Quality of life and predictors of long-term outcome after severe burn injury

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.

Long-Term Functional Outcomes after Hand Burns: A Monocentric Controlled Cohort Study

Background: Hand burns are involved in 80-90% of severe burn injuries. Even though hands correspond to a small total burn surface area (TBSA) of less than 5%, the loss of their functionality has a significant impact on the patient's life. Studies that provide long-term results regarding hand functionality after hand burns are scarce. Therefore, this study aimed to investigate functional long-term results in a patient-centric approach regarding burn depth, unilateral and bilateral hand involvement, and (non-)isolated hand burns as potential influencing factors in patients with hand burns. Methods: We conducted a controlled cohort study of patients with burned hands treated at our department between 2005 and 2022. Healthy age-, sex-, and handedness-matched participants were used as controls. Data on the demographics, burn-related injuries, and treatments were collected. For a patient-centric approach, we used the Disabilities of the Arm, Shoulder, and Hand Questionnaire (Quick-DASH) and the Michigan Hand Questionnaire (MHQ) as patient-reported outcome measures for functional long-term evaluation, and the Patient and Observer Scar Assessment Scale (patient scale) for assessing long-term scar quality. Results: We enrolled 61 patients with 88 affected hands and 63 matched control participants. Up to 77.1% of the participants were male, with a mean age of 50.7 (±15.5) years and a follow-up of 8.1 (±4.7) years. The mean TBSA was 13.9% (±15.8), with 72.4% of the hands presenting with deep partial-thickness and full-thickness burns and most of the patients had only one hand affected (55.7%). The hand burn patients perceived significantly worse long-term functional scores in every domain of the MHQ as well as in the "overall function" and "work" of the Quick-DASH. Superficial hand burns negatively affected the two-handed activities of daily living (p = 0.013) and aesthetic appearance (p = 0.005) when both hands were involved. Isolated hand burns were associated with more difficulties in work performance (p = 0.03), whereas patients with bilateral hand involvement perceived more pain (p = 0.025). Conclusions: The patients with hand burns can achieve satisfactory long-term functional outcomes over time, but they do not reach the same long-term hand functionality as the healthy matched control group. Our study revealed that factors such as burn depth, unilateral or bilateral hand involvement, and (non-)isolated hand burns indeed have an impact on certain aspects of perceived long-term hand functionality.

Early predictors of health-related quality of life outcomes at 12 months post-burn: ABLE study

There remains a paucity of evidence on the early predictors of long-term Health-Related Quality of Life (HRQoL) outcomes post-burn in hospitalised adults. The overall aim of this study was to identify the factors (personal, environmental, burn injury and burn treatment factors) that may predict long-term HRQoL outcomes among adult survivors of hospitalised burn injuries at 12 months post-burn. A total of 274 participants, aged 18 years or over, admitted to a single state-wide burn centre with a burn injury were recruited. Injury and burn treatment information were collected from medical records or the hospital database and surveys collected demographic and social data. HRQoL outcome data were collected at 3-, 6- and 12-months using the 12-Item Short Form Survey (SF-12 v1) and Burns Specific Health Scale-Brief (BSHS-B). Personal, environmental, burn injury and burn treatment factors were also recorded at baseline. Analyses were performed using linear and logistic regression. Among 274 participants, 71.5 % (N=196) remained enrolled in the study at 12 months post-burn. The majority of participants reported HRQoL outcomes comparable with population norms and statistically significant improvements in generic (SF-12 v1) and condition-specific (BSHS-B) outcomes over time. However, for participants with poor HRQoL outcomes at 12-months post-burn, Univariable predictors included longer hospital length of stay, unemployment at the time of injury, a diagnosed pre-injury mental health condition, inadequate pre-burn social support, intentional injury, recreational drug use pre-injury and female gender. The early multivariable predictors of insufficient HRQoL outcomes were female gender, a previously diagnosed mental health condition, unemployment, inadequate social support, intentional injury, and prolonged hospital length of stay. These results suggest potential factors that could be used to screen and burns patients for psychosocial intervention and long-term follow up.

Physical and psychosocial outcomes among burn-injured people with heterotopic ossification: A burn model system study

INTRODUCTION

Heterotopic ossification (HO), or ectopic bone formation in soft tissue, is a not so rare and poorly understood debilitating sequela of burn injury. Individuals developing HO following burn injuries to their hands often experience reductions in mobility, significant contractures, and joint pain. This study identifies demographic characteristics of individuals who develop HO and compares their physical and psychosocial outcomes to the general burn population.

METHODS

Participant demographics, injury characteristics, and PROMIS-29 scores across three time points (discharge, six- and 12- months after injury) were extracted from the Burn Model System National Longitudinal Database representing participants from 2015-2022. Mixed-effects linear regression models were used to compare PROMIS scores across all three longitudinal measurements. Models were adjusted for age, sex, race/ethnicity, HO status, and burn size.

RESULTS

Of the 861 participants with data concerning HO, 33 were diagnosed with HO (3.8% of participants). Most participants with HO were male (n = 24, 73%) and had an average age of 40 + /- 13 years. Participants with HO had significantly larger burn size (49 +/-23% Total Body Surface Area (TBSA)) than those without HO (16 +/-17%). Participants with HO reported significantly worse physical function, depression, pain interference and social integration scores than those without HO. After adjusting for covariables, participants with HO continued to report statistically significantly worse physical function than those without HO. Although physical functioning was consistently lower, the two populations did not differ significantly among psychosocial outcome measures.

CONCLUSIONS

While HO can result in physical limitations, the translation to psychosocial impairments was not evident. Targeted treatment of HO with the goal of maximizing physical function should be a focus of their rehabilitation.

LEVEL OF EVIDENCE

2b TYPE OF STUDY: Symptom Prevalence Study.

Upregulation of MAOA in the hippocampus results in delayed depressive-like behaviors in burn mice

OBJECTIVE

To observe depressive-like behavior and hippocampus monoamine oxidase A (MAOA) changes in burned mice.

METHODS

We tested depression and anxiety like behaviors of burn C57 mice with the sucrose preference test, forced swimming test (FST), open field test and elevated plus maze test and then detected the MAOA content and MAOA gene transcriptional levels in the hippocampus with western blot analysis and real-time quantitative PCR analysis. We then sought to reverse depressive-like behavior of burned mice with an MAOA inhibitor.

RESULTS

(1) Mice showed depressive and anxiety like behaviors one week after they were burned; (2) The content of MAOA in the hippocampus of burned mice was significantly higher than that in control mice (P<0.05); (3) MAOA gene transcription in the hippocampus of burned mice was significantly increased (MAOA mRNA was increased, P<0.05); (4) treatment with a MAOA inhibitor (phenelzine) significantly increased the sucrose preference rate and decreased FST immobility time in burned mice, and also decreased elevated expression of MAOA in the hippocampus of burned mice.

CONCLUSION

Burned mice showed "delayed" depressive-like behavior combined with a degree of anxiety; this phenomenon is likely associated with the increase in MAOA expression in the hippocampus.

Outcomes that matter most to burn patients: A national multicentre survey study in the Netherlands

BACKGROUND

The use of patient-reported outcomes to improve burn care increases. Little is known on burn patients' views on what outcomes are most important, and about preferences regarding online Patient Reported Outcome Measures (PROMs). Therefore, this study assessed what outcomes matter most to patients, and gained insights into patient preferences towards the use of online PROMs.

