Moderation Effects of Daily Behavior on Associations between Symptoms and Social Participation Outcomes after Burn Injury: A 6-month Digital Phenotyping Study

OBJECTIVE

To examine the moderation effects of daily behavior on the associations between symptoms and social participation outcomes after burn injury DESIGN: A 6-month prospective cohort study SETTING: Community PARTICIPANTS: 24 adult burn survivors INTERVENTIONS: Not applicable MAIN OUTCOME MEASURES: Symptoms and social participation outcomes were assessed weekly using smartphone surveys, including symptoms of pain (Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity and Pain Interference), anxiety (PROMIS Anxiety), and depression (Patient Health Questionnaire (PHQ-8)), as well as outcomes of social interactions and social activities (Life Impact Burn Recovery Evaluation (LIBRE) Social Interactions and Social Activities). Daily behaviors were automatically recorded by a smartphone application and smartphone logs, including physical activity (steps, travel miles, and activity minutes), sleep (sleep hours), and social contact (number of phone call and message contacts).

RESULTS

Multilevel models controlling for demographic and burn injury variables examined the associations between symptoms and social participation outcomes, and the moderation effects of daily behaviors. Lower (worse) LIBRE Social Interactions and LIBRE Social Activities scores were significantly associated with higher (worse) PROMIS Pain Intensity, PROMIS Pain Interference, PROMIS Anxiety, and PHQ-8 scores (p<0.05). Additionally, daily steps and activity minutes were associated with LIBRE Social Interactions and LIBRE Social Activities (p<0.05), and significantly moderated the association between PROMIS Anxiety and LIBRE Social Activities (p<0.001).

CONCLUSIONS

Social participation outcomes are associated with pain, anxiety, and depression symptoms after burn injury, and are buffered by daily physical activity. Future interventions studies should examine physical activity promotion on improving social recovery after burns.

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.

Examination of pain comorbid diagnoses in the inpatient rehabilitation population across all impairment groups

OBJECTIVE

Pain is common in inpatient rehabilitation patients; however, the prevalence of pain diagnoses in this population is not well-defined. This study examines comorbid pain diagnoses in inpatient rehabilitation patients across impairment groups.

DESIGN

Adult inpatient rehabilitation patients discharged from January 2016 through December 2019 were identified in the Uniform Data System for Medical Rehabilitation® database using a literature-established framework containing ICD-10-CM pain diagnoses. Demographic data, clinical data, and pain diagnoses were compared across the 17 rehabilitation impairment groups.

RESULTS

Of 1,925,002 patients identified, 1,347,239 (70.0%) had at least one ICD-10 pain diagnosis. Over half of all patients in each impairment group had at least one pain diagnosis. The most common pain diagnoses were limb/extremity and joint pain, with variation between impairment groups. Female sex and being in the arthritis, major multiple trauma, and pain syndrome impairment groups were associated with a greater odds of a pain diagnosis.

CONCLUSION

Over half of all patients in each rehabilitation impairment group have a pain diagnosis, which varies between impairment groups. Due to the high prevalence of pain diagnoses, a new focus on pain management in inpatient rehabilitation patients is needed. Rehabilitation outcomes may also be affected by pain.

Examining the association between military service history and outcomes after burn injury

INTRODUCTION

The association between military service history and long-term outcomes after burn injury is unknown. This study uses data from the Burn Model System National Database to compare outcomes of individuals with and without self-reported military service history.

METHODS

Outcome measures were assessed at 12 months after injury including the Veterans Rand-12 Item Health Survey/Short Form-12, Satisfaction With Life Scale, Patient Reported Outcomes Measure Information System 29, 4-D Itch scale, Post Traumatic Stress Disorder Check List - Civilian Version, self-reported Post Traumatic Stress Disorder, and employment status. This study included 675 people with burns of whom 108 reported a history of military service.

RESULTS

The military service history group was more likely to be older, and male. Those with military service were most likely to be on Medicare insurance and those without military service history were most likely to be on Private Insurance/HMP/PPO. No significant differences were found between those with and without military service history in the outcome measures.

CONCLUSIONS

Further research should examine differences in outcomes between civilians and those with military service history, including elements of resilience and post traumatic growth.

Predictors at 6 and 12 Months for Social Participation Outcome at 24 Months in the Adult Burn Injury Population: A Burn Model System National Database Study

OBJECTIVE

To identify clinical factors (physical and psychological symptoms and post-traumatic growth) that predict social participation outcome at 24-month after burn injury.

DESIGN

A prospective cohort study based on Burn Model System National Database.

SETTING

Burn Model System centers.

PARTICIPANTS

181 adult participants less than 2 years after burn injury (N=181).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Demographic and injury variables were collected at discharge. Predictor variables were assessed at 6 and 12 months: Post-Traumatic Growth Inventory Short Form (PTGI-SF), Post-Traumatic Stress Disorder Checklist Civilian Version (PCL-C), Patient-Reported Outcomes Measurement Information System (PROMIS-29) Depression, Anxiety, Sleep Disturbance, Fatigue, and Pain Interference short forms, and self-reported Heat Intolerance. Social participation was measured at 24 months using the Life Impact Burn Recovery Evaluation (LIBRE) Social Interactions and Social Activities short forms.

RESULTS

Linear and multivariable regression models were used to examine predictor variables for social participation outcomes, controlling for demographic and injury variables. For LIBRE Social Interactions, significant predictors included the PCL-C total score at 6 months (β=-0.27, P<.001) and 12 months (β=-0.39, P<.001), and PROMIS-29 Pain Interference at 6 months (β=-0.20, P<.01). For LIBRE Social Activities, significant predictors consisted of the PROMIS-29 Depression at 6 months (β=-0.37, P<.001) and 12 months (β=-0.37, P<.001), PROMIS-29 Pain Interference at 6 months (β=-0.40, P<.001) and 12 months (β=-0.37, P<.001), and Heat Intolerance at 12 months (β=-4.55, P<.01).

CONCLUSIONS

Post-traumatic stress and pain predicted social interactions outcomes, while depression, pain and heat intolerance predicted social activities outcomes in people with burn injury.

Development of the Preschool Life Impact Burn Recovery Evaluation (PS-LIBRE1-5) Profile

Physical, social, and psychological outcomes have been identified as relevant to the rehabilitation process of children with burn injuries. Existing legacy measures are limited in item content and only cover a few constructs. Condition-specific outcomes are highly relevant to gauge early growth and development. Computerized adaptive tests (CATs) leveraging advanced psychometric technologies minimize respondent burden. This project developed PS-LIBRE1-5 Profile CAT (Preschool Life Impact Burn Recovery Evaluation) to measure relevant postburn outcomes in children aged one to five. Responses to the field-tested PS-LIBRE1-5 Profile (188 items) were measured on a scale of frequency or ability. Scores were coded from 0 to 4 where higher scores reflected better functioning. Factor analysis identified the items retained in the final item bank of each scale. CAT simulations were conducted to estimate the mean score of each scale. The simulated CAT score and full item bank scores were compared based upon the score range, ceiling and floor effects, and marginal reliabilities. The child mean age was 3.0 ± 1.5 years (n = 500). Average burn size and time since burn injury were 4.2% TBSA and 1.1 years, respectively. Psychometric analysis resulted in eight scales: Physical, Communication and Language, Emotional Wellbeing, Mood, Anxiety, Peer Acceptance, Play, and Peer Relations. Ceiling effects were acceptable at <13% for all scales. Marginal reliabilities of the CATs were credible. The PS-LIBRE1-5 Profile CAT contains 111 items, and is a comprehensive measure that captures physical, communication and language, psychological, and social functioning of preschool burn survivors.

PROMIS-25 Reliability and Validity Among Children Living with Burn Injury: A Burn Model System National Database Study

This study examined the reliability and validity of the Patient Reported Outcomes Measurement System (PROMIS)-25, a profile instrument consisting of four-item fixed short forms for six health domains, in children living with burn injury. Data were provided by children participating in a multi-center longitudinal study of outcomes after burn injury. Floor and ceiling effects, unidimensionality, internal consistency, reliability, and differential item functioning (DIF) of the PROMIS-25 Profile v.2.0 were examined. Correlations with other established measures were calculated to assess concurrent validity. Children (n = 256) between the ages of 8-18 years with moderate to severe injury provided responses on PROMIS-25 domains. All PROMIS-25 domains showed high internal consistency. Substantial portions of the sample reported no symptoms (anxiety [58.2%], depressive symptoms [54.6%], fatigue [50.8%], pain [60.1%]). There was a large ceiling effect on peer relationships (46.8%) and physical function mobility (57.5%). One-factor confirmatory factor analyses supported unidimensionality for all domains. Reliability was sufficient for group mean comparisons (>0.8) across at least some trait levels for most domains except fatigue and anxiety. No DIF with respect to burn status was detected when comparing the burn sample to the PROMIS pediatric general U.S. population testing sample. These results provide evidence of reliability and validity of PROMIS-25 scores among children living with burn injury. Reliability of domains was low to moderate and would likely be improved, and ceiling effects reduced for some domains, by administering the PROMIS-37, which includes six items per domain.

