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Verburg L, Gabriel V, McCaffrey G. The impact of burn injuries on indigenous populations: A literature review. Burns 2024; 50:1355-1371. [PMID: 38570250 DOI: 10.1016/j.burns.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 01/31/2024] [Accepted: 02/26/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION Ethnic minorities experience disparities in prevention and treatment of burn injury. Research focused on burn injuries in Indigenous populations is limited. This review summarizes literature on burn injuries in Indigenous populations to be considered to inform new research. METHODS A search was conducted in CINAHL, Ovid MEDLINE, PSYCinfo and SocINDEX. for "burn OR scars OR scald OR deformity OR disfigurement" and "Aboriginal OR Indigenous OR First Nation OR American Indian OR Maori OR Native OR Torres Strait Islander OR Amerindian OR Inuit OR Metis OR Pacific Islander". Inclusion 1) peer reviewed studies of burns in Indigenous persons 2) in English. Exclusion 1) no data specific to Indigenous burns 2) not peer reviewed 3) not in full text 4) protocol publications. RESULTS The search identified 1091 studies with 51 for review. Sixteen were excluded. The 35 included publications were published between 1987 and 2022. Findings indicated higher incidence of injury and poorer outcomes amongst Indigenous people. Indigenous people suffered more flame and inhalation burns, had longer lengths of stay, and more complications including hypertrophic scarring. Australian Indigenous patients struggle with a lack of culturally safe communication and support for aftercare. CONCLUSION Racial disparities exist in burn injury incidence and outcome for Indigenous persons. Qualitative research in this area will help providers better understand the experiences of Indigenous burn patients to develop more culturally competent care. We are currently developing a study using qualitative hermeneutic methodology to learn about the experiences of Indigenous burn survivors' injuries, recovery, and social reintegration.
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Affiliation(s)
- Leah Verburg
- Faculty of Nursing, University of Calgary, Canada.
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2
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Holmes Iv JH, Gibson ALF, Short T, Joe VC, Litt J, Carson J, Carter JE, Wibbenmeyer L, Hahn H, Smiell JM, Rutan R, Wu R, Shupp JW. A phase 3b, open-label, single-arm, multicenter, expanded-access study of the safety and clinical outcomes of StrataGraft® treatment in adults with deep partial-thickness thermal burns. Burns 2024:S0305-4179(24)00172-4. [PMID: 39043513 DOI: 10.1016/j.burns.2024.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 05/08/2024] [Accepted: 05/28/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND A phase 3b, open-label, multicenter, expanded-access study (NCT04123548) evaluated safety and clinical outcomes of StrataGraft treatment in adults with deep partial-thickness thermal burns with intact dermal elements. METHODS Adult patients with 3 % to < 50 % total body surface area burns were treated with a single application of ≤ 1:1 meshed StrataGraft and followed for 24 weeks. Primary endpoint was count and percentage of patients with treatment-emergent adverse events (TEAEs). Secondary endpoints included confirmed wound closure (WC) at Week 12, durable WC at Week 24, time to WC, scar evaluation, and wound infection-related events. RESULTS Fifty-two patients with 96 treatment sites were enrolled. Pruritus was the most common TEAE (22 patients [42.3 %]). Twenty serious TEAEs occurred in 10 patients (19.2 %); none were related to StrataGraft. There were 4 (7.7 %) deaths (aspiration, myocardial infarction, self-injury, Gram-negative rod sepsis); none were related to StrataGraft. Confirmed WC was achieved by Week 12 in 33 patients (63.5 %; 95 % CI: 50.4-76.5 %) and 69 treatment sites (71.9 %; 95 % CI: 62.9-80.9 %). Durable WC was achieved by Week 24 in 29 patients (55.8 %; 95 % CI: 42.3-69.3 %) and 58 treatment sites (60.4 %; 95 % CI: 50.6-70.2 %). CONCLUSIONS StrataGraft demonstrated clinical benefit. Safety data were consistent with previously reported findings.
