groupings. The data illustrate quantitative assessment of burn contractures in pediatric patients at discharge in a multicenter database. Size of injury correlates with range of motion loss for many joint motions, reflecting the anticipated morbidity of contracture for pediatric burn survivors. These results serve as a potential reference for range of motion outcomes in the pediatric burn population, which could serve as a comparison for local practices, quality improvement measures, and future research.
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Affiliation(s)
| | | | - Austin F Lee
- Massachusetts General Hospital, Boston.,University of Massachusetts Medical School, Worcester
| | - Jeremy Goverman
- Massachusetts General Hospital, Harvard Medical School, Boston
| | - Ingrid Parry
- Shriners Hospital for Children, Northern California/UC Davis Medical Center, Sacramento
| | - David N Herndon
- University of Texas Medical Branch, Shriners Hospitals for Children, Galveston
| | - Oscar E Suman
- University of Texas Southwestern Medical Center, Dallas
| | | | | | | | | | - Colleen M Ryan
- Massachusetts General Hospital, Shriners Hospitals for Children, Boston
| | - Jeffrey C Schneider
- Spaulding Rehabilitation Hospital, Spaulding Research Institute and Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
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Wolfe AE, Stockly OR, Abouzeid C, Rodríguez-Mercedes SL, Flores LE, Carrougher GJ, Gibran NS, Holavanahalli R, McMullen K, Trinh NH, Zafonte R, Silver JK, Ryan CM, Schneider JC. Burn model system national longitudinal database representativeness by race, ethnicity, gender, and age. PM R 2021; 14:452-461. [PMID: 33886159 DOI: 10.1002/pmrj.12618] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/23/2021] [Accepted: 04/05/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Representativeness of research populations impacts the ability to extrapolate findings. The Burn Model System (BMS) National Database is one of the largest prospective, longitudinal, multi-center research repositories collecting patient-reported outcomes after burn injury. OBJECTIVE To assess if the BMS Database is representative of the population that is eligible to participate. DESIGN Data on adult burn survivors who were eligible for the BMS Database from 2015 to 2019 were analyzed. SETTING Not applicable. PARTICIPANTS Burn survivors treated at BMS centers meeting eligibility criteria for the BMS Database. Eligibility for the database is based on burn size and receipt of autografting surgery. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) Race, ethnicity, gender, and age were compared between individuals who did and did not enroll. Regression analysis examined the correlation between demographic characteristics and study enrollment. Additional regression analysis examined the association between enrollment and the intersection of race, ethnicity, and gender. RESULTS A total of 982 adult burn survivors were eligible for the BMS database during the study period. Of those who were eligible, 72.1% Enrolled and 27.9% were Not Enrolled. The Enrolled group included more female and more younger survivors compared to the Not Enrolled group. In regression analyses, Black/African American burn survivors were less likely and individuals identifying as female were more likely to enroll in the BMS Database. Furthermore, White men and women were more likely to enroll compared to Black/African American men and women, and non-Hispanic/Latino men were more likely to enroll compared to Hispanic/Latino men. CONCLUSIONS This study found differences in BMS Database enrollment by race, ethnicity, and gender. Further research is warranted to investigate causes for the disparities found in this study. In addition, strategies are needed to improve enrollment to ensure future representativeness.
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Affiliation(s)
- Audrey E Wolfe
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA.,Spaulding Rehabilitation Institute, Boston, Massachusetts, USA
| | - Olivia R Stockly
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA.,Spaulding Rehabilitation Institute, Boston, Massachusetts, USA
| | - Cailin Abouzeid
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA.,Spaulding Rehabilitation Institute, Boston, Massachusetts, USA
| | | | - Laura E Flores
- College of Allied Health Professionals, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | - Nicole S Gibran
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Radha Holavanahalli
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Nhi-Ha Trinh
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA.,Spaulding Rehabilitation Institute, Boston, Massachusetts, USA
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA.,Spaulding Rehabilitation Institute, Boston, Massachusetts, USA.,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Colleen M Ryan
- Shriners Hospitals for Children - Boston, Boston, Massachusetts, USA.,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA.,Spaulding Rehabilitation Institute, Boston, Massachusetts, USA
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Kelter B, Holavanahalli R, Suman O, Ryan C, Schneider J. Recognizing the long-term sequelae of burns as a chronic medical condition. Burns 2020; 46:493-496. [DOI: 10.1016/j.burns.2019.10.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 10/20/2019] [Indexed: 11/28/2022]
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Benavides L, Shie V, Yee B, Yelvington M, Simko LC, Wolfe AE, McMullen K, Epp J, Parry I, Shon R, Holavanahalli R, Herndon D, Rosenberg M, Rosenberg L, Meyer W, Gibran N, Wiechman S, Ryan CM, Schneider JC. An Examination of Follow-up Services Received by Vulnerable Burn Populations: A Burn Model System National Database Study. J Burn Care Res 2020; 41:377-383. [PMID: 31710682 DOI: 10.1093/jbcr/irz185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
While disparities in healthcare outcomes and services for vulnerable populations have been documented, the extent to which vulnerable burn populations demonstrate disparities in long-term care is relatively underexplored. This study's goal was to assess for differences in long-term occupational or physical therapy (OT/PT) and psychological service use after burn injury in vulnerable populations. Data from the Burn Model System National Database (2006-2015) were analyzed. The vulnerable group included participants in one or more of these categories: 65 years of age or older, nonwhite, no insurance or Medicaid insurance, preinjury receipt of psychological therapy or counseling, preinjury alcohol and/or drug misuse, or with a preexisting disability. Primary outcomes investigated were receipt of OT/PT and psychological services. Secondary outcomes included nine OT/PT subcategories. Outcomes were examined at 6, 12, and 24 months postinjury. One thousand one hundred thirty-six burn survivors (692 vulnerable; 444 nonvulnerable) were included. The vulnerable group was mostly female, unemployed at time of injury, and with smaller burns. Both groups received similar OT/PT and psychological services at all time points. Adjusted regression analyses found that while the groups received similar amounts services, some vulnerable subgroups received significantly more services. Participants 65 years of age or older, who received psychological therapy or counseling prior to injury, and with a preexisting disability received more OT/PT and psychological or peer support services at follow-up. Overall, vulnerable and nonvulnerable groups received comparable OT/PT and psychological services. The importance of long-term care among vulnerable subgroups of the burn population is highlighted by this study. Future work is needed to determine adequate levels of follow-up services.