Preliminary Exploration of Long-Term Patient Outcomes After Tracheostomy in Burns: A Burn Model System Study

INTRODUCTION

Upper airway management is crucial to burn care. Endotracheal intubation is often performed in the setting of inhalation injury, burns of the face and neck, or large burns requiring significant resuscitation. Tracheostomy may be necessary in patients requiring prolonged ventilatory support. This study compares long-term, patient-reported outcomes in burn patients with and without tracheostomy.

MATERIALS AND METHODS

Data from the Burn Model System Database, collected from 2013 to 2020, were analyzed. Demographic and clinical data were compared between those with and without tracheostomy. The following patient-reported outcomes, collected at 6-, 12-, and 24-mo follow-up, were analyzed: Veterans RAND 12-Item Health Survey (VR-12), Satisfaction with Life, Community Integration Questionnaire, Patient-Reported Outcomes Measurement Information System 29-Item Profile Measure, employment status, and days to return to work. Regression models and propensity-matched analyses were used to assess the associations between tracheostomy and each outcome.

RESULTS

Of 714 patients included in this study, 5.5% received a tracheostomy. Mixed model regression analyses demonstrated that only VR-12 Physical Component Summary scores at 24-mo follow-up were significantly worse among those requiring tracheostomy. Tracheostomy was not associated with VR-12 Mental Component Summary, Satisfaction with Life, Community Integration Questionnaire, or Patient-Reported Outcomes Measurement Information System 29-Item Profile Measure scores. Likewise, tracheostomy was not found to be independently associated with employment status or days to return to work.

CONCLUSIONS

This preliminary exploration suggests that physical and psychosocial recovery, as well as the ability to regain employment, are no worse in burn patients requiring tracheostomy. Future investigations of larger scale are still needed to assess center- and provider-level influences, as well as the influences of various hallmarks of injury severity. Nonetheless, this work should better inform goals of care discussions with patients and families regarding the use of tracheostomy in burn injury.

Effect of replacing a portion of inorganic chloride trace minerals with trace mineral amino acid complexes

The objective was to determine whether replacing a portion of inorganic chloride trace minerals and cobalt carbonate in the diet with AA complexes of trace minerals and cobalt glucoheptonate will improve lactating cow performance, feed efficiency, and calf performance. In a clinical trial, 69 Holstein cows entering second lactation and greater were randomly assigned to 1 of 2 treatments, with the total dietary trace mineral concentration the same between treatments, starting 1 wk after dry off (50 to 57 d before expected parturition) until 154 d in milk (DIM): (1) an inorganic chloride trace mineral (ITM) blend consisting of Zn (75 mg/kg), Mn (65 mg/kg), and Cu (10 mg/kg) as hydroxychlorides and Co (1 mg/kg) as carbonate (n = 37) or (2) partial replacement of ITM with AA complexes of Zn (40 mg/kg), Mn (20 mg/kg), and Cu (3.5 mg/kg) and Co glucoheptonate (1 mg/kg; AATM; Availa-Dairy, Zinpro Corp.; n = 32). Dry matter intake (DMI) was recorded daily from enrollment through wk 8, and milk yields were recorded daily from calving through wk 22. Milk composition and body weights (BW) were collected weekly. Serum samples were analyzed for albumin (Alb), cholesterol (Chol), total bilirubin (Bili), aspartate aminotransferase (AST), haptoglobin, β-hydroxybutyrate (BHB), and Ca. A liver health index (LHI) was calculated based on Bili, Chol, and Alb concentrations. A liver functionality index (LFI) was calculated to standardize changes in Alb, Chol, and Bili from 4 to 29 DIM. Greater LHI and LFI indicate better health status. Colostrum was analyzed for IgG and Brix, and calf serum was analyzed for IgG. Calf growth was monitored through 9 wk of age (AATM: n = 12, ITM: n = 10). Data were analyzed using SAS software with mixed effects models and repeated-measures analysis, when applicable. Survival analysis for pregnancy by 154 DIM was analyzed by Cox proportional and Kaplan-Meier hazards models. Disorder incidence was tested with Fisher's exact test. Prepartum DMI as a percent of BW was lower in cows fed AATM and not significant postpartum. Cows fed AATM produced more milk from wk 1 to 8 and from wk 1 to 22. Energy-corrected milk yield and colostrum measures did not significantly differ between treatments. A treatment by time interaction was seen for AST and BHB; cows fed AATM tended to have lower AST concentrations at 28 DIM and lower concentrations in BHB through 29 DIM, though not statistically significant. Cows fed AATM had greater LHI at 4 DIM. Haptoglobin, Ca, LFI, hazard of pregnancy, risk to first service, survival curves, or services per pregnancy did not significantly differ. Calf serum IgG and birth weight did not significantly differ between treatments. Calves from dams fed AATM had greater average daily gain than calves from dams fed ITM. Overall, cows fed AATM during the dry period and early lactation had improved postpartum performance and potential health improvements.

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

INTRODUCTION

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

The Effect of Distance to Treatment Center on Long-Term Outcomes of Burn Patients

Geospatial proximity to American Burn Association (ABA)-verified burn centers or self-designated burn care facilities varies across the country. This study evaluates the effect of distance to treatment center on long-term, patient-reported outcomes. Data from the Burn Model System (BMS) National Longitudinal Database were analyzed. Demographic and clinical data were compared between three cohorts stratified by distance to BMS center (<20, 20-49.9, ≥50 miles). Distance to BMS center was calculated as driving distance between discharge and BMS center ZIP code centroids. The following patient-reported outcomes, collected at 12-months follow-up, were examined: Veterans RAND 12-Item Health Survey (VR-12), Satisfaction with Life (SWL) scale, employment status, and days to return to work. Mixed model regression analyses were used to examine the associations between distance to BMS center and each outcome, controlling for demographic and clinical variables. Of 726 patients included in this study, 26.3% and 28.1% were <20 and between 20 and 49.9 miles to a BMS center, respectively; 46.6% were ≥50 miles to a BMS center. Greater distance was associated with white/non-Hispanic race/ethnicity, preinjury employment, flame injury, and larger burn size (P < .001). Regression analyses did not identify significant associations between distance to BMS center and any patient-reported outcomes. This study suggests that patients treated at BMS centers have similar long-term, patient-reported outcomes of physical and psychosocial function, as well as employment, despite centralization of burn care and rehabilitation services. Given a steady decline in the incidence of burn injury, continued concentration of key resources is logical and safe.

Longitudinal Trends in Severe Traumatic Brain Injury Inpatient Rehabilitation

OBJECTIVE

The goal of this study is to describe national trends in inpatient rehabilitation facility (IRF) discharges for the most severely disabled cohort of patients with traumatic brain injury (TBI).

METHODS

Data from the Uniform Data System for Medical Rehabilitation for patients discharged from an IRF between January 1, 2002, and December 31, 2017, with a diagnosis of TBI and an admission Functional Independence Measure of 18, the lowest possible score, were obtained and analyzed.

RESULTS

Of the 252 112 patients with TBI discharged during the study period, 10 098 met the study criteria. From 2002 to 2017, the number of patients with an IRF admission Functional Independence Measure of 18 following TBI discharged from IRFs annually decreased from 649 to 488, modeled by a negative regression (coefficient = -2.97; P = .001), and the mean age (SD) increased from 43.0 (21.0) to 53.7 (21.3) years (coefficient = 0.70; P < .001). During the study period, the number of patients with the most severe disability on admission to IRF who were discharged annually as a proportion of total patients with TBI decreased from 5.5% to 2.5% (odds ratio = 0.95; P < .001) and their mean length of stay decreased from 41.5 (36.2) to 29.3 (24.9) days (coefficient = -0.83; P < .001].

CONCLUSION

The number and proportion of patients with the most severe disability on IRF admission following TBI who are discharged from IRFs is decreasing over time. This may represent a combination of primary prevention, early mortality due to withdrawal of life-sustaining treatment, alternative discharge dispositions, or changes in admitting and reimbursement practices. Furthermore, there has been a decrease in the duration of IRF level care for these individuals, which could ultimately lead to poorer functional outcomes, particularly given the importance of specialized rehabilitative care in this population.