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Affiliation(s)
- James H Holmes Iv
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Angela L F Gibson
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Tracee Short
- Department of Surgery, Baton Rouge General Medical Center, Baton Rouge, LA, USA
| | - Victor C Joe
- Department of Surgery, University of California Irvine Medical Center, Orange, CA, USA
| | - Jeffrey Litt
- Burn and Reconstructive Centers of America, Richmond, VA, USA
| | - Joshua Carson
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Jeffrey E Carter
- Louisiana State University Health Science Center, School of Medicine, University Medical Center New Orleans, New Orleans, LA, USA
| | - Lucy Wibbenmeyer
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Helen Hahn
- Mallinckrodt Pharmaceuticals, Bridgewater, NJ, USA
| | | | - Randi Rutan
- Mallinckrodt Pharmaceuticals, Bridgewater, NJ, USA
| | - Richard Wu
- Mallinckrodt Pharmaceuticals, Bridgewater, NJ, USA
| | - Jeffrey W Shupp
- Department of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
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Won P, Choe D, Gomez LH, Justin Gillenwater T, Yenikomshian HA. Minority pediatric burn survivors undergo more burn operations: A single center's five-year experience. Burns 2024; 50:760-766. [PMID: 37981485 PMCID: PMC10999333 DOI: 10.1016/j.burns.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 09/28/2023] [Accepted: 10/24/2023] [Indexed: 11/21/2023]
Abstract
Burn injuries remain a significant source of trauma in the United States and disproportionately affect racial and ethnic minorities. Although disparities are well documented in adults, less is known regarding those in pediatric populations. To address this gap in literature, we aim to better characterize burn injuries, inpatient treatments, and post-discharge outcomes in minority pediatric burn patients. We hypothesize minority patients undergo more surgery and re-admissions than non-minority patients for burn care. This is a single institution retrospective chart review of pediatric patient admissions with burn injuries from July 1st, 2016 to July 1st, 2021. Demographics, details of injury, inpatient surgical and non-surgical care, and post-discharge outcomes were collected. Patients identifying as Hispanic/Latino, Black, and Asian were coded as minority patients. Univariate analysis was utilized. A total of 332 patients with average age of 4.9 years (SD: 4.4) and average total burn surface area (TBSA) of 8.5% (SD: 10.0) were collected. Minority patients were significantly more likely to experience accidental burn injury (p < 0.01), inhalational injury (p < 0.01), surgical management (p < 0.01), and to undergo skin graft (p < 0.01) than White patients. Minority patients were significantly more likely to undergo laser treatment after discharge (p < 0.01) than White patients. Our study shows minority pediatric patients are at risk for non-intentional burn injuries that undergo surgical management such as skin grafting and longitudinal reconstructive procedures including laser therapy more often. Short-term goals should include facilitating improved physical and psychosocial outcomes in this often-underserved patient population.
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Affiliation(s)
- Paul Won
- Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Deborah Choe
- Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Laura H Gomez
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA, USA
| | - T Justin Gillenwater
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA, USA
| | - Haig A Yenikomshian
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA, USA.
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Du AL, Yao PY, Gabriel RA, Shaw SJ. Association of race and ethnicity with pediatric burn outcomes: A population study of the Kids' Inpatient Database. Burns 2024; 50:244-251. [PMID: 37690963 DOI: 10.1016/j.burns.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/27/2023] [Accepted: 08/23/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND While most studies on burn outcomes have focused on adults, it is unclear if the same socioeconomic and environmental inequalities affect paediatric patients. This study aims to investigate the impact of race and ethnicity on outcomes in paediatric burn patients. METHODS The Kids' Inpatient Database is released by Agency for Healthcare Research and Quality, and is the largest publicly available database for the United States inpatient paediatric population. All paediatric burned patients in 2016 and 2019 were identified. Race and/or ethnicity was the primary exposure variable, and the primary outcome was a composite of several in-hospital morbidities. Secondary outcomes included death, non-routine disposition, and length of stay. Fine-Gray competing risks regression and multivariable logistic regression were used to analyze length of stay and all other outcomes, respectively. Analysis also isolated subgroups related to socioeconomic status and case severity. RESULTS We included12,582 pediatric burn patients in this study. No difference was found in composite morbidity between White patients and those of other race or ethnicity groups. Hispanic ethnicity was associated with longer lengths of stay and increased odds of routine (i.e. home) discharge. Black patients had increased length of stay compared to White patients only in severe burn cases. CONCLUSIONS Our study implies that race- or ethnicity-associated mechanisms driving outcome disparities in adults does not necessarily apply in paediatric burn patients.