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Affiliation(s)
- Lynne Benavides
- Rhode Island Burn Center, Rhode Island Hospital, Providence, Rhode Island
| | - Vivian Shie
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Brennan Yee
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Miranda Yelvington
- Department of Rehabilitation, Arkansas Children's Hospital, Little Rock, Arkansas
| | - Laura C Simko
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Audrey E Wolfe
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | | | - Janelle Epp
- Burnett Burn Center, University of Kansas Health System, Kansas City, Kansas
| | - Ingrid Parry
- University of California Davis and Shriners Hospitals for Children - Northern California; Sacramento, California
| | | | - Radha Holavanahalli
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, Texas
| | - David Herndon
- University of Texas Medical Branch, Shriners Hospitals for Children - Galveston, Texas
| | - Marta Rosenberg
- University of Texas Medical Branch, Shriners Hospitals for Children - Galveston, Galveston, Texas
| | - Laura Rosenberg
- University of Texas Medical Branch, Shriners Hospitals for Children - Galveston, Texas
| | - Walter Meyer
- University of Texas Medical Branch, Shriners Hospitals for Children - Galveston, Texas
| | - Nicole Gibran
- University of Texas Medical Branch, Shriners Hospitals for Children - Galveston, Galveston, Texas
| | - Shelley Wiechman
- University of Texas Medical Branch, Shriners Hospitals for Children - Galveston, Galveston, Texas
| | - Colleen M Ryan
- Department of Surgery, Massachusetts General Hospital, Shriners Hospitals for Children - Boston, Massachusetts
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts
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Bamer AM, McMullen K, Gibran N, Holavanahalli R, Schneider JC, Carrougher GJ, Wiechman S, Wolfe A, Amtmann D. Factors Associated with Attrition of Adult Participants in a Longitudinal Database: A National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System Study. J Burn Care Res 2020; 41:270-279. [PMID: 31738436 PMCID: PMC9121819 DOI: 10.1093/jbcr/irz186] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
Participant attrition in longitudinal studies can lead to substantial bias in study results, especially when attrition is nonrandom. A previous study of the Burn Model System (BMS) database prior to 2002 identified participant and study-related factors related to attrition. The purpose of the current study was to examine changes in attrition rates in the BMS longitudinal database since 2002 and to revisit factors associated with attrition. Individuals 18 years and older enrolled in the BMS database between 2002 and 2018 were included in this study. Stepwise logistic regression models identified factors significantly associated with attrition at 6, 12, and 24 months postburn injury. The percentage of individuals lost to follow-up was 26% at 6 months, 33% at 12 months, and 42% at 24 months. Factors associated with increased risk of loss to follow-up across two or more time points include male sex, lower TBSA burn size, being unemployed at the time of burn, shorter duration of acute hospital stay, younger age, not having private health insurance or workers' compensation, and a history of drug abuse. Retention levels in the BMS have improved by at least 10% at all time points since 2002. The BMS and other longitudinal burn research projects can use these results to identify individuals at high risk for attrition who may require additional retention efforts. Results also indicate potential sources of bias in research projects utilizing the BMS database.