METHODS

Adult patients (≥18 years old), 3-36 months after injury completed a survey measuring importance of outcomes, separately for three time periods: during admission, short-term (<6 months) and long-term (6-24 months) after burn injury. Both open and closed-ended questions were used. Furthermore, preferences regarding the use of patient-reported outcome measures in burn care were queried.

RESULTS

A total of 140 patients were included (response rate: 27%). 'Not having pain' and 'good wound healing' were identified as very important outcomes. Also, 'physical functioning at pre-injury level', 'being independent' and 'taking care of yourself' were considered very important outcomes. The top-ten of most important outcomes largely overlapped in all three time periods. Most patients (84%) had no problems with online questionnaires, and many (67%) indicated that it should take up to 15 minutes. Patients' opinions differed widely on the preferred frequency of follow-up.

CONCLUSIONS

Not having pain and good wound healing were considered very important during the whole recovery of burns; in addition, physical functioning at pre-injury level, being independent, and taking care of yourself were deemed very important in the short and long-term. These outcomes are recommended to be used in burn care and research, although careful selection of outcomes remains crucial as patients prefer online questionnaires up to 15 minutes.

Post Intensive Care Syndrome (PICS) physical, cognitive, and mental health outcomes 6-months to 7 years after a major burn injury: A cross-sectional study

OBJECTIVES

The Post Intensive Care Syndrome (PICS) has been described in intensive care (ICU) survivors, being present in 50% of patients surviving 12 months, with well-defined risk factors. Severely burned patients combine many of these risk factors, but the prevalence of PICS has not yet been documented in burns. The study aimed to answer this question and identify associations of PICS with clinical characteristics.

METHODS

Cross-sectional descriptive study of major burn survivors admitted to the burn ICU between 2013 and 2019. Main inclusion criteria: major burns>20 %BSA and ICU admission. The PICS components were assessed using three questionnaires: 1) Physical with Burn Specific Health Scale-Brief (BSHS-B); 2) Cognitive health with MacNair Cognitive Difficulties Self-Rating Scale (CDS); 3) Mental health with the Hospital Anxiety and Depression Scale (HADS) questionnaire. PICS was considered present if at least one component out of three was abnormal. Data as mean±SD.

RESULTS

Among the 288 patients admitted during the period, 132 met the inclusion criteria: 53 patients were finally enrolled. They were aged 44 ± 18 years at the time of injury and burned 24 ± 20 BSA % and stayed 25 ± 44 days in the ICU. PICS was identified in 35 patients (66 %): more than one component was altered in 21 patients (60 %). Principal risk factors were more than 3 general anesthetics, prolonged mechanical ventilation (>4 days), ICU stay (>8 days), and hospital stay (>25 days) CONCLUSION: PICS occurred in 66 % of major burns with two or three components affected simultaneously in 60 %, i.e. more frequently than in general ICU patients.

Why is priority setting important for global burn care research?

The use of robust evidence is a key component of providing high quality care to patients. Synthesised evidence to support clinical decision-making is lacking for many aspects of clinical burn care. Identifying the most important areas of care that lack high quality evidence and requires research is necessary, as funding for primary research is limited. Priority setting research studies are a joint endeavour between patients, carers and clinicians to identify and rank topics for research in a healthcare area in order to reduce research waste. Such an exercise has yet to be undertaken in burns. The aim of this paper is to outline the importance of research prioritisation in burn care, to discuss how it facilitates the maximum benefit from limited research funding and to explain the methodologies used.

Mindfulness and its Positive Effect on Quality of Life among Chronic Burn Survivors: A descriptive Correlational Study

BACKGROUND

Burns are a global public health phenomenon accounting for 180,000 deaths yearly. Burn wounds were considered among the most devastating injuries worldwide and is the fourth most common type of injury globally. It is also negatively associated with the quality of life of those patients. Improving the quality of life and mindfulness could be helpful in those survivors after burn injury to deal with others. Based on the findings of the study, there remains limited knowledge about the unique role of mindfulness in improving the quality of life of burn survivors. Therefore, this study aims to identify the role of mindfulness in improving the QOL of Jordanian burn survivors.

METHODS

A descriptive correlational design was used to answer the research questions. A convenience sample of 212 participants took part in the study. Participants completed measures regarding the quality of life and mindfulness.

RESULTS

Some demographic and clinical variables were associated with quality of life. The burn-related QOL was significantly and positively correlated with mindfulness (r = .294, p < 0.01). Mindfulness explained a distinctive variance in burn-related quality of life among the study participants.

CONCLUSION

This study identified the role of various factors in the burn-related quality of life among burn survivors. Mindfulness could have an important role in improving the burn-related quality of life among burn survivors.

Self-reported health measures in burn survivors undergoing burn surgery following acute hospitalization: A burn model system national database investigation

INTRODUCTION

Health Related Quality of Life (HRQoL) surveys such as PROMIS-29 may facilitate shared decision-making regarding surgery after burn injury. We aimed to examine whether scar revision and contracture release surgery after index hospitalization was associated with differences in HRQoL.

METHODS

Patient and PROMIS-29 Profile v2.0 data were extracted from the Burn Model System (BMS) at 6-, 12-, and 24-months after burn. PROMIS-29 measures 7 health-related domains. Linear regression was performed to identify associations between independent burn patient variables (e.g. scar-related surgery) and PROMIS-29 scores. Socio-demographic and injury variables were analyzed using logistic regression to determine the likelihood of undergoing burn-related surgery.

RESULTS

Of 727 participants, 201 (27.6%) underwent ≥ 1 scar/contracture operation within 24 months of injury. Number of operations at index hospital admission and range of motion (ROM) deficit at discharge were correlated with an increased likelihood of undergoing subsequent scar/contracture surgery (p < 0.05). Participants undergoing scar/contracture surgery and those that were Medicaid insured reported significantly worse HRQoL for PROMIS domains: anxiety, depression, and fatigue (p < 0.05).

CONCLUSIONS

After adjusting for burn severity and available confounders, participants who underwent scar-related burn reconstructive surgery after index hospitalization reported overall worse Health-Related Quality of Life (HRQoL) in multiple domains.

Life after Burn, Part I: Health-Related Quality of Life, Employment and Life Satisfaction

Background and Objectives: As advances in medicine are proceeding, so are treatment goals shifting from sheer mortality rates to improving HRQoL and social reintegration after burn injury. Following this trend, we aimed to assess HRQoL, employment and life satisfaction after burn injury to gain insight on confounding factors. Materials and Methods: This single-center follow-up study was conducted using the SF-36 V1.0 in German and further questions evaluating employment and life satisfaction. It reached 128 adult in-patients (recall 33.0%) with former burn injuries, treated between 2012 and 2019 at the Division of Plastic, Aesthetic and Reconstructive Surgery at the University Hospital of Graz. The questionnaire outcomes were set into relation with clinical data obtained from the medical records. Statistical analysis was performed with SPSS 27.0 for Windows. Results: Of the 128 participants, 72.7% were male and 27.3% female. The mean age at the time of injury was 40.0 ± 15.7 years and mean %TBSA among the study population was 9.2 ± 11.0%. The male patients had sustained more extensive injuries (p = 0.005). However, the female patients scored significantly (p < 0.05) and consistently lower in all the domains of the SF-36, except for “bodily pain” (p = 0.061). Moreover, the female patients scored lower in all the domains of life satisfaction, although significant differences were only found in the domains of fulfillment (p = 0.050) and mental wellbeing (p = 0.015). Furthermore, employment status differed significantly between the male and female patients before as well as after the burn injury. Proportionally less women were employed at both time points. Overall, unemployment had declined. Conclusions: Life satisfaction after burn injury in this study cohort seems to be good. Return to work has shown a promising trend. Strikingly, HRQoL and life satisfaction were lower in women after burn injury. Further research on the reasons for this gender discrepancy might improve HRQoL and life satisfaction after burns.