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Affiliation(s)
- Austin L Du
- School of Medicine, University of California, San Diego, La Jolla, CA, USA; Department of Anesthesiology, Division of Perioperative Informatics, University of California, San Diego, La Jolla, CA, USA.
| | - Phil Y Yao
- Department of Anesthesiology, Division of Perioperative Informatics, University of California, San Diego, La Jolla, CA, USA
| | - Rodney A Gabriel
- Department of Anesthesiology, Division of Perioperative Informatics, University of California, San Diego, La Jolla, CA, USA; Department of Medicine, Division of Biomedical Informatics, University of California, San Diego, La Jolla, CA, USA
| | - Susanna J Shaw
- Department of Anesthesiology, Division of Perioperative Informatics, University of California, San Diego, La Jolla, CA, USA
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Sheikh-Oleslami S, Tao B, Papp B, Luthra S, Papp A. A Cross-Sectional Study of Sex, Race, and Ethnic Representation in Burn Registered Clinical Trials. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01897-8. [PMID: 38148442 DOI: 10.1007/s40615-023-01897-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/14/2023] [Accepted: 12/11/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE The demographic proportions of plastic surgery trials approximating real-world disease have not well been studied. Judicious trial representation is essential in evaluation of treatments across diverse patient populations. Herein, we investigate sex, racial, and ethnic disparities in patient enrollment across burn trials. METHODS Cross-sectional analysis of participants enrolled in high-quality, with reduced risk of bias, randomized controlled trials (RCT) on burns registered on clinicaltrials.gov under the query "burn." Completed RCTs reporting at least two demographic groups, employing double masking or greater, and with results accessible through the registry or publications were included. Trial characteristics (sponsor country, site location, initiation year, study phase, masking) and demographic data (sex, race, ethnicity per US reporting guidelines) were collected. The Global Burden of Disease database provided sex-based burn disease burdens. The primary outcome was the population-to-prevalence ratio of enrolled female participants. Secondary outcomes included representation of racial and ethnic populations as related to study blinding, phase, and study/sponsor locations. RESULTS Of 546 records, 39 trials met the inclusion criteria (2919 participants). All trials reported sex demographics, with females comprising 37.02% of all participants (PPR = 0.71, 95% CI [0.59, 0.82], likely indicating underrepresentation against their empiric disease burden). Only 7 and 9 trials reported ethnicity and race, respectively, although not comprehensively. Among trials reporting race or ethnicity, Caucasians and Black persons comprised 57.52% and 21.80% of participants, respectively, while only 9.80% had Hispanic/Latino ethnicity. Severe underreporting of race and ethnicity precluded much of secondary significance testing across study variables. CONCLUSIONS Females are likely underrepresented in high-quality, US-registered burn trials, unreflective of their real-world disease burden. Further, severe underreporting of race and ethnicity was noted. Future trials should enroll diverse demographics and equitable populations for promotion of study generalizability.
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Affiliation(s)
| | - Brendan Tao
- Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Bettina Papp
- Faculty of Science, Capilano University, North Vancouver, British Columbia, Canada
| | - Shreya Luthra
- Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Anthony Papp
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, 899 12 Avenue, Vancouver, BC, V5Z1M9, Canada.