A PREVENTIVE TOOL FOR PREDICTING BLOODSTREAM INFECTIONS IN CHILDREN WITH BURNS

ABSTRACT

Introduction: Despite significant advances in pediatric burn care, bloodstream infections (BSIs) remain a compelling challenge during recovery. A personalized medicine approach for accurate prediction of BSIs before they occur would contribute to prevention efforts and improve patient outcomes. Methods: We analyzed the blood transcriptome of severely burned (total burn surface area [TBSA] ≥20%) patients in the multicenter Inflammation and Host Response to Injury ("Glue Grant") cohort. Our study included 82 pediatric (aged <16 years) patients, with blood samples at least 3 days before the observed BSI episode. We applied the least absolute shrinkage and selection operator (LASSO) machine-learning algorithm to select a panel of biomarkers predictive of BSI outcome. Results: We developed a panel of 10 probe sets corresponding to six annotated genes ( ARG2 [ arginase 2 ], CPT1A [ carnitine palmitoyltransferase 1A ], FYB [ FYN binding protein ], ITCH [ itchy E3 ubiquitin protein ligase ], MACF1 [ microtubule actin crosslinking factor 1 ], and SSH2 [ slingshot protein phosphatase 2 ]), two uncharacterized ( LOC101928635 , LOC101929599 ), and two unannotated regions. Our multibiomarker panel model yielded highly accurate prediction (area under the receiver operating characteristic curve, 0.938; 95% confidence interval [CI], 0.881-0.981) compared with models with TBSA (0.708; 95% CI, 0.588-0.824) or TBSA and inhalation injury status (0.792; 95% CI, 0.676-0.892). A model combining the multibiomarker panel with TBSA and inhalation injury status further improved prediction (0.978; 95% CI, 0.941-1.000). Conclusions: The multibiomarker panel model yielded a highly accurate prediction of BSIs before their onset. Knowing patients' risk profile early will guide clinicians to take rapid preventive measures for limiting infections, promote antibiotic stewardship that may aid in alleviating the current antibiotic resistance crisis, shorten hospital length of stay and burden on health care resources, reduce health care costs, and significantly improve patients' outcomes. In addition, the biomarkers' identity and molecular functions may contribute to developing novel preventive interventions.

Digital Interventions for Social Participation in Adults with Long-term Physical Conditions: A Systematic Review

This review aims to identify and evaluate digital interventions for social participation in the growing population of adults with long-term physical conditions. Articles were sourced from MEDLINE, EMBASE, CINAHL and PsycINFO databases using subject headings and keywords related to "social participation" and "digital technology". Studies that adopted digital technology interventions to improve social participation in adults with long-term physical conditions were included. Data on study methodology, participant and digital intervention characteristics, and findings related to social participation were extracted. The search yielded a total of 4646 articles and 14 articles met criteria for final review with five randomized controlled trials, two non-randomized clinical trials and seven one-group pretest-posttest clinical trials. Studies were organized based on the digital intervention strategy implemented to improve social participation: group support (n = 4), individual skill training or counseling (n = 6), education and support (n = 3), and mixed intervention (n = 1). The group support interventions developed a social network among participants through videoconference, app, or virtual reality platform. Three studies reported positive improvements in different aspects of social participation. Individual skill training or counseling mainly utilized phone calls to help participants cope with activity participation and interpersonal relationship issues. Only two studies demonstrated benefits for social participation. The education and support intervention, which used messages and website information to increase participants' knowledge and provide support, showed positive findings in three studies. This review suggests digital interventions for improving social participation in adults with long-term physical conditions are feasible and the effectiveness of different strategies may vary.Registration: This review was prospectively registered on the International Prospective Register of Systematic Reviews (PROSPERO) (registry number: CRD42021254105).

Epidemiology of bovine colostrum production in New York Holstein herds: Cow, management, and environmental factors

Adequate supply of high-quality colostrum is essential for calf health. Colostrum production, at first milking, varies between animals and seasons, but herd-level and management associations with colostrum production have not been well described. Our objectives were to (1) describe colostrum production and colostrum handling practices and (2) to identify individual cow, herd management, and environmental factors associated with colostrum production. A convenience sample of 19 New York Holstein dairy farms (620 to 4,600 cows) were enrolled in this observational study to describe colostrum production and to evaluate cow, management, and prepartum environmental factors associated with colostrum yield and Brix %. Herd owners or managers were given a colostrum management questionnaire, and farm personnel recorded individual colostrum yield and Brix % for primiparous (PP; n = 5,978) and multiparous (MPS; n = 13,228) cows between October 2019 and February 2021. Temperature, relative humidity, and light intensity were measured by sensors placed in each farm's close-up dry cow pens for the entire length of the study. Median colostrum yield for each farm ranged from 2.5 to 7.6 kg for PP and 4.0 to 7.7 kg for MPS cows. Mean Brix % from each farm ranged from 22.2 to 27.9% for PP and 22.0 to 28.8% for MPS cows. Lowest colostrum yield from PP animals was associated with calf sex (female) and colostrum Brix % (≤22%). Greatest colostrum yield from MPS cows was associated with colostrum Brix % (≤22%), calf sex (twin), dry period length (>67 d), gestation length (283-293 d), an alive calf, second parity, previous lactation length (>344 d) and previous lactation 305-d mature equivalent milk yield (>13,091 kg), heat and humidity exposure area under the curve (AUC) 7 d before calving (>69.2 average temperature-humidity index per 30-min interval), and light intensity AUC 14 d before calving (>154.2 average lux per 15-min interval). Greatest colostrum Brix % from PP animals was associated with calf sex (male), an alive calf, and light intensity AUC 14 d before calving (≤64.0 average lux per 15-min interval). Greatest colostrum Brix % from MPS cows was associated with dry period length (>67 d), an alive calf, 305-d mature equivalent milk yield of previous lactation (≤15,862 kg), gestation length (274-282 d), colostrum yield (<6 kg), fifth or greater parity, and heat and humidity exposure AUC 7 d before calving (≤50.1 average temperature-humidity index per 30-min interval). Dairy producers can use this information to recognize the variation in colostrum production and alter colostrum management programs in anticipation of periods of low production or quality.

Development of a 30-Day Readmission Risk Calculator for the Inpatient Rehabilitation Setting

OBJECTIVES

Readmission to acute care from the inpatient rehabilitation facility (IRF) setting is potentially preventable and an important target of quality improvement and cost savings. The objective of this study was to develop a risk calculator to predict 30-day all-cause readmissions from the IRF setting.

DESIGN

Retrospective database analysis using the Uniform Data System for Medical Rehabilitation (UDSMR) from 2015 through 2019.

SETTING AND PARTICIPANTS

In total, 956 US inpatient rehabilitation facilities and 1,849,768 IRF discharges comprising patients from 14 impairment groups.

METHODS

Logistic regression models were developed to calculate risk-standardized 30-day all-cause hospital readmission rates for patients admitted to an IRF. Models for each impairment group were assessed using 12 common clinical and demographic variables and all but 4 models included various special variables. Models were assessed for discrimination (c-statistics), calibration (calibration plots), and internal validation (bootstrapping). A readmission risk scoring system was created for each impairment group population and was graphically validated.

RESULTS

The mean age of the cohort was 68.7 (15.2) years, 50.7% were women, and 78.3% were Caucasian. Medicare was the primary payer for 73.1% of the study population. The final models for each impairment group included between 4 and 13 total predictor variables. Model c-statistics ranged from 0.65 to 0.70. There was good calibration represented for most models up to a readmission risk of 30%. Internal validation of the models using bootstrap samples revealed little bias. Point systems for determining risk of 30-day readmission were developed for each impairment group.

CONCLUSIONS AND IMPLICATIONS

Multivariable risk factor algorithms based upon administrative data were developed to assess 30-day readmission risk for patients admitted from IRF. This report represents the development of a readmission risk calculator for the IRF setting, which could be instrumental in identifying high risk populations for readmission and targeting resources towards a diverse group of IRF impairment groups.

The Impact of Burn Size on Community Participation: A Life Impact Burn Recovery Evaluation (LIBRE) Study

OBJECTIVE

To assess the association of burn size and community participation as measured by the LIBRE Profile.

SUMMARY OF BACKGROUND DATA

Burn size is an established clinical predictor of survival after burn injury. It is often a factor in guiding decisions surrounding early medical interventions; however, literature is inconclusive on its relationship to quality of life outcomes.