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Affiliation(s)
- Alyssa M. Bamer
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Kara McMullen
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Nicole Gibran
- Department of Surgery, University of Washington, Seattle
| | | | - Jeffrey C. Schneider
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Audrey Wolfe
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, Seattle
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Grant GG, Wolfe AE, Thorpe CR, Gibran NS, Carrougher GJ, Wiechman SA, Holavanahalli R, Stoddard FJ, Sheridan RL, Kazis LE, Schneider JC, Ryan CM. Exploring the Burn Model System National Database: Burn injuries, substance misuse, and the CAGE questionnaire. Burns 2020; 46:745-747. [PMID: 31901407 DOI: 10.1016/j.burns.2019.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 12/22/2019] [Indexed: 10/25/2022]
Abstract
Burn survivors who misuse alcohol and/other substances have been associated with poorer long-term outcomes and clinical complications following injury. The self-reported CAGE questionnaire (Cut down, Annoyed, Guilty, and Eye-opener) is an outcomes assessment tool used to screen for potential substance misuse. Understanding the persistence and emergence of potential substance misuse through examination of CAGE scores may provide important information about this population. Using data collected from the Burn Model System National Database, demographic and clinical characteristics of individuals who reported positive CAGE scores (total score of ≥2) and those who reported negative CAGE scores (total score of 0 or 1) for either alcohol or other drugs were compared.
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Affiliation(s)
- Gabrielle G Grant
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - Audrey E Wolfe
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Catherine R Thorpe
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States
| | - Nicole S Gibran
- Department of Surgery, University of Washington, Seattle, WA, United States
| | | | - Shelley A Wiechman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Radha Holavanahalli
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, TX, United States
| | - Frederick J Stoddard
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Robert L Sheridan
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Surgery, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Lewis E Kazis
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Colleen M Ryan
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Surgery, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
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Juengst SB, Osborne CL, Holavanahalli R, Silva V, Kew CL, Nabasny A, Bell KR. Feasibility Study of Problem-Solving Training for Care Partners of Adults With Traumatic Brain Injury, Spinal Cord Injury, Burn Injury, or Stroke During the Inpatient Hospital Stay. Arch Rehabil Res Clin Transl 2019; 1:100009. [PMID: 33543049 PMCID: PMC7853336 DOI: 10.1016/j.arrct.2019.100009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To determine the feasibility of delivering an evidence-based self-management intervention, problem-solving training (PST), to care partners of individuals with traumatic brain injury (TBI), spinal cord injury (SCI), burn injury, or stroke during the inpatient hospital stay. DESIGN In this single group pre-post intervention pilot feasibility study. SETTING Inpatient rehabilitation or acute care and community. PARTICIPANTS Care partners (spouse or partner, family member, friend who is in any way responsible for the health or well-being of the care recipient) of individuals with TBI, SCI, burn injury, or stroke (N=39). INTERVENTION PST is a metacognitive self-management intervention that teaches individuals a global strategy for addressing self-selected problems. Participants received up to 6 sessions of PST in person or via telephone during their care recipient's inpatient stay. MAIN OUTCOME MEASURES We measured feasibility of recruitment, intervention delivery, and postintervention use of a smartphone app (Care Partner Problem Solving [CaPPS]) and participant satisfaction (Client Satisfaction Questionnaire [CSQ]) and engagement (Pittsburgh Rehabilitation Participation Scale [PRPS]) with the intervention. RESULTS Of 39 care partners approached, n=10 (25.6%) were ineligible. Of n=29 (74.4%) who were eligible, n=17 (58.6%) refused, and n=12 (41.4%) consented, of whom n=8 (66.7%) completed ≥3 PST sessions. Not perceiving any benefit was the most common reason for refusal, followed by no interest in research. Participants were very satisfied with PST (CSQ mean=3.35, SD=0.60), reported strong working alliance (Working Alliance Inventory mean=6.8, SD=3.1), and demonstrated very good engagement (PRPS mean=4.75, SD=1.41). CaPPS was downloaded and used by only n=3 participants. CONCLUSIONS Delivering a self-management intervention to care partners during the care recipient's acute hospital stay is feasible for a subset of potential participants. Short lengths of stay, language fluency, and perceiving no potential benefit were noted barriers. Boosters via smartphone app have potential, but several barriers must first be overcome.
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Affiliation(s)
- Shannon B. Juengst
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Rehabilitation Counseling, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Candice L. Osborne
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Radha Holavanahalli
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Valeria Silva
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Chung Lin Kew
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Rehabilitation Counseling, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Andrew Nabasny
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Rehabilitation Counseling, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kathleen R. Bell
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
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Gueler JR, McMullen K, Kowalske K, Holavanahalli R, Fauerbach JA, Ryan CM, Stoddard FJ, Wiechman SA, Roaten K. Exploratory analysis of long-term physical and mental health morbidity and mortality: A comparison of individuals with self-inflicted versus non-self-inflicted burn injuries. Burns 2019; 46:531-538. [PMID: 31640886 DOI: 10.1016/j.burns.2019.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/20/2019] [Accepted: 09/12/2019] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Self-inflicted burn (SIB) injuries are relatively rare, but patients may experience complex biopsychosocial challenges. This study aimed to compare long-term physical and psychological outcomes for individuals with SIB and non-SIB injuries. METHODS Records of adult SIB (n = 125) and non-SIB (n = 3604) injuries were collected from U.S. burn centers within the Burn Model System between 1993 and 2018. Assessments were administered at discharge, 6 months, 24 months, 5 years, and 10 years. RESULTS SIB patients were more often younger, unmarried, unemployed, male, struggling with pre-morbid psychiatric issues, and injured by fire/flame (all p < 0.001). SIB injury predicted prolonged mechanical ventilation, hospitalization, and rehabilitation (all p < 0.001). After injury, SIB patients had increased anxiety at 24 months (p = 0.0294), increased suicidal ideation at 5 years (p = 0.004), and clinically worse depression at 10 years (p = 0.0695). SIB patients had increased mortality across 24 months compared to non-SIB patients (OR = 4.706, p = 0.010). CONCLUSION SIB injuries are associated with worse physical and psychological outcomes compared to non-SIB injuries including complicated hospitalizations and chronic problems with anxiety, depression, suicidality, and mortality, even when controlling for common indicators of severity such as burn size. This underscores the importance of multidisciplinary treatment, including mental healthcare, and long-term follow-up for SIB patients. Identified pre-morbid risk factors indicate the need for targeted injury prevention.