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Won P, Stoycos SA, Ding L, McMullen KA, Kowalske K, Stewart BT, Yenikomshian HA. Worse Itch and Fatigue in Racial and Ethnic Minorities: A Burn Model System Study. J Burn Care Res 2023; 44:1445-1451. [PMID: 37083246 PMCID: PMC10589385 DOI: 10.1093/jbcr/irad054] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Indexed: 04/22/2023]
Abstract
Racial and ethnic minority patients experience worse hypertrophic scars after burn injury than White patients. Subsequently, minority patients encounter differences in scar-related recovery domains such as itch and fatigue. This study examines disparities regarding postburn injury itch and fatigue in minority patients to better inform counseling and treatment considerations. From the multicenter National Institute of Disability, Independent Living and Rehabilitation Research Burn Model System Database (2015-2019), outcomes were analyzed at three time-points (discharge from index hospitalization, 6- and 12-months post-injury) using the 5D Itch and PROMIS-29 Fatigue measures. Multilevel linear mixed effects regression modeling analyzed associations between race/ethnicities and outcomes over time. Of 893 total patients, minority patients reported higher/worse itch scores at all time points compared to White patients. Itch scores were significantly higher for Black patients at 6 months (β = 1.42, P = .03) and 12 months (β = 3.36, P < .001) when compared to White patients. Black patients reported higher fatigue scores than White patients at all time points. Fatigue scores were significantly higher for Hispanic/Latino patients at discharge (β = 6.17, P < .001), 6 months (β = 4.49, P < .001), and 12 months (β = 6.27, P < .001) than White patients. This study supports investigation of potential factors leading to increased itch and fatigue such as sociocultural factors, disparities in healthcare access, and psychosocial impacts of these symptoms. In the short-term, minority patients may benefit from additional counseling and focused treatments addressing itch and fatigue after burn injury.
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Affiliation(s)
- Paul Won
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Sarah A Stoycos
- Department of Psychiatry, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Li Ding
- Southern California Clinical and Translational Science Institute, Los Angeles, California, USA
| | | | - Karen Kowalske
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, Texas, USA
| | - Barclay T Stewart
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Haig A Yenikomshian
- Division of Plastic Surgery, University of Southern California, Los Angeles, California, USA
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Zhang A, Vazquez S, Das A, Spirollari E, Dominguez JF, Finnan K, Turkowski J, Salik I. High area deprivation index is associated with increased injury severity in pediatric burn patients. Burns 2023; 49:1670-1675. [PMID: 37344308 DOI: 10.1016/j.burns.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/27/2023] [Accepted: 05/12/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Burn injuries play a significant role in pediatric injury-related mortality and morbidity. In this study, we aim to explore the relationship between patient demographics, socioeconomic factos and burn severity in pediatric patients. METHODS Patients under age 14 hospitalized at Westchester Medical Center for burn injury between 2015 and 2021 were reviewed. Demographic variables including mechanism of burn, total body surface area (TBSA) involvement, surgical intervention, hospital length of stay (LOS), and LOS per TBSA burn were extracted. The Area Deprivation Index (ADI) was calculated to further assess socioeconomic factors. RESULTS We included 399 patients under the age of 14 hospitalized for burn injuries at our institution between 2015 and 2021. The median age was 2 (IQR 1-6) years old, and 42.6% were female. High ADI (p = 0.018), Caucasian race (p = 0.001), and flame mechanism (p < 0.001) were independently associated with burn TBSA> 5%. LOS per TBSA was shorter in the Caucasian population (p = 0.022). CONCLUSION In burn injury patients, further research is necessary to investigate modifiable risk factors in individuals of Caucasian race or lower socioeconomic status to target effective prevention campaigns.
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Affiliation(s)
- Alice Zhang
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Sima Vazquez
- School of Medicine, New York Medical College, Valhalla, NY, USA.
| | - Ankita Das
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Eris Spirollari
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Jose F Dominguez
- Department of Neurosurgery, Westchester Medical Center, New York Medical College School of Medicine, Valhalla, NY, USA
| | - Kerri Finnan
- Department of Burn Care, Westchester Medical Center, Valhalla, NY, USA
| | - Joseph Turkowski
- Department of Burn Care, Westchester Medical Center, Valhalla, NY, USA; Department of General Surgery, Westchester Medical Center, New York Medical College School of Medicine, Valhalla, NY, USA
| | - Irim Salik
- Department of Pediatric Anesthesiology, Westchester Medical Center, New York Medical College School of Medicine, Valhalla, NY, USA
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Gonzalez MD, Ortega P, Hendren-Santiago BK, Gillenwater TJ, Vrouwe SQ. Burn Prevention in Spanish: Assessment of Content Accuracy, Website Quality, and Readability of Online Sources. J Burn Care Res 2023; 44:1031-1040. [PMID: 37249234 DOI: 10.1093/jbcr/irad081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Indexed: 05/31/2023]
Abstract
Burn prevention information may be inadequate or inaccessible to communities with non-English language preference. Our objective was to systematically analyze the content accuracy, website quality, and readability of online Spanish information for burn prevention in the home and compare it to English websites. We collected the top ten burn prevention results from a search on Google, Bing, and Yahoo using a list of Spanish key terms. Using recommendations from national organizations and a burn care expert team, content accuracy was evaluated for each website. We assessed website quality following the "Health on the Net" Code of Conduct. Readability was scored by averaging five validated readability tests for the Spanish language. After using the same protocol, a comparison was made with English websites as a control. Once duplicates and non-relevant search results were removed, 23 Spanish websites were assessed. Out of 21 possible points for content accuracy, the top website scored 14 (67%) and the average score was 6.6 (31%). For website quality, the average score was 50%. The average grade level needed to read the websites was 8.6. Compared to English, Spanish websites were less accurate (31% vs 41%), harder to read (9.8 vs 7.8), but were of higher website quality (50% vs 43%). Online burn prevention information in Spanish is often inaccurate, incomplete, and inferior to available English language websites. We propose a call to action to increase the quality of online burn prevention material available in Spanish.