METHODS

This is a secondary data analysis of a cross-sectional survey of adult burn survivors. Self-reported data were collected between October 2014 and December 2015 from 601 burn survivors aged ≥18 years with ≥5% total body surface area (TBSA) or burns to critical areas. Sociodemographic characteristics were compared between participants with small burns (≤40% TBSA burned) and large burns (>40% TBSA burned). Ordinary least squares regression models examined associations between burn size and LIBRE Profile scale scores with adjustments for sex, current work status, burns to critical areas, and time since burn injury.

RESULTS

The analytic sample comprised 562 participants with data available for burn size. 42% of respondents had large burns (>40% TBSA burned) and 58% reported smaller burns (TBSA ≤40%). In adjusted regression models, patients with large burns tended to score lower on the Social Activities and Work & Employment scales ( P < 0.05) and higher on the Family & Friends scale ( P < 0.05). Participants with burns >40% TBSA scored lower for several individual items in the Social Activities scale and one item in the Work & Employment scale ( P < 0.05).

CONCLUSIONS

Increasing burn size was found to be negatively associated with selected items of Work & Employment and Social Activities, but positively associated with aspects of Family & Friend Relationships. Future longitudinal studies are necessary to assess and understand the long-term social impact of burn injuries on adult populations.

Item Pool Development for the School-Aged Life Impact Burn Recovery Evaluation Profile Computerized Adaptive Test: An Observer-Reported Outcome Assessment Measuring the Impact of Burn Injuries in School-Aged Children

The transition from early childhood to teen years (5-12) is a critical time of development, which can be made particularly challenging by a burn injury. Assessing postburn recovery during these years is important for improving pediatric survivors' development and health outcomes. Few validated burn-specific measures exist for this age group. The purpose of this study was to generate item pools that will be used to create a future computerized adaptive test (CAT) assessing postburn recovery in school-aged children. Item pool development was guided by the previously developed School-Aged Life Impact Burn Recovery Evaluation (SA-LIBRE5-12) conceptual framework. The item pool development process involved a systematic literature review, extraction of candidate items from existing legacy measures, iterative item review during expert consensus meetings, and parent cognitive interviews. The iterative item review with experts consisted of six rounds. A total of 10 parent cognitive interviews were conducted. The three broad themes of concern were items that needed 1) clarification, needed context, or were vague, 2) age dependence and relevance, and 3) word choice. The cognitive interviews indicated that survey instructions, recall period, item stem, and response choices were interpretable by respondents. Final item pool based on parental feedback consists of 57, 81, and 60 items in physical, psychological, and family and social functioning, respectively. Developed item pools (n = 198) in three domains are consistent with the existing conceptual framework. The next step involves field testing the item pool and calibration using item response theory to develop and validate the SA-LIBRE5-12 CAT Profile.

Strength of association between body mass index and physical function scores in paediatric burn patients: A National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System study

OBJECTIVE

Increased body weight has been associated with reduced muscle wasting in the early catabolic phase after a severe burn. Yet, overweight and obese non-burn children often exhibit impaired musculoskeletal function, which may lead to poor physical function (PF). We aimed to determine the association between body mass index (BMI) at discharge and self-reported PF and caregiver proxy-reported PF during recovery of burned children.

MATERIALS AND METHODS

This is a retrospective multisite longitudinal study in paediatric burn patients ((8-17 y old at time of burn). PF outcome measures were self-reported mobility, proxy-reported mobility, and upper extremity PF evaluated using PROMIS measures at 6-, 12-, and 24-months after injury. Primary exposure variable was BMI-for-age at discharge.

RESULTS

A total of 118 paediatric patients, aged 11.7 ± 3.3 y, with burns covering 37.6 ± 18.8% of their total body surface area (TBSA) and BMI-for-age of 23.1 ± 5.4 kg/m² at discharge were analyzed. BMI at discharge was not significantly associated with self-reported mobility scores 6 months after burn (beta coefficient =-0.23, p = 0.31), had a positive effect on mobility at 12 months (beta = 0.46, p = 0.05), and no effect at 24 months after injury (beta=-0.10, p = 0.60), when adjusted for burn size. BMI did not have a significant effect on proxy-reported mobility or upper extremity PF.

CONCLUSION

A greater BMI at discharge was associated with improved self-reported PF at 12 months after burn but not at 6 months or 24 months, which suggests a faster recovery of PF in paediatric patients of larger body weight. Our data suggests that a larger body weight does not compromise the recovery of PF after burn.

27 Pain Medication Use at Follow up Is Associated with Long-term Outcomes

Introduction

Use of prescription pain medication after burn injury is commonly required. However, little is known about long-term pain medication use and its association with outcomes. Therefore, the purpose of this study is to assess patterns of prescription pain medication use after discharge and the association between these medications and quality of life outcomes.

Methods

Data from the Burn Model System National Longitudinal Database (2015-2021) were analyzed. Pain medication use was assessed at pre-injury (recall at discharge), discharge (medical record) and follow-up (self-report at 6, 12, and 24 months after injury). Outcome measures included: VR-12 Physical and Mental Component Summary scores (PCS and MCS), Community Integration Questionnaire (CIQ), Posttraumatic Stress Disorder Checklist (PCL), Satisfaction with Life Scale (SWLS), and NeuroQOL Stigma. The population was divided into two groups, those taking and not taking prescription pain medications at one year. Regression analyses examined associations between prescription pain medication use and outcomes at 12 months, controlling for age, gender, race, ethnicity and burn size.

Results

Of the 645 participants, 15% reported prescription pain medication use prior to their burn. At discharge, 81% reported use of an opioid and 46% reported use of a neuropathic pain medication. At 12 months, 32% of individuals indicated prescription pain medication use. The pain medication group exhibited larger burn size (24.0% vs 15.2%) and longer hospital stays (40.4 vs 25.0 days) than the non-pain medication group (p< 0.0001 for all). Additionally, 25% of individuals who reported pre-injury pain medication use also reported use at 12 months. Regression analyses demonstrated that pain medication use was associated with worse physical health (PCS: coefficient 8.69, p< 0.0001) mental health (MCS: 6.31, p< 0.0001), stigma (NeuroQOL Stigma: 3.91, p< 0.0001), and satisfaction with life (SWLS: -3.66, p< 0.0001) at one year. Additionally, pain medication use was associated with 45% decreased odds of being employed (coefficient 0.55, p=0.029) and approximately 3 times greater odds of having post-traumatic stress disorder at 12 months (coefficient 3.25, p< 0.0001).

Conclusions

There are significant associations between prescription pain medication use and worse physical, mental and employment outcomes at twelve months. This information may be used to trigger screening and manage long-term recovery outcomes.

80 Validation of PROMIS-25 Among Children Living with Burn Injuries

Introduction

Patient-reported outcomes are important for burn injury research and clinical practice. The NIH-funded Patient Reported Outcomes Measurement System (PROMIS)-25 profile has been validated for use in diverse populations of children with many conditions, though not among children living with burn injuries. The purpose of this study was to examine the reliability and validity of PROMIS-25 scores in children living with burn injury.

Methods

Data were provided by children who were participating in a multi-center longitudinal study of outcomes after burn injury. The PROMIS-25 Profile, which includes 4 items for each domain of physical function mobility, anxiety, depression, fatigue, peer relationships, and pain interference, was evaluated for reliability and validity. Floor and ceiling effects, unidimensionality, internal consistency, and reliability were examined. Correlations with other measures (Post-Traumatic Growth Inventory-Child (PTGI-C), Child PTSD Symptom Scale (CPSS) and Burn Outcome Questionnaire Body Image Scale (BOQBI)) were calculated to assess concurrent validity.

Results

256 children living with burn injury who sustained a moderate to severe injury provided responses on PROMIS-25 domains 6 months-10 years post burn. Participants’ age ranged from 8-18 years at time of assessment; mean years since injury was 4.3 (SD 4.1). All PROMIS-25 domains showed high internal consistency (Cronbach’s α=0.90–0.95). Substantial portions of the sample reported no symptoms (anxiety [58.2%], depressive symptoms [54.6%], fatigue [50.8%], pain [60.1%]). There was a large ceiling effect on peer relationships (46.8%) and physical function mobility (57.5%). One-factor confirmatory factor analyses supported unidimensionality for all domains (all CFI >0.98). Reliability was credible for group mean comparisons ( >0.8) across at least some trait levels for all domains except fatigue and anxiety which had low reliability (< 0.8) across the entire trait range. The magnitude and direction of correlations were as anticipated (0.32 for peer relationships and body image; 0.51 for depressive symptoms and PTSD) with the exception of weak negative correlations between PTGI-C and the anxiety and depression domains.

Conclusions

The results provide some evidence of reliability and validity of PROMIS-25 scores among children living with burn injury. Reliability of all domains was low to moderate and would likely be improved, and ceiling effects reduced, by administering the PROMIS-37, which includes 6 items per domain.