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Affiliation(s)
| | - Kara McMullen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Karen Kowalske
- Department of Physical Medicine & Rehabilitation, UT Southwestern Medical Center, Dallas, TX, USA
| | - Radha Holavanahalli
- Department of Physical Medicine & Rehabilitation, UT Southwestern Medical Center, Dallas, TX, USA
| | - James A Fauerbach
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Colleen M Ryan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Shriners Hospital for Children, Boston, MA, USA
| | - Frederick J Stoddard
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Shriners, USA
| | - Shelley A Wiechman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Kimberly Roaten
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA.
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Vu K, Holavanahalli R, Kowalske K. Functional Outcomes in Patients With Hand Burns. Arch Phys Med Rehabil 2019. [DOI: 10.1016/j.apmr.2019.08.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Gerber LH, Bush H, Holavanahalli R, Esselman P, Schneider J, Heinemann A, Garfinkel S, Cai C. A scoping review of burn rehabilitation publications incorporating functional outcomes. Burns 2019; 45:1005-1013. [DOI: 10.1016/j.burns.2018.09.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 03/23/2018] [Accepted: 09/28/2018] [Indexed: 10/28/2022]
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Chin TL, Carrougher GJ, Amtmann D, McMullen K, Herndon DN, Holavanahalli R, Meyer W, Ryan CM, Wong JN, Gibran NS. Trends 10 years after burn injury: A Burn Model System National Database study. Burns 2018; 44:1882-1886. [PMID: 30385060 PMCID: PMC10085112 DOI: 10.1016/j.burns.2018.09.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 07/15/2018] [Accepted: 09/28/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Burn Specific Health Scale-Brief (BSHS-B) evaluates 9 aspects of health and has been validated globally. Existing reports typically focus on outcomes shortly after injury. The purpose of this study is to determine whether quality of life remains a concern for burn survivors ten years after-injury. METHODS Cross sectional data of survivors admitted from 1994 to 2006 to four US burn centers were collected in the Burn Model System National Database 10 years after injury. Responses to the items in the nine BSHS-B domains range from 0 to 4. Lower scores indicating poorer quality of life. Median scores are reported and differences were compared using Wilcoxon-Mann-Whitney test. RESULTS Ten-year survivor injury characteristics suggest a moderate severity of injury. Survivors scored lower in heat sensitivity, affect, body image, and work (median=3.2, 3.6, 2.8, and 3.6, respectively). Affect, body image, and interpersonal scores were significantly lower for females (median=3.1, 2.8, 3.8, respectively) than males [median=3.6, 3.3, 4, respectively (p=0.008, 0.004, 0.022, respectively)]. CONCLUSIONS Our results suggest certain domains of burn specific health benefit from support at 10 years after injury, and select populations such as females may necessitate additional treatment to restore burn-specific health. These results support that burn injuries represent a chronic condition and long-term medical and psychosocial support may benefit burn survivor recovery.