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Affiliation(s)
- Miguel D Gonzalez
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Pilar Ortega
- Departments of Medical Education and Emergency Medicine, University of Illinois, Chicago, Illinois, USA
- Department of Diversity, Equity, and Inclusion, Accreditation Council for Graduate Medical Education, Chicago, Illinois, USA
| | - Bryce K Hendren-Santiago
- Department of Diversity, Equity, and Inclusion, Accreditation Council for Graduate Medical Education, Chicago, Illinois, USA
| | - T Justin Gillenwater
- Division of Plastic & Reconstructive Surgery, University of Southern California, Los Angeles, California, USA
| | - Sebastian Q Vrouwe
- Section of Plastic & Reconstructive Surgery, University of Chicago, Chicago, Illinois, USA
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DiPaolo N, Hulsebos IF, Yu J, Gillenwater TJ, Yenikomshian HA. Race and Ethnicity Influences Outcomes of Adult Burn Patients. J Burn Care Res 2023; 44:1223-1230. [PMID: 36881674 PMCID: PMC10480350 DOI: 10.1093/jbcr/irad033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Indexed: 03/09/2023]
Abstract
Outcomes of burn survivors is a growing field of interest; however, there is little data comparing the outcomes of burn survivors by ethnicity. This study seeks to identify any inequities in burn outcomes by racial and ethnic groups. A retrospective chart review of an ABA Certified burn center at a large urban safety net hospital identified adult inpatient admissions from 2015 to 2019. A total of 1142 patients were categorized by primary ethnicity: 142 black or African American, 72 Asian, 479 Hispanic or Latino, 90 white, 215 other, and 144 patients whose race or ethnicity was unrecorded. Multivariable analyses evaluated the relationship between race and ethnicity and outcomes. Covariate confounders were controlled by adjustment of demographic, social, and prehospital clinical factors to isolate differences that might not be explained by other factors. After controlling for covariates, black patients had 29% longer hospital stays (P = .043). Hispanic patients were more likely to be discharged to home or to hospice care (P = .005). Hispanic ethnicity was associated with a 44% decrease in the odds of discharge to acute care, inpatient rehabilitation, or a ward outside the burn unit (P = .022). Black and Hispanic patients had a higher relative chance of having publicly assisted insurance, versus private insurance, than their white counterparts (P = .041, P = .011 respectively). The causes of these inequities are indeterminate. They may stem from socioeconomic status not entirely accounted for, ethnic differences in comorbidity related to stressors, or inequity in health care delivery.