Graded aerobic exercise (GAEx): An effective exercise regimen to improve cardio-respiratory fitness and physical and psychosocial functioning in children with burn sequelae of the chest

PURPOSE

The cardio-respiratory function is compromised in children recovering from burns, particularly, those who sustain a burn injury across the chest, which leads to further prejudicial effects on physical and psychosocial health. This study endeavored to explore the efficacy of 12 weeks of graded aerobic exercise (GAEx) on the cardiorespiratory capacity and physical and psychosocial functioning in children with burn sequelae of the chest.

METHODS

Thirty-six burn-injured children aged 10-18 years (%TBSA: 24.2 ± 4.9, and 38.8 ± 12.9 months since injury) were randomly assigned to GAEx group (n = 18; undergone a 12-week intensity- and time-graded aerobic exercise program plus standard rehabilitation) or control group (n = 18; received the standard rehabilitation only). The cardio-respiratory fitness [marked by the peak oxygen uptake (VO_2peak), minute ventilation (V_E), ventilatory equivalent of inhaled oxygen (VEq/VO₂), oxygen pulse (O₂P), respiratory exchange ratio (RER), maximum heart rate (HR_max), and the heart rate recovery at one minute (HRR₁)] and physical and psychosocial functioning were assessed pre- and post-intervention.

RESULTS

Children in the GAEx group showed significant increases in VO_2peak (P = 0.013), V_E (P = 0.026), O₂P (P = 0.034), HR_max (P = 0.035), and HRR₁ (P = 0.04) and declines in VEq/VO₂ (P = 0.009) and RER (P = 0.011) as compared to the control group. Additionally, the GAEx group reported higher physical (P = 0.029) and psychosocial (P = 0.012) functioning.

CONCLUSION

Twelve weeks of GAEx has salutary effects on cardio-respiratory capacity and physical and psychosocial functioning in children with burn sequelae of the chest. These findings suggest that adding GAEx as a complementary therapy to the long-term rehabilitation protocol for this patient population is worthwhile.

Beyond the acute phase: understanding relationships among cardio-respiratory response to exercises, physical activity levels, and quality of life in children after burn injuries

The long-term cardiorespiratory function in burn-injured children can be jeopardized due to complications brought on by the injury. This study sought to assess the cardio-respiratory responses to maximal exercise in children who sustained a burn injury and explore the relationships among cardio-respiratory response, physical activity levels (PALs), and health-related quality of life (HRQL). Forty-five burn-injured children (age:13.89±2.43 years; duration since burn-injury: 3.13±0.93 years) and 52 age- and gender-matched healthy children (14.15±2.27 years) participated in this study. Both cohorts were evaluated for the maximal exercise capacity [defined by peak oxygen uptake (VO2peak), maximum heart rate (HRmax), minute ventilation (VE), ventilatory equivalent (VEq), respiratory rate (RR), and respiratory exchange ratio (RER)], PALs, and HRQL. The burn-injured children had significantly lower VO2peak (P=.0001) and VE (P=.003) and higher VEq (P<.0001) and RR (P=.007) than their healthy controls, indicating less efficient cardio-respiratory capacity. However, the HRmax (P=.092) and RER (P=.251) were similar. The burn-injured children reported significantly lower PALs (P=.014) and HRQL (P<.0001). The PALs [r (95%CI) = 0.411 (0.132 to 0.624); P = .005] and HRQL [r (95%CI) = 0.536 (0.284 to 0.712); P = .0001] were significantly correlated with the cardio-respiratory capacity represented by VO2peak in burn-injured group. The variations in VO2peak explained ⁓ 17% and 28.7% of the variations in PALs and HRQL, respectively. In conclusion, the cardio-respiratory efficiency of the burn-injured children may remain limited, even up to a few years following the injury. The limited cardio-respiratory capacity account in part for the reduced PALs and HRQL.

Instruments to assess function or functionality in adults after a burn injury: A systematic review

INTRODUCTION

Assessment of functionality or function, through valid and reliable instruments, is essential during rehabilitation of adults after a burn injury. Currently, there is no consensus in the literature regarding the most appropriate tool that should be used to assess function or functionality; there is also no synthesis of the current studies published in this area.

OBJECTIVES

To investigate and report the instruments used to assess function or functionality in adults after a burn injury; to identify the characteristics and evidence on their measurement properties; and to evaluate their clinical utility.

METHODS

We systematically searched the literature via six electronic databases and via screening reference lists of relevant studies. The review was registered in PROSPERO (CRD42016048065) and reported according to the PRISMA statement. Studies in which function or functionality of upper and/or lower limbs of adults after a burn injury was assessed were included. Exclusion criteria comprised studies in pediatric populations and conference abstracts.

RESULTS

Thirty-four studies were included. Twelve questionnaires and seven objective tests for function or functionality were identified. Three specific tools were found; four generic instruments have been validated in burns. Nine studies evaluated the instruments' measurement properties, presenting at least one property classified as 'fair' quality. Finally, 18 instruments demonstrated clinical utility.

CONCLUSION

This systematic review demonstrated that most instruments used to assess function or functionality in adults with a burn injury have not been specifically developed for this population and had their measurement properties poorly studied. Conversely, almost all instruments had clinical utility.

Differences in parent-perceived and patient-reported quality of life among young adult burn patients: A prospective longitudinal study

PURPOSE

This study examines the differences in parent-perceived and patient-reported quality of life (QoL) among young adult burn patients three years after injury and the factors affecting these differences.

METHOD

The sample comprised 35 burn patients from the Formosa Fun Coast Water Park dust explosion and their parents. The study was conducted from June 2016 to August 2018. We used self-report questionnaires to collect socio-demographic data, the adapted Chinese version of the Burn Specific Health Scale-Brief, and the Impact of Events Scale for Burn.

RESULTS

The analysis indicated that simple abilities recovered the fastest, while body image recovered the slowest. The variation trends of these factors were similar but parents' scores were lower than patients' scores. Parents' post-traumatic stress disorder (PTSD) scores were higher than that of patients, but were not statistically significant. Parents' gender and PTSD levels and patients' burn area affected differences in parent-perceived QoL among patients. PTSD levels were significantly higher among mothers.

CONCLUSIONS

For parents, PTSD is a common response to their children experiencing burn injuries. Parents' observations of warning signs enable early medical intervention. Establishing a family-centered care plan, providing psychological support for both parents and patients, and forming a continuous care system with efficient communication can support patients' return to society.

Satisfaction with appearance and sexual satisfaction in women with severe burn injuries

Burn, particularly in women, can cause a variety of difficulties. Women's feelings of themselves and of life satisfaction are affected by their body dimensions and satisfaction with appearance, which can be significant predictors of their sexual satisfaction. Therefore, this study aimed to investigate the relationship between satisfaction with appearance and sexual satisfaction among female patients with severe burn. The present study, adopted a descriptive-analytic approach and used a convenience sampling technique, to select 180 female patients Data collection instruments included a demographic questionnaire, the index of sexual satisfaction (ISS), and the satisfaction with appearance scale (SWAP). The results of this study showed that about 82% of women with severe burn injuries, had a lower level of sexual satisfaction. It was observed that satisfaction with appearance had a significant negative relationship with sexual satisfaction in women with burns (P < 0.001). According to the results of the present study, in order to improve appearance satisfaction and consequently sexual satisfaction, intervention attempts are essential. The findings of this study may have practical applications in the formulation of plans for patients with burn injuries.