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Wiechman S, Holavanahalli R, Roaten K, Rosenberg L, Rosenberg M, Meyer W, Smith B, Carrougher G, Ceranoglu T, Gibran N. 63 The Relation Between Satisfaction with Appearance and Ethnicity. J Burn Care Res 2018. [DOI: 10.1093/jbcr/iry006.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- S Wiechman
- University of Washington/Harborview Medical Center, Seattle, WA; UT Southwestern, Dallas, TX; Shriners Hospital for Children-Galveston, Galveston, TX; Shriners Hospital for Children-Boston, Boston, MA
| | - R Holavanahalli
- University of Washington/Harborview Medical Center, Seattle, WA; UT Southwestern, Dallas, TX; Shriners Hospital for Children-Galveston, Galveston, TX; Shriners Hospital for Children-Boston, Boston, MA
| | - K Roaten
- University of Washington/Harborview Medical Center, Seattle, WA; UT Southwestern, Dallas, TX; Shriners Hospital for Children-Galveston, Galveston, TX; Shriners Hospital for Children-Boston, Boston, MA
| | - L Rosenberg
- University of Washington/Harborview Medical Center, Seattle, WA; UT Southwestern, Dallas, TX; Shriners Hospital for Children-Galveston, Galveston, TX; Shriners Hospital for Children-Boston, Boston, MA
| | - M Rosenberg
- University of Washington/Harborview Medical Center, Seattle, WA; UT Southwestern, Dallas, TX; Shriners Hospital for Children-Galveston, Galveston, TX; Shriners Hospital for Children-Boston, Boston, MA
| | - W Meyer
- University of Washington/Harborview Medical Center, Seattle, WA; UT Southwestern, Dallas, TX; Shriners Hospital for Children-Galveston, Galveston, TX; Shriners Hospital for Children-Boston, Boston, MA
| | - B Smith
- University of Washington/Harborview Medical Center, Seattle, WA; UT Southwestern, Dallas, TX; Shriners Hospital for Children-Galveston, Galveston, TX; Shriners Hospital for Children-Boston, Boston, MA
| | - G Carrougher
- University of Washington/Harborview Medical Center, Seattle, WA; UT Southwestern, Dallas, TX; Shriners Hospital for Children-Galveston, Galveston, TX; Shriners Hospital for Children-Boston, Boston, MA
| | - T Ceranoglu
- University of Washington/Harborview Medical Center, Seattle, WA; UT Southwestern, Dallas, TX; Shriners Hospital for Children-Galveston, Galveston, TX; Shriners Hospital for Children-Boston, Boston, MA
| | - N Gibran
- University of Washington/Harborview Medical Center, Seattle, WA; UT Southwestern, Dallas, TX; Shriners Hospital for Children-Galveston, Galveston, TX; Shriners Hospital for Children-Boston, Boston, MA
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Goverman J, Mathews K, Goldstein R, Holavanahalli R, Kowalske K, Esselman P, Gibran N, Suman O, Herndon D, Ryan CM, Schneider JC. Adult Contractures in Burn Injury: A Burn Model System National Database Study. J Burn Care Res 2018; 38:e328-e336. [PMID: 27380122 PMCID: PMC10032147 DOI: 10.1097/bcr.0000000000000380] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
As the overall survival rate for burn injury has improved, increased emphasis is placed on postburn morbidity and the optimization of functional and cosmetic outcomes. One major cause of morbidity and functional deficits is that of joint contractures. The true incidence of postburn contractures and their associated risk factors remains unknown. This study examines the incidence and severity of contractures in a large, multicenter, burn population. The associated risk factors for the development of contractures are determined. Data from the National Institute on Disability and Rehabilitation Research Burn Model System database, for adult burn survivors from 1994 to 2003, were analyzed. Demographic and medical data were collected on each subject. The primary outcome measures included the presence of contractures, number of contractures per patient, and severity of contractures at each of nine locations (shoulder, elbow, hip, knee, ankle, wrist, neck, lumbar spine, and thoracic spine) at time of hospital discharge. Regression analysis was performed to determine predictors of the presence, severity, and numbers of contractures, with P < .05 used for statistical significance. Of the 1865 study patients, 620 (33%) developed at least 1 contracture at hospital discharge. Among those with at least one contracture, the mean is three (3.38) contractures per person. The shoulder was the most frequently contracted joint (23.0%), followed by the elbow (19.9%), wrist (17.3%), ankle (13.6%), and knee (13.4%). Most contractures were mild (47.2%) or moderate (32.9%) in severity. Statistically significant predictors of contracture development were male sex, black race, Hispanic ethnicity, medical problems, neuropathy, TBSA grafted, and TBSA burned. Predictors of the severity of contracture included male sex, black race, medical problems, neuropathy, TBSA grafted, and TBSA burned. Predictors of the number of contractures included male sex, medical problems, flash burn, neuropathy, TBSA burned, and TBSA grafted. Similar to a previous single-center study on postburn contractures, approximately one third of the patients with an eligible burn injury requiring autografting developed a contracture at hospital discharge. It is likely that these contractures develop despite early therapeutic interventions such as positioning and splinting; therefore, the challenge to the burn community remains, to identify new and better prevention strategies.