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Affiliation(s)
- Nicola DiPaolo
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Ian F Hulsebos
- Department of Surgery, Hospital Corporation of America Medical City North Texas Hospitals, Plano, Texas, USA
| | - Jeremy Yu
- Clinical and Translational Science Institute, University of Southern California, Los Angeles, California, USA
| | - Timothy Justin Gillenwater
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Haig A Yenikomshian
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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10
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Won P, Ding L, McMullen K, Yenikomshian HA. Post-Burn Psychosocial Outcomes in Pediatric Minority Patients in the United States: An Observational Cohort Burn Model System Study. EUROPEAN BURN JOURNAL 2023; 4:173-183. [PMID: 37359277 PMCID: PMC10290777 DOI: 10.3390/ebj4020015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Racial and ethnic minority burn patients face barriers to longitudinal psychosocial support after injury. Studies utilizing the Burn Model System (BMS) National Database report adult minority patients experience worse psychosocial outcomes in domains such as body image during burn recovery. No study to date has investigated disparities in psychosocial outcomes by racial or ethnic category in the pediatric population using the BMS database. This observational cohort study addresses this gap and examines seven psychosocial outcomes (levels of anger, sadness, depression, anxiety, fatigue, peer relationships, and pain) in pediatric burn patients. The BMS database is a national collection of burn patient outcomes from four centers in the United States. BMS outcomes collected were analyzed using multi-level, linear mixed effects regression modeling to examine associations between race/ethnicity and outcomes at discharge after index hospitalization, and 6- and 12-months post-injury. A total of 275 pediatric patients were included, of which 199 (72.3%) were Hispanic. After burn injury, of which the total body surface area was significantly associated with racial/ethnicity category (p < 0.01), minority patients more often reported higher levels of sadness, fatigue, and pain interference and lower levels of peer relationships compared to Non-Hispanic, White patients, although no significant differences existed. Black patients reported significantly increased sadness at six months (β = 9.31, p = 0.02) compared to discharge. Following burn injury, adult minority patients report significantly worse psychosocial outcomes than non-minority patients. However, these differences are less profound in pediatric populations. Further investigation is needed to understand why this change happens as individuals become adults.
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Affiliation(s)
- Paul Won
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Li Ding
- Department of Population and Public Health Science, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Kara McMullen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195-2100, USA
| | - Haig A. Yenikomshian
- Division of Plastic Surgery, University of Southern California, Los Angeles, CA 90033, USA
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11
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Martz F, McMullen KA, Carrougher GJ, Bunnell A, Sheckter CC, Wolf SE, Schneider JC, Stewart BT. Impacts of Financial Assistance on Quality of Life Among People Living With Burn Injury: Matched Cohort Analysis of the National Institute on Disability, Independent Living and Rehabilitation Research Burn Model System Database. J Burn Care Res 2023; 44:363-372. [PMID: 35699664 DOI: 10.1093/jbcr/irac079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Indexed: 11/14/2022]
Abstract
Disparities in socioeconomic status and minority status affect the risk of burn injury and the severity of that injury, thus affecting the subsequent cost of care. We aimed to characterize the demographic details surrounding receipt of financial assistance due to burn injury and its relationship with health-related quality of life scores. Participants ≥18 from Burn Model System National Longitudinal Database (BMS) with complete demographic data were included (n = 4330). Nonresponders to financial assistance questions were analyzed separately. The remaining sample (n = 1255) was divided into participants who received financial assistance because of burn injury, those who received no financial assistance, and those who received financial assistance before injury and as a result of injury. A demographic and injury-characteristic comparison was conducted. Health-related quality of life metrics (Satisfaction with Life, Short Form-12/Veterans RAND 12-Item Health Survey, Community Integration Questionnaire Social Component, and the Post-Traumatic Growth Inventory) were analyzed preinjury, then 6-months, 1-year, and 2-years postinjury. A matched cohort analysis compared these scores. When compared to their no financial assistance counterparts, participants receiving financial assistance due to burns were more likely to be minorities (19% vs 14%), have more severe injuries (%TBSA burn 21% vs 10%), and receive workers' compensation (24% vs 9%). They also had lower health-related quality of life scores on all metrics except the post-traumatic growth inventory. Financial assistance may aid in combating disparities in posttraumatic growth scores for participants at the greatest risk of financial toxicity but does not improve other health-related quality of life metrics.
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Affiliation(s)
- Flora Martz
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Kara A McMullen
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington, Seattle, USA.,Department of Rehabilitation Medicine, University of Washington, Seattle, USA
| | - Gretchen J Carrougher
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington, Seattle, USA
| | - Aaron Bunnell
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington, Seattle, USA
| | | | - Steven E Wolf
- Department of Surgery, The University of Texas Medical Branch, Galveston, USA.,Shriners Children's, Texas, Galveston, USA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Barclay T Stewart
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington, Seattle, USA.,Harborview Injury Prevention and Research Center, Seattle, Washington, USA
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