Quality of Life in Adults With Lower Limb Burn Injury

Burn injury is an unpredictable incident that may result in long-term disability. Complications after burn injury are most common, for example, contracture, hypertrophic scar, or infection. A descriptive cross-sectional study was conducted at a burn unit in Pakistan, and data were collected by "World Health Organization Disability Assessment Schedule (WHODAS) v 2.0 Self-Administered" from 140 burn victims with at least 6 months old injury. Subjects with at least 10% TBSA of either lower limb were included while patients suffering from any congenital or neurological disease or with amputation were excluded. The analyses were done by statistic version 16. Participant's mean age was 28.13 years and SD was ±7.87 years. Of the 140 patients, 96 (68.6%) were males and 44 (31.4%) were females. The cause of the burn injury was flame burn [72.9% (102)], chemical burn [5% (7)], scald burn [7.9% (11)], and electrical burn [14.3% (20)]. There were 74(52.9%) victims having burn injury at the right-hand side of the body and 47.1% (66) were with the left-hand side affected; 32.9% (46) were having burn injury at the hip joint, 37.9% (53) with the knee joint, 8.6% (12) ankle joint, and 20.7% (29) are having burn injury at whole limb. The mean disability score calculated by WHODAS v 2.0 self-administered was 13.96 with a SD of ±4.696. Burn injuries to the lower limb have a negative impact on all domains of quality of life of the victims. These individuals should be assessed at various times while developing a comprehensive rehabilitation treatment plan, especially focusing on the issues faced by such individuals to improve their quality of life.

Matrine alleviates neurobehavioral alterations via modulation of JNK-mediated caspase-3 and BDNF/VEGF signaling in a mouse model of burn injury

RATIONALE

The c-Jun N-terminal kinase (JNK) pathway and neurotrophic factor dysregulation play a critical role in the pathogenesis of neurobehavioral disorders (anxiety and depression). Targeting the JNK pathway and BDNF/VEGF signaling may signify a new avenue for the treatment of neurobehavioral disorders.

OBJECTIVES

The present study investigated the effect of matrine (Mat) against anxiety- and depressive-like emotional status in an acute mouse model of burn injury and explores its underlying mechanism.

METHODS

In the mouse model of thermal injury, anxiety- and depression-related behaviors were evaluated using the elevated plus-maze test, the light-dark box test, the open-field test, the forced swimming test, and the tail suspension test. The JNK/caspase-3 and BDNF/VEGF proteins were determined by immunohistochemistry. Additionally, proinflammatory cytokine, antioxidant, nitric oxide, and corticosterone levels were also measured.

RESULTS

The results showed that treatment with Mat significantly improves anxiety- and depressive-like behaviors. It remarkably reduced the levels of proinflammatory cytokines, malondialdehyde, and nitric oxide in the hippocampus and prefrontal cortex of a mouse brain. It considerably improved burn-induced alteration in the antioxidant status, corticosterone, and BDNF/VEGF. It also inhibited burn-induced apoptotic signaling by downregulating the expression of JNK/caspase-3. Similarly, it prevented DNA damage and histopathological changes in the dentate gyrus of the hippocampus. Furthermore, molecular docking results showed that Mat possess better binding affinity for JNK/caspase-3 and BDNF/VEGF proteins.

CONCLUSIONS

These findings provide convincing evidence that Mat improves anxiety- and depressive-like emotional status through modulation of JNK-mediated inflammatory, oxidative stress, apoptotic, and BDNF/VEGF signaling in an acute mouse model of burn injury.

The benefits of an unsupervised exercise program in persons with well-healed burn injuries within the International Classification of Functioning, Disability and Health (ICF)

Vast improvements in the survival rates following burn injuries has led to a greater number of patients living with a wide range of long-term impairments, activity limitations, and participation constraints. Therefore, long-term care is critical in this clinical population and necessitates appropriate rehabilitation strategies to maximize an individual's overall health. The purpose of this study was to test the hypothesis that the extent to which outcomes within the International Classification of Functioning, Disability, and Health (ICF) framework are improved following 6 months of unsupervised exercise training is influenced by the severity of a burn injury (i.e., percent body surface area injured). Outcome variables representing the dimensions of the ICF, body functions & structure, activity, and participation, were collected pre- and post- 6 months of exercise training in three groups of participants: non-injured control subjects (N = 11), subjects with moderate-level well-healed burn injuries (N = 13, 26 ± 6% body surface area burned), and subjects with high-level well-healed burn injuries (N = 20, 58 ± 15% body surface area burned). Exercise training improved lower extremity strength (changes in peak torque/kg body mass at 90 degrees/sec flexion: 30 ± 5% and extension: 36 ± 4%, p < 0.05) and functional activities (changes in sit to stand: -9 ± 4% and ascend stairs: -4 ± 1%; p < 0.05) in all groups. For outcome variables representing ICF levels of body functions & structure and activity, there were no differences at baseline or improvements made between the groups after training. That said, with the exception of the domain of functional activity (reported 17 ± 34% improvement in the high-level burn cohort, p < 0.05), no changes were revealed in the participation level of ICF indexed by health-related quality of life questionnaires. These findings support the utilization of a 6-month unsupervised exercise training program in the long-term rehabilitation of individuals with burn injuries; that is, improvements in body functions & structure and activity can be achieved with an exercise regimen regardless of the severity of burn injury.

The Epidemiology of Burn Injuries in Saudi Arabia: A Systematic Review

Burns are potentially catastrophic injuries that disproportionately affect non-Western countries. We summarize results on the epidemiology of burn injuries in Saudi Arabia of all eligible papers through 2019, specifically evaluating the age and gender of patients, the location and mechanism of injury, burn size and severity, and outcomes. Between July 5 and July 10, 2019, a comprehensive literature review was performed on MEDLINE, EMBASE, Google Scholar, and the Cochrane Library. For this search, "Saudi Arabia," coupled with the search terms "burn," "thermal burn," "flame burn," "chemical burn," "electrical burn," and "contact burn" to identify all abstracts potentially relating to the topic of interest. Eleven studies, encompassing 3308 patients, met eligibility criteria. Younger children (variably defined as ≤10-12) accounted for 52% of all burns. Males outnumbered females by an overall ratio of 1.42:1. About 83% of burns occurred at homes. Scald injuries accounted for 62.4% of injuries, followed by flame-induced burns (28.7%), electrical burns (3.3%), and chemical burns (2.8%). Pertaining to burn extent and severity, 80% to 100% of the burns were limited to <40% total body surface area, while roughly 60% were second-degree burns. Most patients remain in the hospital for 1 to 4 weeks. The overall mortality across studies including patients of all ages was 6.9%, while just 0.76% in the two studies restricted to pediatric patients. Scald injuries involving young children comprise the lion's share of burn injuries in Saudi Arabia. Increased public awareness is necessary to reduce the incidence and severity of these potentially catastrophic injuries.