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Affiliation(s)
- Jeremy Goverman
- Surgical Services, Sumner Redstone Burn Center, Massachusetts General Hospital, Boston
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Shriners Hospitals for Children®-Boston, Massachusetts
| | - Katie Mathews
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Richard Goldstein
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Radha Holavanahalli
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas
| | - Karen Kowalske
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas
| | - Peter Esselman
- Department of Surgery, University of Washington Medicine Regional Burn Center, University of Washington, Seattle
| | - Nicole Gibran
- Department of Surgery, University of Washington Medicine Regional Burn Center, University of Washington, Seattle
| | - Oscar Suman
- University of Texas Medical Branch, Shriners Hospitals for Children, Galveston
| | - David Herndon
- University of Texas Medical Branch, Shriners Hospitals for Children, Galveston
| | - Colleen M. Ryan
- Surgical Services, Sumner Redstone Burn Center, Massachusetts General Hospital, Boston
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Shriners Hospitals for Children®-Boston, Massachusetts
| | - Jeffrey C. Schneider
- Surgical Services, Sumner Redstone Burn Center, Massachusetts General Hospital, Boston
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Shriners Hospitals for Children®-Boston, Massachusetts
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Amtmann D, McMullen K, Bamer A, Fauerbach JA, Gibran NS, Herndon D, Schneider JC, Kowalske K, Holavanahalli R, Miller AC. National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System: Review of Program and Database. Arch Phys Med Rehabil 2017; 101:S5-S15. [PMID: 28989076 DOI: 10.1016/j.apmr.2017.09.109] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 09/01/2017] [Accepted: 09/06/2017] [Indexed: 10/18/2022]
Abstract
The Burn Model System (BMS) centers program was created in 1994 to evaluate the long-term outcomes of burn injuries. As part of this multicenter program, a comprehensive longitudinal database was developed to facilitate the study of a number of functional and psychosocial outcomes after burn injury. In this article, we provide an overview of the data collection procedures, measures selection process, and an overview of the participant data collected between 1994 and 2016. Surveys were administered during hospitalization and at 6, 12, and 24 months after discharge, and in the most recent funding cycle, data collection at every 5 years postinjury was added. More than 7200 people with burn injury were eligible to participate in the BMS National Longitudinal Database. Of these, >5900 (82%) were alive at discharge and consented to follow-up data collection. The BMS National Longitudinal Database represents a large sample of people with burn injury, including information on demographic characteristics, injury characteristics, and health outcomes. The database is publicly available and can be used to examine the effect of burn injury on long-term outcomes.
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Affiliation(s)
- Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA.
| | - Kara McMullen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Alyssa Bamer
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | | | - Nicole S Gibran
- Department of Surgery, University of Washington, Seattle, WA
| | | | | | - Karen Kowalske
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | - A Cate Miller
- Administration on Community Living, U.S. Department of Health and Human Services, National Institute on Disability, Independent Living, and Rehabilitation Research, Washington, DC
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Gerrard P, Kazis LE, Ryan CM, Shie VL, Holavanahalli R, Lee A, Jette A, Fauerbach JA, Esselman P, Herndon D, Schneider JC. Validation of the Community Integration Questionnaire in the adult burn injury population. Qual Life Res 2015; 24:2651-5. [DOI: 10.1007/s11136-015-0997-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2015] [Indexed: 11/25/2022]
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Smith MT, Klick B, Kozachik S, Edwards RE, Holavanahalli R, Wiechman S, Blakeney P, Lezotte D, Fauerbach JA. Sleep onset insomnia symptoms during hospitalization for major burn injury predict chronic pain. Pain 2008; 138:497-506. [PMID: 18362052 DOI: 10.1016/j.pain.2008.01.028] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Revised: 12/23/2007] [Accepted: 01/22/2008] [Indexed: 01/17/2023]
Abstract
Both cross-sectional studies of chronic pain and sleep deprivation experiments suggest a bi-directional relationship between sleep and pain. Few longitudinal studies, however, have assessed whether acute insomnia following traumatic injury predicts the development of persistent pain. We sought to evaluate (1) whether in-hospital insomnia independently predicts long-term pain after burn injury and (2) whether in-hospital pain predicts future insomnia symptoms. We analyzed data on 333 subjects hospitalized for major burn injury (72.7% male; mean age=41.1+/-14.5years) who were participating in the multi-site, Burn Model System project. Subjects completed measures of health, function (SF-36), and psychological distress (Brief Symptom Inventory) while in hospital, at 6, 12, and 24months after discharge. Participants were categorized as either having or not having sleep onset insomnia at discharge. Linear mixed effects analyses revealed that persons reporting insomnia at discharge (40.5%) had significantly decreased improvement in pain and increased pain severity during long-term follow-up (p<0.001). More severe pain during the week preceding hospital discharge, time from injury, lack of college education and older age also contributed independent effects on chronic pain (p<0.05). In a reciprocal model (N=299), more severe pain during the week preceding discharge predicted increased rates of long-term sleep onset insomnia. In-hospital insomnia and pre-burn mental health symptoms were also highly significant predictors of insomnia. This study provides support for a long-term, prospective and reciprocal interaction between insomnia and pain. Future work should ascertain whether treatment of insomnia and pain during acute injury can prevent or minimize chronic pain.