73 Associations Between Pre-burn Occupation Type and Employment Outcomes at One Year

Introduction

Reintegration into the workforce after burn injury is an important issue for survivors. In a 2012 systematic review, 28% of burn survivors never returned to any form of employment. Although pre-burn employment status is strongly associated with post-burn employment, there are little data on the role of pre-injury occupation type on workplace reintegration. The aim of this project was to assess the impact of occupation type on employment outcomes after burn injury.

Methods

Data from the National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System National Longitudinal Database from 2015 to 2021 were used to investigate the association between occupation type and employment outcomes. Occupation type was classified into two groups, Labor and Non-labor, using the U.S. Bureau of Labor Statistics Standard Occupational Classification System. Demographic and clinical data were compared between groups. Mixed regression analyses examined associations between pre-burn occupation type and post-burn employment outcomes (employment at 1 year, days to return to work), controlling for age, gender, race, ethnicity, pre-injury employment, and burn size.

Results

Of the 600 patients who were employed pre-injury, 247 (41%) identified with a non-labor occupation and 353 (59%) with labor occupations. The Labor group was more male (82% vs. 61%) and Hispanic (23% vs. 6%), younger (mean age 42.1 vs. 48.3 years), less educated (high school or less, 25% vs. 11%) and more likely to have been injured at work (28% vs. 14%) compared to the Non-labor group (p< 0.001 for all comparisons). Changes in occupation were seen from pre-injury to post-injury; 16% of working survivors changed from Non-labor to Labor and 13% from Labor to Non-labor occupation types. For those who did return to work after injury, the average time to return to work was greater for Labor compared to the Non-labor group (150 vs 100 days; p=0.003). Additionally, those in the pre-injury Labor group were less likely to be employed at 12 months compared to the Non-labor group (odds ratio = 0.41; p=0.009).

Conclusions

Pre-injury occupation type is associated with employment outcomes after injury. Therefore, occupation type can be used to inform vocational reintegration resources, such as vocational rehabilitation programs, to optimize survivor outcomes.

66 The Association of Burn Size and Global Functioning: A Preschool LIBRE1-5 Study

Introduction

Between the ages of one and five, children gain increased mobility and begin to explore their surroundings. This makes them a particularly vulnerable age group for burn-related injuries, which can influence a child’s physical and psychosocial development. Previous research in adult burn survivors associated larger burn size with poorer functional outcomes for social activities. Currently, there are limited data on the association in preschool aged survivors between burn size and functioning. The aim of this study is to understand how demographic characteristics, particularly burn size, correlate with the global functioning items using data from the Preschool-LIBRE_1-5 study.

Methods

The Preschool-LIBRE_1-5 was field-tested with 426 parents of burn survivors. Eight global items assessed change in functioning in four domains (physical, psychological, communication & language, and social) compared to pre-burn functioning. Demographic variables included gender, race, age at survey completion, total body surface area burned (TBSA), ethnicity, and pain severity. Post-burn abilities were assessed with “Following the burn injury, my child lost abilities he/she had before the burn injury in…”, measured with a yes or no response and compared to other children without burns with, “Compared to other children in the same age, in general, how would you rate your child’s…”, measured with a 5-point Likert scale ranging from much worse to much better. Multivariate logistic regression with multiple imputation for missing values were used to measure the association between demographic characteristics and global items.

Results

The population had a mean age at time of burn injury of 1.9 + 1.1 years and mean TBSA% of 4.2 + 8.0. Of the 426 participants, 305 have a TBSA < 5%, 45 have a TBSA between 5%-15% and 45 have a TBSA >15%. Larger TBSA was associated with lower odds of abilities in functional status for all four global functioning items. Adjusted odd ratios with 95% CI’s included communication and language 0.57(0.35,0.93), physical function 0.55(0.37,0.83), social function 0.33(0.2,0.52), and psychological/behavioral function 0.49(0.31,0.75). There was also a negative correlation of larger TBSA with weaker social abilities of the child compared to other children without burns.

Conclusions

The findings of this study show a negative association between a child’s burn size and parent-reported functioning in the four domains post-burn injury. These findings may help clinicians improve pediatric recovery and rehabilitation.

124 The Relationship Between Social Functioning and Psychological Status: A preschool-libre1-5 Study

Introduction

Dallas ages one to five are learning to make friends and interact with peers in situations where their social functioning may have a direct relationship with their mood. Dallas may be isolated from peers during the acute phase of burn recovery and face rejection by their peers during recovery. This could influence their psychological health through feelings of anxiety, loneliness, social withdrawal and/or defiant behavior. This study evaluates the relationship between social and psychological functioning using the data collected from the field-tested Preschool-LIBRE_1-5 instrument.

Methods

Parents of burn survivors (n=426) completed Preschool-LIBRE_1-5. Items from the psychological (48 items) and social (37 items) functioning domains were coded on a 5-point Likert scale ranging from 0 (never) to 4 (always) where higher scores denote better functioning. Confirmatory factor analysis was conducted for individual items in the social and psychological domains respectively. Regression model assessed the relationship between the social and psychological domains, controlling for demographic characteristics (gender, race, ethnicity, age at survey completion, burn size, and pain severity).

Results

Factor analysis identified three factors for social functioning: play, peer relations, and peer rejection. The psychological items confirmed a single factor that included dysregulation (negative behaviors and sleep), externalization (impulsivity and aggression), internalization (general anxiety and depression), and trauma (fear and avoidance). Distress items, also in the internalizing subdomain, weren’t strongly confirmed as part of this single scale. The subdomains with the lowest and highest mean scores in psychological domain were dysregulation (2.68 + 0.58) and depression (3.50 + 0.37), and in social domain were peer relation (2.39 + 0.95) and peer rejection (3.42 + 0.64) respectively. Adjusted regression analysis demonstrate that the social functioning domain has a significant relationship with psychological status (p < 0.004).

Conclusions

Analysis suggests a significant association between social functioning and psychological status. Results provide a basis for understanding the importance of these domains in relationship to each other.

10 The Impact of Insurance Disparities on Long-term Burn Outcomes: A Burn Model System Investigation

Introduction

Access to healthcare and insurance coverage are associated with quality of life, morbidity, and mortality outcomes. However, most studies have only focused on same-admission and short-term outcomes due to the lack of national longitudinal data and there is limited data on this topic in the burn literature. Our aim was to determine the effect of insurance status on long-term outcomes in a national sample of burn patients.

Methods

This is a retrospective study using the longitudinal Burn Model System National Database from January 2015 to April 2021. The inclusion criteria were all adult patients admitted for burn injury from participating sites. Main outcomes were the physical (PCS) and mental (MCS) health component summary scores of the Veterans RAND 12 (VR-12) score at 6, 12, and 24 months after injury. Multivariable regression was used to examine the association between insurance status and the outcomes, adjusting for demographics (i.e., age, gender, race/ethnicity) and burn injury severity.

Results

A total of 3,698 burn patients were included. Mean age was 43.39 (SD 15.84) years, 72% were male and 76% were white. Most patients had private/commercial insurance (56.37%), followed by Medicare (14.42%) and Medicaid (13.18%). The remaining 16% were uninsured patients (self-pay or philanthropy). Mean PCS scores were 43.64 (SD 10.87), 45.31 (SD 11.04) and 46.45 (SD 10.65) and Mean MCS scores were 47.80 (SD 12.35), 48.18 (SD 12.30) and 48.44 (SD 12.18) at 6, 12 and 24 months, respectively. In adjusted analyses, Medicaid insurance was associated with worse MCS at 6 months (Coefficient -3.90, p=0.001), and worse PCS at 12 and 24 months (Coefficient -3.09, p=0.004 and Coefficient -4.18, p< 0.001, respectively), compared to uninsured status. Medicare insurance was associated with worse PCS scores at 24 months (Coefficient -3.07, p=0.013).

Conclusions

Having Medicaid and Medicare insurance was significantly associated with a lower health-related quality of life at long-term follow up, even after adjusting for demographics and burn injury severity. Further studies need to focus on analyzing the reasons for these disparities and developing strategies to improve the quality of life of this subpopulation.

109 The Impact of Distance to Treatment Center on Long-term Outcomes of Burn Patients

Introduction

Geospatial access to American Burn Association (ABA)-verified burn centers or self-designated burn care facilities varies across the country. It is often necessary to transport patients hundreds of miles to provide definitive burn care and rehabilitation services. This study evaluates the impact of distance to treatment center on long-term outcomes of burn patients.