Pediatric burn-trauma patients have increased length of stay compared to trauma-only patients: A propensity matched analysis

BACKGROUND

Trauma is the leading cause of mortality in children. Burn injury involves intensive resources, especially in pediatric patients. We hypothesized that among pediatric trauma patients, combined burn-trauma (BT) patients have increased length of stay (LOS) and mortality compared to trauma-only (T) patients.

METHODS

The Pediatric Trauma Quality Improvement Program (2014-2016) was queried and BT patients were 1:2 propensity-score-matched to T patients based on age, gender, hypotension on admission, injury type and severity.

RESULTS

93 BT patients were matched to 186 T patients. There were no differences in matched characteristics. BT patients had a longer median LOS (4 vs 2 days, p<0.001) with no difference in mortality (1.1% vs 1.1%, p=1.00), intensive care unit (ICU) LOS (3 vs 3 days, p=0.55), or complications including decubitus ulcer (0% vs 1.1%, p=0.32), deep vein thrombosis (0% vs 0.5%, p=0.48), extremity compartment syndrome (1.1% vs 0%, p=0.16), and urinary tract infection (1.1% vs 1.1%, p=1.00).

CONCLUSION

Pediatric BT patients had twice the LOS compared to a matched group of pediatric T patients. There was no difference between the cohorts in ICU LOS, complications or mortality rate. When evaluating risk-stratified quality metrics such as LOS, concomitant burn injury should be incorporated.

Improved and standardized method for assessing years lived with disability after burns and its application to estimate the non-fatal burden of disease of burn injuries in Australia, New Zealand and the Netherlands

Background

Burden of disease estimates are an important resource in public health. Currently, robust estimates are not available for the burn population. Our objectives are to adapt a refined methodology (INTEGRIS method) to burns and to apply this new INTEGRIS-burns method to estimate, and compare, the burden of disease of burn injuries in Australia, New Zealand and the Netherlands.

Methods

Existing European and Western-Australian health-related quality of life (HRQL) datasets were combined to derive disability weights for three homogenous burn injury groups based on percentage total body surface area (%TBSA) burned. Subsequently, incidence data from Australia, New Zealand, and the Netherlands from 2010 to 2017 were used to compute annual non-fatal burden of disease estimates for each of these three countries. Non-fatal burden of disease was measured by years lived with disability (YLD).

Results

The combined dataset included 7159 HRQL (EQ-5D-3 L) outcomes from 3401 patients. Disability weights ranged from 0.046 (subgroup < 5% TBSA burned > 24 months post-burn) to 0.497 (subgroup > 20% TBSA burned 0–1 months post-burn). In 2017 the non-fatal burden of disease of burns for the three countries (YLDs/100,000 inhabitants) was 281 for Australia, 279 for New Zealand and 133 for the Netherlands.

Conclusions

This project established a method for more precise estimates of the YLDs of burns, as it is the only method adapted to the nature of burn injuries and their recovery. Compared to previous used methods, the INTEGRIS-burns method includes improved disability weights based on severity categorization of burn patients; a better substantiated proportion of patients with lifelong disability based; and, the application of burn specific recovery timeframes. Information derived from the adapted method can be used as input for health decision making at both the national and international level. Future studies should investigate whether the application is valid in low- and middle- income countries.

The psychological impact of Stevens-Johnson syndrome and toxic epidermal necrolysis on patients' lives: a Critically Appraised Topic

CLINICAL SCENARIO

A 65-year-old man presented with a 12-h history of deteriorating rash. Two weeks previously he had completed a course of neoadjuvant chemotherapy for ductal carcinoma of the breast. On examination there were bullae, widespread atypical targetoid lesions and 15% epidermal detachment. There was no mucosal involvement on presentation, but subsequently it did evolve. Skin biopsy showed subepidermal blistering with epidermal necrosis. This confirmed our clinical diagnosis of overlap Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN). On transfer to intensive care he was anxious and fearful.

MANAGEMENT QUESTION

What are the psychological impacts of SJS/TEN on this man's life?

BACKGROUND

SJS and TEN have devastating outcomes for those affected.

OBJECTIVES

To conduct a Critically Appraised Topic to (i) analyse existing research related to the psychological impact of SJS and TEN and (ii) apply the results to the clinical scenario.

METHODS

Seven electronic databases were searched for publications focusing on the psychological impact of SJS/TEN on adults over 18 years of age.

RESULTS

Six studies met the inclusion criteria. Healthcare practitioners' (HCPs') lack of information around the disorder was highlighted. Patients experienced undue stress and fear. Some patients had symptoms aligned to post-traumatic stress disorder (PTSD), anxiety and depression.

DISCUSSION AND RECOMMENDATION

The evidence suggests that SJS and TEN impact psychologically on patients' lives. Education of HCPs, to address their lack of awareness and information on SJS/TEN, should facilitate their capacity to provide information and support to patients, thereby reducing patient anxiety. On discharge, a follow-up appointment with relevant HCPs to reduce the possibility of PTSD occurring should be considered.

Recovery of health-related quality of life after burn injuries: An individual participant data meta-analysis

Background

A prominent outcome measure within burn care is health related quality of life (HRQL). Until now, no model for long-term recovery of HRQL exists for adult burn patients which requires large samples with repeated measurements. Re-use and the combination of existing data is a way to achieve larger data samples that enable the estimation of long-term recovery models. The aim of this secondary data analysis was to assess the recovery of HRQL after a burn injury over time.

Methods and findings

Data from ten European studies on generic HRQL assessed in adult burn patients (either with the EQ-5D or SF-36) from five different countries were merged into one dataset. SF-36 outcomes were transformed into EQ-5D outcomes. A 24-month recovery of HRQL (EQ-5D utility) was modeled using a linear mixed-effects model and adjusted for important patient and burn characteristics. Subgroups of patients with mild and intermediate burns (≤20% total body surface area (TBSA) burned) and with major burns (>20% TBSA burned) were compared. The combined database included 1687 patients with a mean age of 43 (SD 15) years and a median %TBSA burned of 9% (IQR 4–18). There was large improvement in HRQL up to six months after burns, and HRQL remained relatively stable afterwards (studied up to 24 months post burn). However, the estimated EQ-5D utility scores remained below the norm scores of the general population. In this large sample, females, patients with a long hospital stay and patients with major burns had a delayed and worse recovery. The proportion of patients that reported problems for the EQ-5D dimensions ranged from 100% (pain/discomfort at baseline in patients with major burns) to 10% (self-care ≥3 months after injury in patients with mild and intermediate burns). After 24 months, both subgroups of burn patients did not reach the level of the general population in the dimensions pain/discomfort and anxiety/depression, and patients with major burns in the dimension usual activities. A main limitation of the study includes that the variables in the model were limited to age, gender, %TBSA, LOS and time since burn as these were the only variables available in all datasets.

Conclusions

The 24-month recovery model can be used in clinical practice to inform patients on expected HRQL outcomes and provide clinicians insights into the expected recovery of HRQL. In this way, a delayed recovery can be recognized in an early stage and timely interventions can be started in order to improve patient outcomes. However, external validation of the developed model is needed before implementation into clinical practice. Furthermore, our study showed the benefit of secondary data usage within the field of burns.

Evaluation of an International Classification of Functioning, Disability and Health-based rehabilitation for thermal burn injuries: a prospective non-randomized design

Background

Severe burn injuries result in relevant restrictions of physical capacity as well as psychological and social integrity and require a specialized rehabilitation. There is a common agreement, among national as well as international burn associations, that burn rehabilitation is a complex, dynamic process which needs an interdisciplinary and specialized treatment team. There is wide agreement that more research is needed in this field.