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Affiliation(s)
- Michael T Smith
- Johns Hopkins University School of Medicine, Department of Psychiatry, USA Johns Hopkins University School of Nursing, USA University of Texas - Southwestern Medical Center, USA University of Washington, Harborview Burn Center, USA University of Texas, Medical Branch, USA University of Colorado, Health Sciences Center, USA
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17
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Edwards RR, Smith MT, Klick B, Magyar-Russell G, Haythornthwaite JA, Holavanahalli R, Patterson DR, Blakeney P, Lezotte D, McKibben J, Fauerbach JA. Symptoms of depression and anxiety as unique predictors of pain-related outcomes following burn injury. Ann Behav Med 2008. [PMID: 18020941 DOI: 10.1080/08836610701677725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The adverse consequences of burn injuries include pain and psychological distress, which show bidirectional associations. However, much of the existing research has relied on global measures of distress that do not separate distinct symptoms of anxiety and depression. PURPOSE The purpose is to assess the prospective effects of anxiety and depression on pain and functional outcomes following burn injury. METHODS This article describes a 2-year cohort study in patients hospitalized for serious burn injuries (assessments at discharge and 6-month, 1-year, and 2-year follow-up). Linear mixed effects analyses were conducted to model anxiety and depression's unique longitudinal effects; at each time point, depressive and anxiety symptoms were studied as predictors of subsequent changes in pain, fatigue, and physical function. RESULTS When studied in separate prediction models, both depression and anxiety were strong prospective predictors of greater pain, more fatigue, and physical dysfunction at the subsequent time point (ps < .01). However, when both were included in a single model to study their unique effects, depressive symptoms (but not anxiety) emerged as a significant predictor of subsequent increases in pain and reductions in physical functioning, whereas anxiety (but not depression) predicted subsequent elevations in fatigue. CONCLUSIONS These findings suggest potentially distinct effects of depression and anxiety and imply that assessment and early treatment of both depressive and anxiety symptoms may help improve a broad range of long-term pain-related outcomes following burn injury.
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Affiliation(s)
- Robert R Edwards
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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Fauerbach JA, McKibben J, Bienvenu OJ, Magyar-Russell G, Smith MT, Holavanahalli R, Patterson DR, Wiechman SA, Blakeney P, Lezotte D. Psychological distress after major burn injury. Psychosom Med 2007; 69:473-82. [PMID: 17585064 PMCID: PMC5788166 DOI: 10.1097/psy.0b013e31806bf393] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To track the prevalence and stability of clinically significant psychological distress and to identify potentially modifiable in-hospital symptoms predictive of long-term distress (physical, psychological, and social impairment). METHOD We obtained data from the Burn Model Systems project, a prospective, multisite, cohort study of major burn injury survivors. The Brief Symptom Inventory (BSI) was used to assess symptoms in-hospital (n = 1232) and at 6 (n = 790), 12 (n = 645), and 24 (n = 433) months post burn. Distress was examined dimensionally (BSI's Global Severity Index (GSI)) and categorically (groups formed by dichotomizing GSI: T score > or =63). Attrition was unrelated to in-hospital GSI score. RESULTS Significant in-hospital psychological distress occurred in 34% of the patients, and clinically significant and reliable change in symptom severity by follow-up visits occurred infrequently. Principal components analysis of in-hospital distress symptoms demonstrated "alienation" and "anxiety" factors that robustly predicted distress at 6, 12, and 24 months, controlling for correlates of baseline distress. CONCLUSIONS This is the largest prospective, multisite, cohort study of patients with major burn injury. We found that clinically significant in-hospital psychological distress was common and tends to persist. Two structural components of in-hospital distress seemed particularly predictive of long-term distress. Research is needed to determine if early recognition and treatment of patients with in-hospital psychological distress can improve long-term outcomes.
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Affiliation(s)
- James A Fauerbach
- Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
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Klein MB, Lezotte DL, Fauerbach JA, Herndon DN, Kowalske KJ, Carrougher GJ, deLateur BJ, Holavanahalli R, Esselman PC, San Agustin TB, Engrav LH. The National Institute on Disability and Rehabilitation Research Burn Model System Database: A Tool for the Multicenter Study of the Outcome of Burn Injury. J Burn Care Res 2007; 28:84-96. [PMID: 17211206 DOI: 10.1097/bcr.0b013e31802c888e] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Advances in critical care and surgical management have significantly improved survival after burn injury over the past several decades. However, today, survival alone is an insufficient outcome. In 1994, the National Institute on Disability and Rehabilitation Research (NIDRR) created a burn model system program to evaluate the long-term sequelae of burn injuries. As part of this multicenter program, a comprehensive demographic and outcome database was developed to facilitate the study of a number of functional and psychosocial outcomes after burns. The purpose of this study is to review the database design and structure as well as the data obtained during the last 10 years. This is a descriptive study of the NIDRR database structure as well as the patient data obtained from the four participating burn centers from 1994 to 2004. Data obtained during hospitalization and at 6, 12, and 24 months after discharge were reviewed and descriptive statistics were calculated for select database fields. The database is divided into several subsections, including demographics, injury complications, patient disposition, and functional and psychological surveys. A total of 4600 patients have been entered into the NIDRR database. To date, 3449 (75%) patients were alive at discharged and consented to follow-up data collection. The NIDRR database provides an expansive repository of patient, injury, and outcome data that can be used to analyze the impact of burn injury on physical and psychosocial function and for the design of interventions to enhance the quality of life of burn survivors.