Methods

Data from the National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System (BMS) National Database, collected from 2015 to 2019, were analyzed to investigate the impact of distance to BMS center on long-term, patient-reported outcomes. Distance was calculated as driving distance between home zip code centroid and BMS center. Demographic and clinical data were compared between groups by distance from BMS center (< 20, 20-49.9, >50 miles). The following patient-reported outcome measures, collected 12 months after injury, were examined: Veterans Rand 12 Physical Component Summary Score (VR-12 PCS), Veterans Rand 12 Mental Component Summary Score (VR-12 MCS), Satisfaction with Life (SWL), employment status, and days to return to work. Mixed regression model analyses were used to examine the associations between distance to BMS center and each outcome measure, controlling for demographic and clinical variables.

Results

Of the 726 participants included in this study, 191 (26.3%) and 204 (28.1%) were < 20 and between 20-49.9 miles from a BMS center, respectively; 331 (46.6%) were >50 miles from a BMS center. Greater distance to BMS center was associated with white race/ethnicity (p< 0.001) and employment at time of injury (p=0.001). Greater distance to BMS center was also associated with flame injury (p< 0.001) and larger burn size (p< 0.001). There were no significant differences in length of stay or number of operations between groups. Regression analyses did not identify significant associations between distance to BMS center and VR-12 PCS, VR-12 MCS, SWL, employment at 12 months, or days to return to work.

Conclusions

After burn injury, patient-reported outcome measures of physical and psychosocial function, as well as employment, do not differ based on distance to BMS center.

125 Community Socioeconomic Status Is Associated with Social Participation Outcomes

Introduction

Socioeconomic factors are recognized as important social determinants of health. Data however are sparse describing the relationship between socioeconomic status and long term burn outcomes. This study aims to examine associations between community-level socioeconomic status and social participation outcomes in burn survivors.

Methods

Data was obtained from the Life Impact Burn Recovery Evaluation (LIBRE) Journey study that assesses longitudinal social participation outcomes of community dwelling burn survivors. Subjects were linked to the Distressed Communities Index (DCI), which combines seven indicators into a metric that depicts community economic well-being. Participants were categorized by time since burn (< 5, 5-15, ≥15 years). Linear regression models examined associations between DCI (zip code and county levels) and LIBRE domain scores (Family & Friends, Social Interactions, Social Activities, Work & Employment).

Results

The study included 314 burn survivors, (mean age 44.1 years; 61.0% female; 48.6% married; 82.8% white). The population was distributed among the time since injury categories (< 5: 35.8%, 5-15: 27.5%, ≥15: 36.7%). Approximately 18% of subjects were categorized in the “at risk” or “distressed” DCI categories. For survivors less than five years from burn, a DCI score increase of 1 standard deviation (worse socioeconomic status) at the zip code level was associated with decreased Family & Friends and Social Activity scores of 2.6 (p=.01) and 2.0 points (p=0.04), respectively (small effect sizes). This relationship was even stronger when controlling for sociodemographic factors. In regression analysis, survivors within the first five years from injury living in “at risk” or “distressed” communities showed worse Family & Friend scores by 6.5 points compared to those living in “prosperous” communities, even after adjusting for age, gender, race, ethnicity, education, and marital status (p=0.04; moderate effect size). There were no significant associations between DCI and LIBRE domain scores for survivors assessed beyond 5 years from injury.

Conclusions

Social participation outcomes were worse in burn survivors who lived in socioeconomically disadvantaged neighborhoods. Burn survivors who face socioeconomic challenges may need additional support to address social disparities to improve outcomes.

114 Long Term Impact of Hospital Acquired Multi-drug Resistant Organisms on Health-related Quality of Life

Introduction

MDROs colonize wounds and cause infections for hospitalized burn patients, which may lead to increased infection risk, wound complications, longer (LOS) and more cost. Little is known about the long-term impacts of MDRO colonization and infection on burn survivors. We aimed to describe the impacts of colonization on long-term health-related quality of life (HRQoL), itch, and pain.

Methods

Data from adult participants in a multicenter longitudinal outcome study were used. Data was described and χ ² and Kruskal-Wallis testing was applied to determine differences between the two groups. Outcomes included Veterans RAND 12 (VR-12) physical component summary score (PCS), and PROMIS 29 domains for pain intensity, fatigue, pain interference, physical function, and sleep disturbance. Pruritus was assessed using the 4-D Itch scale for total itch. Multilevel, multiple linear regressions were used for outcome measures at 6 m post-injury. Random effects regression with robust standard errors (SE) were used to evaluate the impacts over time.

Results

The study included 704 individuals and 92 were MDRO colonized (13%). Colonized patients had larger burns (25% TBSA, IQR 9-45 vs. 8% TBSA, IQR 3–20; p < .001), more operations (4, IQR 2-7 vs. 1, IQR 1-3; p < .001), more grafting (17% TBSA, IQR 3-46 vs. 3% TBSA, IQR 1- 9; p < .001), more ventilator days (2, IQR 0–8 vs. 0 IQR 0-0; p < .001), and longer LOS (34 days, IQR 17 – 64 vs. 16, IQR 9 - 27; p < .001). Adjusting for confounding covariables, such as demographics, colonization was associated with a lower PCS score (OR -0.33, 95% CI -0.68, -0.06; p=.018); a higher fatigue score (OR 0.46, 95% CI 0.13, 0.79; p = .007) and worse itch (OR 0.4, 95% CI -0.01, 0.75; p = .036). There was no association with pain intensity, pain interference, or sleep disturbance. Random effects regression indicated that colonization was associated with lower PCS (OR -5.0, 95% CI -8.60, -1.39; p = .007).

Conclusions

Impact of colonization extends beyond the immediate hospitalization and likely has long-term effects on HRQoL. Given our observation of lower physical function after MDRO, more granular research on taxa-specific effects, timing of colonization, and interventions are indicated to elucidate the impact on HRQoL.

68 The Association Between Body Mass Index and Physical Function in Adult Burn Survivors

Introduction

An area of rehabilitation research in burns is the impact of co-morbidities. Obesity is one of these, is an increasing public health concern, and its role remains controversial regarding burn injury and physical recovery. Our aim was to evaluate associations between body mass index (BMI) as a measure of obesity, at discharge and self-reported physical function (PF) during recovery of adult burn survivors.

Methods

This study included data that was collected by four American Burn Association-verified burn centers, which contribute to the Burn Model System National Database project. The data included BMI obtained at hospital discharge and self-reported Patient-Reported Outcomes Measurement Information System (PROMIS)-29 PF-mobility and upper extremity scores assessed at 6-, 12-, and 24-months after burn. Mixed linear models for repeated measures and regression models were used to assess associations between BMI and PROMIS-29 PF scores over time. Values are expressed as means ± SD. Significance was set at p&lt; 0.05.

Results

A total of 502 adult patients aged 47 ± 16 years were included, with mean total body surface area burned (TBSA) of 17 ± 18 % (range; 1.0-88%) and mean BMI of 23.1 ± 5.4 kg*m-2 (range; 14.0-64.7 kg*m-2). We found no significant effect at 6 months (beta=-0.045, p= 0.54) nor at 12 months after injury (beta=-0.063, p= 0.44) when adjusted for age, burn size, and sex, however, BMI at discharge had a significant negative effect on self-reported mobility scores 24 months after injury (beta=0.218, p=&lt; 0.05).

Conclusions

Increased weight (i.e. BMI) at discharge was negatively associated with PF during recovery. Benefiting from a large sample size, our analysis suggests that long term recovery and restoration of PF in adult burn survivors is compromized by excess body weight.

Physical, Psychological, and Social Outcomes in Pediatric Burn Survivors Ages 5 to 18 Years: A Systematic Review

Acute pediatric burn injuries often result in chronic sequelae that affect physical, psychological, and social outcomes. To date, no review has comprehensively reported on the impact of burn injuries across all three domains in school-aged children. The aim of this systematic review was to identify published literature that focuses on the impact of burn injuries on physical, psychological, or social functioning, and report upon the nature of study characteristics and their outcomes. We included literature published after 1980, focusing on burn outcomes in children aged 5 to 18 years. Each eligible study was systematically reviewed and primary outcomes were classified into outcome domains based on existing frameworks. Fifty-eight studies met inclusion criteria, and reported on physical (n = 24), psychological (n = 47), and social (n = 29) domains. The majority of the studies had sample sizes of <100 participants, burn size of <40%, and findings reported by parents and/or burn survivors. Only eight of 107 different measures were used in three or more studies. Parents and burn survivors generally reported better physical and social outcomes and worse psychological functioning compared to non-burn populations. Physical disabilities were associated with psychological and social functioning in several studies. Follow-up data reported improvements across domains. This review demonstrates the importance of physical, psychological, and social status as long-term outcomes in burn survivors. Mixed findings across three outcome domains warrant long-term research. Findings of this review will guide the foundation of comprehensive burn and age-specific instruments to assess burn recovery.