Methods/design

The aim of the study is to examine the effectiveness and efficiency of our new ICF (International Classification of Functioning, Disability and Health)-based rehabilitation for thermal injuries. Because of ethical reasons, we have chosen a prospective non-randomized design, which takes place at two different rehabilitation centers. At center A, a newly developed ICF-based rehabilitation program was established; at rehabilitation center B, a well-established rehabilitation program has existed for 20 years and is used as reference. The primary research question addresses the “Pre-post comparison of the physical and psychological outcome measurements,” secondary question I looks at the “Examination of the non-inferiority of the new treatment concept with the established concept,” and secondary question II is the “Analysis of the rehabilitation process based on the rehabilitation cycle.”

Only patients of the two burn rehabilitation centers who are insured by workers’ compensation will be asked to participate in this study to avoid outcome bias by insurance status. A physical examination (physical working capacity testing, grip strength, range of motion, and scar evaluation by Cutometer and Vancouver Scar Scale) and a standardized questionnaire battery (Burn Specific Health Scale-Brief , Short Form 36, Impact of Event Scale-Revised, the German version of the Symptom Checklist, the Freiburg Social Support Questionnaire, Patient/Client Satisfaction Questionnaire, Disabilities of the Arm, Shoulder and Hand, and Lower Extremity Functional Scale ) measure physical and psychological conditions. Data will be taken on admission, during stay, and on discharge of the rehabilitation program and at follow-up 3 and 12 months after discharge. A minimum of 162 participants will be enrolled in this clinical longitudinal, prospective, observational study.

Discussion

The proof of the effectiveness of the ICF-based rehabilitation program for thermal injuries will give evidence in a comprehensive way for the first time in this field. As result, a standardized rehabilitation concept will be introduced, which can be provided to other rehabilitation institutions treating thermal injuries.

Trial registration

German Clinical Trials Register, DRKS00017702. Registered on 2 September 2019.

TBSA and length of stay impact quality of life following burn injury

INTRODUCTION

Burn injuries create physiologic, physical, and emotional effects acutely and long-lasting. Recovery is extensive and requires long-term care. Impaired function related to pain, deconditioning, weakness, and contracture formation are common. We sought to determine factors that impact quality of life (QOL) post recovery. Specifically, to assess whether Health Related QOL (HRQOL) decreases with increasing percent total body surface area (TBSA) and length of stay (LOS). We also explored QOL as a function of burn mechanism.

METHODS

Patients >18 years of age with >9.5% TBSA between 1 and 6 years post-burn injury were contacted by mail and asked if they were willing to participate. Those who agreed responded by returning their completed Burn Specific Health Scale-Brief (BSHS-B). Medical records were accessed to determine demographic and treatment information.

RESULTS

Statistical analysis revealed a strong correlation between total QOL (total score of BSHS-B) and LOS and TBSA. All domains were negatively correlated with increasing LOS and TBSA. LOS was most strongly correlated with decreasing work function and social function. There were no differences in QOL between burn mechanism.

CONCLUSIONS

QOL is greatly impacted by TBSA and LOS.More attention to body image and returning to work should be given, regardless of the type of burn mechanism.

"I couldn't even do normal chores": a qualitative study of the impacts of injury for Māori

AIMS

To investigate the rehabilitation experiences of Māori who were still reporting disability 24 months after an injury resulting in hospitalisation.

METHODS

Participants had been hospitalised for an Accident Compensation Corporation (New Zealand's no-fault injury compensation insurer) entitlement claim injury between 2007 and 2009, and were experiencing disability 24 months post-injury. In-depth kanohi ki te kanohi (face-to-face) qualitative interviews with 12 participants aged between 37 and 71 years at the time of interviews were conducted. Interpretive analyses of interview transcripts, focused on the impacts of injury was conducted with the aid of NVivo software.

RESULTS

The overarching theme identified during the analysis was "Impact" with four sub-themes of: Impact on daily life; Impact on relationships, Impact on employment; and, long-term or ongoing impacts.

CONCLUSIONS

For Māori living with disability 24 months after hospitalisation for injury, adjusting to life after the injury and the rehabilitation process was challenging. Participants discussed frustration with feeling dependent on others, being bored and feeling unfulfilled after their injury, and that many aspects of their lives were impacted on and not always in the expected directions. Many reported longer lasting impacts even after rehabilitation was completed. Implications for rehabilitation programmes e.g., strengthening programmes by taking into account issues discussed by participants, recognising the long-term impacts on both those injured and their whānau (family), and further investigations required are also discussed.IMPLICATIONS FOR REHABILITATIONDisability after injury can have long term impacts for injured Māori and their relationships.Social impacts can be perceived as more debilitating than the physical impacts after injury.Experiences of employment changes and future prospects are often difficult to navigate for Māori returning to work after an injury.

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

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.

Anxiety and depression after burn, not as bad as we think-A nationwide study

OBJECTIVE

A history of psychiatric disorders is more common among patients who have had burns than in the general population. To try and find out the scale of the problem we have assessed self-reported symptoms of anxiety and depression after a burn.

METHODS

Consecutive patients with burns measuring more than 10% total body surface area or duration of stay in hospital of seven days or more were included. Personal and clinical details about the patients were extracted from the database at each center. Data were collected from the Hospital Anxiety and Depression Scale, as well as Health-Related Quality of Life (HRQoL; Short Form-36, SF-36) and questionnaires about socioeconomic factors. All results were obtained 12 and 24 months after the burn, and compared with those from a reference group.

RESULTS

A total of 156 patients responded to the questionnaires. Mean (SD) age and TBSA (%) were 46 (16.4) years and 23.6 (19.2) %, respectively. There were no differences in incidence between the burn and reference groups in anxiety or depression either 12 or 24 months after the burn. Those who reported higher anxiety and depression scores also had consistently poorer HRQoL as assessed by the SF-36.

CONCLUSION

Seen as a group, people who have had burns report anxiety and depression the same range as a reference group. Some patients, however, express more anxiety and depression, and concomitantly poorer HRQoL. These patients should be identified, and offered additional support.

The influence of age on quality of life after upper body burn

BACKGROUND

In Spain, the number of aged persons is increasing. By the year 2066, it is expected that 34.6% of the Spanish population will be over 65 years of age. Elderly people present a higher burning risk owing in part to impaired balance and decreased physical strength, lower cognitive abilities, or socioeconomic context.

OBJECTIVE

Burns to the upper body body are common and affect both emotional state and physical function, thus leading to reduced quality of life (QoL). Our objective was to determine the influence of age on the QoL of patients who experienced burns to the upper body, with burns with 2 years.

METHODS

This is an observational study with a sample of 58 patients with burns only on the upper body. Patients were divided into two groups: 29 patients of age over 65 years and 29 patients under 65 years; all of them attended the Vall d'Hebron Burn Center, Barcelona, between 2011 and 2014. From the original sample, 45 patients had survived by the time the information was gathered. The QoL of these individuals was evaluated with the Spanish version of the Burn Specific Health Scale. Demographic data (sex, age, total burn surface area [TBSA], burn mechanism, pathological history, length of hospital stay, and rehabilitation duration) were collected. Statistical analysis included parametric and nonparametric tests as appropriate with R3.3.3.