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Affiliation(s)
- Matthew B Klein
- Division of Plastic Surgery and the Burn Center, Department of Surgery, Harborview Medical Center, University of Washington, Seattle, Washington 98104, USA
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20
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Abstract
This study prospectively examined the incidence and severity of large joint contractures after burn injury and determined predictors of contracture development. Data were collected prospectively from 1993 to 2002 for consecutive adult burn survivors admitted to a regional burn center. Demographic and medical data were collected on each subject. The primary outcome measures included the presence of contractures, number of contractures per patient, and severity of contractures at each of four joints (shoulder, elbow, hip, knee) at time of hospital discharge. Logistic regression analysis was performed to determine predictors of the presence and severity of contractures and a negative binomial regression was performed to determine predictors of the number of contractures. Of the 985 study patients, 381 (38.7%) developed at least one contracture at hospital discharge. Among those with at least one contracture, the mean is three contractures per person. The shoulder was the most frequently contracted joint (38%), followed by the elbow (34%) and knee (22%). Most contractures were mild (60%) or moderate (32%) in severity. Statistically significant predictors of contracture development were length of stay (P < .005) and extent of burn (P = .033) and graft (P < .005). Predictors of the severity of contracture include graft size (P < .005), amputation (P = .034), and inhalation injury (P = .036). More than one third of the patients with a major burn injury developed a contracture at hospital discharge, which highlights the importance of therapeutic positioning and intensive therapy intervention during acute hospitalization. Furthermore, this challenges the burn care community to find new and better ways of preventing contractures after burn injury.
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Affiliation(s)
- Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Boston, Massachusetts 02114, USA
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21
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Abstract
Impairment rating is regularly reported for trauma and other conditions but rarely for burns. The purposes of this study were: (1) to report impairment collected prospectively at our burn center, (2) to relate this impairment to measures of psychosocial and functional outcome, and (3) to compare these data to similar data from another burn center to verify that rating impairment is standardized and that the impairments are similar. We studied 139 patients from the University of Washington (UW) Burn Center and 100 patients from the University of Texas (UT) Southwestern Burn Center. The average whole person impairment (WPI) ratings at the University of Washington were 17% and this correlated with total body surface area burned and days off work. It did not correlate with Brief Symptom Inventory (BSI), Functional Independence Measure (FIM), Short-Form 36-Item Health Survey (SF-36), Satisfaction With Life Scale (SWLS), and the Community Integration Questionnaire (CIQ). Average whole person impairment ratings at UT Southwestern were similar at 19%. Several components of the impairment rating, however, differed at the two institutions. To minimize this variation, we recommend: (1) use the skin impairment definitions of the fifth edition of the Guides to the Evaluation of Permanent Impairment (or the most recent published versions of the Guide), and (2) include sensory impairment in healed burns and skin grafts in the skin impairment.
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Affiliation(s)
- B A Costa
- Division of Plastic Surgery, Department of Surgery, University of Washington Burn Center, Harborview Medical Center, 325 Ninth Avenue, 98104, Seattle, WA, USA
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Cromes GF, Holavanahalli R, Kowalske K, Helm P. Predictors of quality of life as measured by the Burn Specific Health Scale in persons with major burn injury. J Burn Care Rehabil 2002; 23:229-34. [PMID: 12032377 DOI: 10.1097/00004630-200205000-00016] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
To determine 1) change over time in Quality of Life (QOL) and 2) functional, community reentry, and psychosocial predictors of QOL, data were prospectively collected from adults with major burn injury 2 months after hospital discharge (n = 110) and 6 (n = 97) and 12 (n = 69) months after injury. The dependent QOL variable was the Burn Specific Health Scale (BSHS) and the predictor variables were Brief Symptom Inventory, Functional Assessment Screening Questionnaire, Functional Independence Measure, Pain Analog Scale, and Community Integration Questionnaire. BSHS global scores were unchanged across the measurement periods. Stepwise multiple-regression analyses resulted in statistically significant multiple Rs of.79 at 2 months,.81 at 6 months, and.76 at 12 months. Variables predicting more favorable BSHS global score were less emotional distress and pain at 2 months, less emotional distress and pain and better community reentry at 6 months, and less emotional distress and better community reentry at 12 months.
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Affiliation(s)
- G F Cromes
- University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9055, USA
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Abstract
The purpose of this study was to evaluate the incidence of neuropathy in a consecutive cohort of patients with major burn injuries and investigate the clinical correlates for both mononeuropathy and generalized peripheral polyneuropathy. Of 572 patients examined, 64 (11%) patients had clinical evidence of mononeuropathy or peripheral neuropathy or both. Associations of mononeuropathy and peripheral neuropathy with potential risk factors were identified using logistic regression analyses. Electrical cause (odds ratio [OR] = 4.1022, P < .01), history of alcohol abuse (OR = 2.2893, P <.05), and number of days in intensive care (OR = 1.0457, P < .001) were significantly associated with mononeuropathy. The number of days in intensive care (OR = 1.0740, P < .001) and patient age (OR = 1.0543, P < .01) were significantly associated with peripheral neuropathy. This study demonstrates that neuropathy is a common complication of severe burn injury in patients who are older, critically ill, have an electrical cause, or history of alcohol abuse.
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Affiliation(s)
- K Kowalske
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center at Dallas, 75390-9055, USA
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