769 The association of a burn injury with social engagement: A Preschool-LIBRE1-5 study

Introduction

Social engagement, primarily through peer interactions, is an active-coping strategy that is key to community re-integration after a burn injury. For young children, social engagement encourages standard development, with burn injuries potentially affecting their likelihood to engage with others. We utilized the parent-report Preschool-LIBRE_1-5 (Life Impact Burn Recovery Evaluation) to explore factors that can influence a child’s social engagement.

Methods

Our participants were 426 parents of burned children ages one through five who completed the Preschool-LIBRE_1-5. Four variables involving social engagement were assessed: “frequency of child avoiding other children,” “frequency of child playing alone,” “frequency of child wanting to be left alone,” and “frequency of child liking to be around other children.” Responses from a 5-point Likert scale ranging from never to always were recoded on a 3-point Likert scale such that a higher score indicated increased social engagement. A nominal logistic regression analysis was conducted with each social engagement variable as a separate dependent variable for each model. The age of the patient when the survey was completed and gender were independent variables. The models also were adjusted by the presence of a hand burn, a face burn, burn size, race, and ethnicity. A bootstrap analysis was conducted to assess internal validity of the significant findings.

Results

The sample characteristics included: mean age of 3.1+1.4 years, mean time since burn injury of 1.2+1.3 years, mean total body surface area (TBSA) of 4.2+7.9, 55.2% male, and 74.2% white. Findings did not reach significance for three of the dependent variables. However, the dependent variable “frequency of child liking to be around other people” was significant with an increased odds of 35.8% for older children compared to younger ones. (OR [95% CI] =1.358 [1.027, 1.795]). Further, boys were much less likely to want to be left alone (OR [95% CI] = 2.97[1.36,6.5]). Among 500 bootstrap samples, 59% and 79% of the samples replicated the significant findings respectively.

Conclusions

In preschool children with burn injuries, burn location, race, and ethnicity were not associated with the social engagement items tested in this study. Boys did show a higher likelihood of peer engagement suggesting that gender may influence a child’s desire to be alone.

774 Digital Interventions for Social Participation in Adults with Long-term Physical Conditions: A Systematic Review

Introduction

Burn survivors experience significant social participation challenges in their recovery. However, enrolment and compliance with face-to-face interventions for such issues are often limited by time, location, and financial resources. Digital technologies are increasingly utilized in healthcare and provide a flexible, accessible, and low-cost treatment option. Given the sparse literature on this topic in the burn field, this review evaluated digital interventions for social participation in adults with long-term physical conditions to inform future use in the burn population.

Methods

MEDLINE, EMBASE, CINAHL and PsycINFO databases were searched using keywords and Medical Subject Headings (MeSH) terms related to ‘digital intervention’ and ‘social participation’ for studies published in English between January 2010 and May 2021. Studies that adopted digital technology interventions to improve social participation in adults with long-term physical conditions were included. Study quality was evaluated using Oxford Levels of Evidence. Data on study methodology, digital intervention and findings related to social participation were summarized.

Results

The search yielded a total of 4646 articles, of which 158 were full-text screened and 14 met inclusion and exclusion criteria. There were five randomized controlled trials, two non-randomized clinical trials and seven one-group pretest-posttest clinical trials. Twenty-five different measurement tools were utilized to assess social participation and two of them were used twice. Three types of digital interventions were implemented to improve social participation: group support, individual skill training or counselling, and education and support. The group support intervention developed a social network among affected people through videoconference, app, or virtual reality platform (3 of 4 studies with positive results). Individual skill training or counselling utilized phone calls or videoconference to help participants with activity participation and interpersonal relationships (2 of 6 studies with positive results). The education and support intervention used messages and website information to increase participants’ knowledge and provide support (3 of 3 studies with positive results).

Conclusions

This review presents evidence of different digital interventions’ effect on improving social participation in adults with long-term physical conditions. However, the existing literature is limited by the heterogeneity of outcome measures and varied methodology quality that preclude larger generalizations.

83 The Impact of Tracheostomy on Long-term Patient Outcomes: A Burn Model System National Database Study

Introduction

Management of the upper airway is crucial to burn care, especially in the setting of inhalation injury or burns to the face or neck. Endotracheal intubation is often performed to secure the airway; however, tracheostomy may be necessary in patients requiring prolonged ventilatory support. This study compares long-term outcomes of burn patients with and without tracheostomy.

Methods

Data from the Burn Model System National Database, collected from 2013 to 2020, were analyzed. Demographic and clinical data were compared between those with and without tracheostomy. The following patient-reported outcome measures, collected at 6-, 12-, and 24-months, were analyzed: Veterans Rand 12 Physical Component Summary Score (VR-12 PCS), Veterans Rand 12 Mental Component Summary Score (VR-12 MCS), Satisfaction with Life (SWL), Community Integration Questionnaire (CIQ), Patient-Reported Outcomes Measurement Information System (PROMIS-29), employment status, and number of days to return to work. Regression models were used to assess the impact of tracheostomy status on long-term outcome measures, controlling for demographic and clinical variables.

Results

Of the 714 patients included in this study, 39 (5.46%) received a tracheostomy and 675 (94.54%) did not. The two groups were similar across all demographic data collected. Tracheostomy patients were more likely to have flame injury, inhalation injury, larger burn size, more trips to the operating room, longer hospital stay, and greater number of days on a ventilator (p< 0.001). Regression model analyses demonstrated that tracheostomy was associated with worse VR-12 PCS scores at 6-, 12-, and 24-months (6.6 [95% CI 1.5, 11.8], p=0.012; 11.5 [6.2, 16.8], p< 0.001; 10.8 [4.2, 17.5], p=0.001). Tracheostomy was also associated with worse scores in two PROMIS-29 domains, physical function and pain interference. For physical function, the association was seen at 6-, 12-, and 24-months (7.4 [3.0, 11.8], p=0.001; 9.6 [5.2, 14.0], p< 0.001; 11.3 [5.8, 16.9], p< 0.001). For pain interference, the association was only seen at 12-months (-5.3 [-10.0, -0.55], p=0.029).

Conclusions

After burn injury, patient-reported outcome measures of physical function and pain interference were significantly worse with tracheostomy.

74 The Association Between Burn Injury and Peer Relations: A preschool-libre1-5 Study

Introduction

Children ages one to five years old are naturally curious and build their personality and social skills through interactions with others. Positive peer relations are especially important after a burn injury as bullying and peer rejection can delay development of social skills. This study assessed the association between burn injuries and burn survivors’ ability to connect with and maintain peer relations in this age group using the Preschool-LIBRE _1-5 (Life Impact Burn Recovery Evaluation).

Methods

The Preschool-LIBRE_1-5 was field-tested with 426 parents of burn survivors. Each item was scored on a 5-point Likert scale ranging from 0 (never) to 4 (always). Data was recoded for selected items such that higher scores denote better functioning. Classic test theory methods were used to assess the peer relation items from a social functioning domain. Individual items and mean scores in the domain were examined. Multiple linear regression analyses (controlling for gender, race and ethnicity, pain severity, burn injury to critical area, burn size, and age at survey completion) measured the association between demographic and clinical characteristics and calculated a peer relation score based on multiple imputation samples.

Results

The mean age was 3.06 + 1.41 years, mean time since injury of 1.16 + 1.34 years, mean total body surface area (TBSA%) of 4.21 + 7.92, and 55.16% male and 74.18% white. Items from peer relations item pool (n=15) were identified as a unidimensional scale (α=0.92, item-total correlations for all 15 items >0.4, ratio of the 1st and 2nd eigenvalues (8.729/1.287=6.78) = > 4). The mean peer relation score was 2.86 + 0.76. The two items with the lowest and highest score were “My child would ask for things nicely when playing with other children” (x̄ = 2.09) and “My child liked to play near and be with family members and friends (x̄ = 3.59) respectively. Results indicated that age was a significant predictor, such that older age at survey completion was significantly associated with higher peer relation score (β = 0.16, p < 0.0001). With each year of age increase, peer relationship score increased by 0.16 + 0.21 points.

Conclusions

Preschool-aged burn survivors, as reported by parents, often had the ability to connect with peers through imitation and participating in play activities, and maintained peer relationships well. These findings emphasize the importance of promoting early interventions that build social skills, allowing for positive interactions with peers and improving social functioning in the long-term.