RESULTS

There were no differences between groups regarding the mechanism of burn, TBSA, length of hospital stay, and the domains of QoL test. High blood pressure, diabetes, and other comorbidities were significantly more common in the elderly group than in the younger group. Eleven patients died in the elderly group and two in the younger group (p=0.012).

CONCLUSION

As opposed to what could be expected, in this study, there were no significant differences between surviving patients in both age groups in terms of perceived QoL. Nevertheless, mortality after a burn in the upper side of the body was significantly higher in elderly people than in younger people. The present study results do not support the use of different rehabilitation approaches in elderly patients.

Necrotizing fasciitis and the midterm outcomes after survival

Background and Aims:

Radical surgical intervention is necessary to save patients’ lives in cases of necrotizing fasciitis. This leads to persistent disabilities and most likely to a deteriorated quality of life. The purpose of this study was to evaluate the midterm outcomes after survival of necrotizing fasciitis.

Materials and Methods:

A retrospective analysis of 69 patients, treated for necrotizing fasciitis between 2003 and 2012. The patients were identified using the International Classification of Diseases (10th Revision) code M 72.6. Of the 50 survivors, 22 patients completed the Short Form 36 and Short Musculoskeletal Function Assessment questionnaires as a postal survey. The follow-up averaged 59 months (range: 6–128 months).

Results:

The average age at the time of necrotizing fasciitis was 60.0 years. The body mass index average was 29.7. The patients had a significantly decreased physical component summary score of 33.3 compared to a normative group (p < 0.001) (Short Form 36). They further showed a significantly decreased dysfunction and bother indices (Short Musculoskeletal Function Assessment) (p < 0.001). An increased age (⩾70 years) was associated with an inferior role emotional (p = 0.048) and physical functioning (p = 0.011) as well as social functioning (p = 0.038) (Short Form 36). The majority of patients (16, 72.7%) complained of pain at the final follow-up and 50% of patients required an assistive device on a regular basis.

Conclusion:

Patients who survived necrotizing fasciitis suffer from functional impairment and changed body appearance. Assistive devices or pain medication are often required, and the patients present with significantly decreased physical, social, and emotional functioning at the midterm follow-up. The patient’s age is a critical factor regarding functional or mental outcome parameters. Further research on the post-hospital course and long-term multidisciplinary care is required to improve the outcomes of these patients.

The Relationship between Quality of Life and Sexual Satisfaction in Women with Severe Burns

Introduction

Burn, especially in women, can affect the quality of life and it due to a change in sexual life. This study was designed to investigate the relationship between the quality of life and sexual satisfaction in women with burns.

Material and methods

This was a descriptive-analytical cross-sectional study conducted on 101 women with severe burns who were referred to Imam Khomeini Hospital in Urmia, Iran, in 2016. The data gathering scales were demographic questionnaire, burn specific health scale-brief (BSHS-B) and Index of Sexual Satisfaction (ISS).

Results

The mean scores of the quality of life and sexual satisfaction were 102.94 ± 20.88 and 57.03 ± 25.91, respectively. Also, there was a significant relationship between quality of life and its subscales with sexual satisfaction and some demographic variables (p <0.05).

Conclusion

Interventional efforts for improving sexual satisfaction and thus, quality of life in these patients are important. The findings of this study appear to be effective in planning for women with a history of burns.

Predictors of health-related quality of life after burn injuries: a systematic review

Background

Identifying predictors of health-related quality of life (HRQL) following burns is essential for optimization of rehabilitation for burn survivors. This study aimed to systematically review predictors of HRQL in burn patients.

Methods

Medline, Embase, Web of Science, Cochrane, CINAHL, and Google Scholar were reviewed from inception to October 2016 for studies that investigated at least one predictor of HRQL after burns. The Quality in Prognostic Studies tool was used to assess risk of bias of included studies.

Results

Thirty-two studies were included. Severity of burns, postburn depression, post-traumatic stress symptoms, avoidance coping, less emotional or social support, higher levels of neuroticism, and unemployment postburn were found to predict a poorer HRQL after burns in multivariable analyses. In addition, weaker predictors included female gender, pain, and a postburn substance use disorder. Risk of bias was generally low in outcome measurement and high in study attrition and study confounding.

Conclusions

HRQL after burns is affected by the severity of burns and the psychological response to the trauma. Both constructs provide unique information and knowledge that are necessary for optimized rehabilitation. Therefore, both physical and psychological problems require attention months to years after the burn trauma.

Electronic supplementary material

The online version of this article (10.1186/s13054-018-2071-4) contains supplementary material, which is available to authorized users.

Health related quality of life in adults after burn injuries: A systematic review

OBJECTIVES

Measurement of health-related quality of life (HRQL) is essential to qualify the subjective burden of burns in survivors. We performed a systematic review of HRQL studies in adult burn patients to evaluate study design, instruments used, methodological quality, and recovery patterns.

METHODS

A systematic review was performed. Relevant databases were searched from the earliest record until October 2016. Studies examining HRQL in adults after burn injuries were included. Risk of bias was scored using the Quality in Prognostic Studies tool.

RESULTS

Twenty different HRQL instruments were used among the 94 included studies. The Burn Specific Health Scale-Brief (BSHS-B) (46%), the Short Form-36 (SF-36) (42%) and the EuroQol questionnaire (EQ-5D) (9%) were most often applied. Most domains, both mentally and physically orientated, were affected shortly after burns but improved over time. The lowest scores were reported for the domains 'work' and 'heat sensitivity' (BSHS-B), 'bodily pain', 'physical role limitations' (SF-36), and 'pain/discomfort' (EQ-5D) in the short-term and for 'work' and 'heat sensitivity', 'emotional functioning' (SF-36), 'physical functioning' and 'pain/discomfort' in the long-term. Risk of bias was generally low in outcome measurement and high in study attrition.

CONCLUSION

Consensus on preferred validated methodologies of HRQL measurement in burn patients would facilitate comparability across studies, resulting in improved insights in recovery patterns and better estimates of HRQL after burns. We recommend to develop a guideline on the measurement of HRQL in burns. Five domains representing a variety of topics had low scores in the long-term and require special attention in the aftermath of burns.

Of These, Faith, Hope, and Love: Assessing and Providing for the Psychosocial and Spiritual Needs of Burn Patients

Burn treatment has grown increasingly advanced and technologically capable. Clinicians must take into account, however, multidimensional patient needs that factor into long-term burn recovery. Important psychosocial factors associated with burn care include psychiatric comorbidities, such as anxiety and depression, healthy family relationships, social support, and community involvement. Spiritual factors and resources, such as time spent praying and/or meditating and access to pastoral services, are also important to consider. Further study is needed to identify specific psychosocial and spiritual needs of patients and to develop interventions or therapies that specifically provide for these needs.

Type-D Personality and Elevated Psychological Symptoms In Early Adjustment of Severe Burn Injury Patients

Severe burn injuries are highly traumatic requiring lengthy recovery. High levels of distress in the early stages of treatment have been associated with poor physical and psychosocial recovery outcomes. Identifying traits relating to distress and personal coping styles may aid screening. Type-D, or 'distressed', personality may be such a trait. Type-D personality refers to an ongoing personality organization defined by a tendency to experience greater negative emotions and thoughts while simultaneously socially inhibiting their expression (Denollet et al., 1996 . Type-D has been linked to poor health outcomes in those with cardiovascular disease as well as other populations and has been found to be associated with elevated psychological symptoms. Currently, there are no investigations in the literature looking at Type-D in the severe burns injury population. This study aimed to investigate Type-D in severe burn injury patients, specifically regarding the presence of psychological symptoms in early treatment, using data gathered during a pilot study conducted at a severe burn injury unit. The DS-16, Davidson Trauma scale and Depression Anxiety and Stress Scale scores were analysed along with demographic and clinical data in 54 participants (40 males, 14 females). Participants who were found to have Type-D displayed significantly higher levels of psychopathology. Additionally, Type-D was found to be a significant predictor of psychological symptoms.

Factors predicting health-related quality of life following necrotizing fasciitis

BACKGROUND

Necrotizing fasciitis (NF) is a debilitating soft tissue infection that results in disfiguring scars and often amputations. While mortality rates have improved, long-term outcomes in survivors of NF are poorly understood.

OBJECTIVES

The objective of this study is to analyze the impact of NF on survivors' health-related quality of life (HRQoL) influenced by age, sex, comorbidities, %TBSA, and confidence with appearance.

METHODS

We surveyed 56 adult patients with NF treated at either of two regional referral centers in Manitoba, Canada, between January 1, 2004, and December 31, 2014. Necrotizing soft tissue infections involving the fascial planes were identified during surgical debridement. HRQoL was measured by the Medical Outcomes Short Form-36. Derriford Appearance Scale-24, age, sex, comorbidities, and %TBSA were recorded, and group comparisons and stepwise regression models were developed for the mental and physical component scores separately.

RESULTS

Mean Mental Component Score (MCS) was 44.5 ± 14.3 and mean Physical Component Score (PCS) was 36.5 ± 11.5; both means were lower than the Canadian population norm of 50. Although stepwise linear regression analyses with block entry indicated influence from age, sex, and comorbid conditions for the MCS and PCS, the only factors that were statistically significant in the final models were confidence with appearance for the MCS and %TBSA for the PCS.

CONCLUSIONS

NF has long-term impact on mental and physical health-related quality of life. Distress regarding confidence with appearance affects mental quality of life, whereas the size of the injured area impacted physical quality of life. These findings can help guide targeted interventions that could potentially improve recovery from NF.

Resistance training for rehabilitation after burn injury: A systematic literature review & meta-analysis

BACKGROUND/AIM

Resistance training is beneficial for rehabilitation in many clinical conditions, though this has not been systematically reviewed in burns. The objective was to determine the effectiveness of resistance training on muscle strength, lean mass, function, quality of life and pain, in children and adults after burn injury.

METHODS

Medline & EMBASE, PubMed, CINAHL and CENTRAL were searched from inception to October 2016. Studies were identified that implemented resistance training in rehabilitation. Data were combined and included in meta-analyses for muscle strength and lean mass. Otherwise, narrative analysis was completed. The quality of evidence for each outcome was summarised and rated using the GRADE framework.

RESULTS

Eleven studies matched our inclusion criteria. Primary analysis did not demonstrate significant improvements for increasing muscle strength (SMD 0.74, 95% CI -0.02 to 1.50, p=0.06). Sensitivity analysis to correct an apparent anomaly in published data suggested a positive effect (SMD 0.37, 95% CI 0.08-0.65, p=0.01). Psychological quality of life demonstrated benefit from training (MD=25.3, 95% CI 3.94-49.7). All studies were rated as having high risk of bias. The quality of the evidence was rated as low or very low.

CONCLUSION

Further research with robust methodology is recommended to assess the potential benefit suggested in this review.

Review of Burn Research for Year 2014

Management of burn injuries requires treatments and interventions from many disciplines. Worldwide, burn patients suffer from physical and psychological challenges that impact their lives socially and economically. In this review, we will highlight a handful of the numerous articles published in multiple areas of burn care. The areas of burn care addressed in the article are: epidemiology; burn resuscitation, critical care, and infection; nutrition and metabolism; pain and rehabilitation; prevention and firefighter safety; psychology; and reconstruction and wounds.

Long term outcomes data for the Burns Registry of Australia and New Zealand: Is it feasible?

BACKGROUND

Incorporating routine and standardised collection of long term outcomes following burn into burn registries would improve the capacity to quantify burn burden and evaluate care.

AIMS

To evaluate methods for collecting the long term functional and quality of life outcomes of burns patients and establish the feasibility of implementing these outcomes into a multi-centre burns registry.

METHODS

Five Burns Registry of Australia and New Zealand (BRANZ) centres participated in this prospective, longitudinal study. Patients admitted to the centres between November 2009 and November 2010 were followed-up at 1, 6, 12 and 24-months after injury using measures of burn specific health, health status, fatigue, itch and return to work. Participants in the study were compared to BRANZ registered patients at the centres over the study timeframe to identify participation bias, predictors of successful follow-up were established using a Generalised Estimating Equation model, and the completion rates by mode of administration were assessed.

RESULTS

463 patients participated in the study, representing 24% of all BRANZ admissions in the same timeframe. Compared to all BRANZ patients in the same timeframe, the median %TBSA and hospital length of stay was greater in the study participants. The follow-up rates were 63% at 1-month, 47% at 6-months; 40% at 12-months, and 21% at 24-months after injury, and there was marked variation in follow-up rates between the centres. Increasing age, greater %TBSA and opt-in centres were associated with greater follow-up. Centres which predominantly used one mode of administration experienced better follow-up rates.

CONCLUSIONS

The low participation rates, high loss to follow-up and responder bias observed indicate that greater consideration needs to be given to alternative models for follow-up, including tailoring the follow-up protocol to burn severity or type.

Coping with burns: the role of coping self-efficacy in the recovery from traumatic stress following burn injuries

We conducted a three-wave prospective study among patients with burns (N = 178) to examine the prospective influence of coping self-efficacy (CSE) perceptions on trajectories of posttraumatic stress symptoms in the first 12 months after burn injuries. Using linear growth curve modeling, we corrected for demographics, the number of surgeries during initial admittance, trait coping styles, and changing levels of health-related quality of life. CSE during initial admission was by far the strongest predictor of both initial PTSD symptoms and degree of symptom change with higher CSE levels associated with lower initial symptoms and a steeper decline of symptoms over time. Of the other variables only avoidant coping was associated with higher initial symptom levels, and only emotional expression associated with greater rate of recovery. Current findings suggest that CSE plays a pivotal role in recovery from posttraumatic stress after a burn injury, even when the role of burn-related impairments is taken into consideration. Implications of findings are discussed.

Regularization method for predicting an ordinal response using longitudinal high-dimensional genomic data

Abstract An ordinal scale is commonly used to measure health status and disease related outcomes in hospital settings as well as in translational medical research. In addition, repeated measurements are common in clinical practice for tracking and monitoring the progression of complex diseases. Classical methodology based on statistical inference, in particular, ordinal modeling has contributed to the analysis of data in which the response categories are ordered and the number of covariates (p) remains smaller than the sample size (n). With the emergence of genomic technologies being increasingly applied for more accurate diagnosis and prognosis, high-dimensional data where the number of covariates (p) is much larger than the number of samples (n), are generated. To meet the emerging needs, we introduce our proposed model which is a two-stage algorithm: Extend the generalized monotone incremental forward stagewise (GMIFS) method to the cumulative logit ordinal model; and combine the GMIFS procedure with the classical mixed-effects model for classifying disease status in disease progression along with time. We demonstrate the efficiency and accuracy of the proposed models in classification using a time-course microarray dataset collected from the Inflammation and the Host Response to Injury study.