Adolescents with and without head and neck burns: comparison of long-term outcomes in the burn model system national database

INTRODUCTION

Facial burns account for persistent differences in psychosocial functioning in adult burn survivors. Although adolescent burn survivors experience myriad chronic sequelae, little is known about the effect of facial injuries. This study examines differences in long-term outcomes with and without head and neck involvement.

METHODS

Data collected for 392 burn survivors between 14-17.9 years of age from the Burn Model System National Database (2006-2015) were analyzed. Comparisons were made between two groups based on presence of a head and neck burn (H&N) using the following patient reported outcome measures: Satisfaction with Appearance Scale, Satisfaction with Life Scale, Community Integration Questionnaire, and Short Form-12 Health Survey at 6, 12, and 24 months after injury. Regression analyses were used to assess association between outcome measures and H&N group at 12-months.

RESULTS

The H&N group had more extensive burns, had longer hospital stays, were more likely to be burned by fire/flame and were more likely to be Hispanic compared to the non-H&N group. Regression analysis found that H&N burn status was associated with worse SWAP scores. No significant associations were found between H&N burn status and other outcome measures.

CONCLUSIONS

Adolescents with H&N burn status showed significantly worse satisfaction with appearance at 12-months after injury. Future research should examine interventions to help improve body image and coping for adolescent burn survivors with head and neck burns.

Trajectory Curves for Purposes of Benchmarking and Predicting Clinical Outcomes: A Scoping Review

Trajectory curves are valuable tools to benchmark patient health status and predict future outcomes. A longitudinal study is underway to examine social participation after burn injury using the Life Impact Burn Recovery Evaluation (LIBRE) Profile with the goal of developing trajectory curves for specific domains that focus on social reintegration. We conducted a scoping review to inform and understand trajectory curves applied in clinical settings to compare outcomes for an individual to a matched cohort of comparable patients or predicted expected outcomes over time. This scoping review utilized a PubMed search from January 2014 to August 2019 for the following terms: "trajectory curves" or "trajectory models" and "clinic" or "clinical." Only articles that specifically referenced longitudinal and clinical research designs were included in the scoping review. Articles were assessed using standard scoping review methods and categorized based on clinical application of trajectory curves for either benchmarking or prediction. The initial literature review identified 141 manuscripts and 34 met initial inclusion criteria. The reviewed articles support the clinical use of trajectory curves. Findings provide insight into several key determinants involved with the successful development and implementation of trajectory curves in clinical settings. These findings will inform efforts to use the LIBRE Profile to model social participation recovery and assist in developing effective strategies using trajectory curves to promote social reintegration after burn injury.

Validation of PROMIS-29 domain scores among adult burn survivors: A National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System Study

BACKGROUND

Patient-reported outcomes are important for understanding recovery after burn injury, benchmarking service delivery and measuring the impact of interventions. Patient-Reported Outcomes Measurement Information System (PROMIS)-29 domains have been validated for use among diverse populations though not among burn survivors. The purpose of this study was to examine validity and reliability of PROMIS-29 scores in this population.

METHODS

The PROMIS-29 scores of physical function, anxiety, depression, fatigue, sleep disturbance, ability to participate in social roles, and pain interference were evaluated for validity and reliability in adult burn survivors. Unidimensionality, floor and ceiling effects, internal consistency, and reliability were examined. Differential item functioning was used to examine bias with respect to demographic and injury characteristics. Correlations with measures of related constructs (Community Integration Questionnaire, Satisfaction with Life Scale, Post-Traumatic Stress Checklist-Civilian, and Veteran's Rand-12) and known-group differences were examined.

RESULTS

Eight hundred and seventy-six burn survivors with moderate to severe injury from 6 months to 20 years postburn provided responses on PROMIS-29 domains. Participants' ages ranged from 18 years to 93 years at time of assessment; mean years since injury was 3.4. All PROMIS domain scores showed high internal consistency (Cronbach's α = 0.87-0.97). There was a large ceiling effect on ability to participate in social roles (39.7%) and physical function (43.3%). One-factor confirmatory factor analyses supported unidimensionality (all comparative fit indices >0.95). We found no statistically significant bias (differential item functioning). Reliability was high (>0.9) across trait levels for all domains except sleep, which reached moderate reliability (>0.85). All known-group differences by demographic and clinical characteristics were in the hypothesized direction and magnitude except burn size categories.

CONCLUSION

The results provide strong evidence for reliability and validity of PROMIS-29 domain scores among adult burn survivors. Reliability of the extreme scores could be increased and the ceiling effects reduced by administering PROMIS-43, which includes six items per domain, or by administering by computerized adaptive testing.

LEVEL OF EVIDENCE

Diagnostic Test or Criteria, level III.

Predicting Depression and Post-Traumatic Stress Symptoms Following Burn Injury: A Risk Scoring System

Depression and post-traumatic stress are common psychiatric comorbidities following burn injury. The purpose of this study was to develop an admission scoring system that assesses the risk of development of depression or post-traumatic symptoms in the burn population. This study is a retrospective review of the prospectively collected Burn Model System National Database. Adult burn survivors enrolled from 2014-2018 (n=486) were included. The primary outcome was the presence of depression or post-traumatic stress symptoms at 6, 12, or 24 months post-injury. Logistic regression analysis was used to identify demographic and clinical predictors of depression and post-traumatic stress symptoms. A risk scoring system was then created based on assigning point values to relevant predictor factors. The study population had a mean age of 46.5±15.8 years, mean burn size of 18.3±19.7%, and was 68.3% male. Prior to injury, 71.3% of the population was working, 47.9% were married, and 50.8% had completed more than a high school education. An 8-point risk scoring system was developed using the following predictors of depression or post-traumatic stress symptom development: gender, psychiatric treatment in the past year, graft size, head/neck graft, etiology of injury, and education level. This study is the first to develop a depression and post-traumatic stress symptom risk scoring system for burn injury. This scoring system will aid in identifying burn survivors at high risk of long-term psychiatric symptoms that may be used to improve screening, monitoring, timely diagnosis and interventions.

Measuring the impact of burn injury on the parent-reported health outcomes of children 1-to-5 years: Item pool development for the Preschool1-5 Life Impact Burn Recovery Evaluation (LIBRE) Profile

Modern, reliable, and valid outcome measures are essential to understanding the health needs of young children with burn injuries. Burn-specific and age-appropriate legacy assessment tools exist for this population but are hindered by the limitations of existing paper-based instruments. The purpose of this study was to develop item pools comprised of questions appropriate for children aged 1-5 with burn injuries. Item development was based on a framework provided by previous work to develop the Preschool Life Impact Burn Recovery Evaluation (LIBRE) Conceptual Model. The Preschool LIBRE Conceptual Model work established four sub-domains of functioning for children with burns aged 1-5. Item development involved a systematic literature review, a qualitative item review process with clinical experts, and parent cognitive interviews. Four item pools were established: (1) communication and language development; (2) physical functioning; (3) psychological functioning and (4) social functioning for preschool-aged children with burn injuries. We selected and refined candidate items, recall periods, survey instructions, and response option choices through clinical and parental feedback during the qualitative review and cognitive interview processes. Item pools are currently being field-tested as part of the process to calibrate and validate the Preschool1-5 LIBRE Computer Adaptive Test (CAT) Profile.

Evaluation of the psychometric properties of the burn specific health scale-brief: A National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System Study

OBJECTIVE

The Burn Specific Health Scale-Brief (BSHS-B) is a commonly used burn specific health outcome measure that includes 40 items across nine subscales. The objective of this study was to use both classical and modern psychometric methods to evaluate psychometric properties of the BSHS-B.

METHODS

Data were collected post burn injury by a multisite federally funded project tracking long term outcomes. We examined dimensionality, local dependence, item fit, and functioning of response categories, homogeneity, and floor and ceiling effects. Items were fit to Item Response Theory models for evaluation.

RESULTS

A total of 653 adults with burn injury completed the BSHS-B. Factor analyses supported unidimensionality for all subscales, but not for a total score based on all 40 items. All nine of the subscales had significant ceiling effects. Six item pairs displayed local dependence suggesting redundance and 11 items did not fit the Item Response Theory models. At least 15 items have too many response options.

CONCLUSIONS

Results identified numerous psychometric issues with the BSHS-B. A single summary score should never be used for any purpose. Psychometric properties of the scale need to be improved by removing redundant items, reducing response categories and modifying or deleting problematic items. Additional conceptual work is needed to, at a minimum, revise the work subscale and optimally to revisit and clearly define the constructs measured by all the subscales. Additional items are needed to address ceiling effects.

Systematic Review and Expert Consensus on the Use of Orthoses (Splints and Casts) with Adults and Children after Burn Injury to Determine Practice Guidelines

The objective of this review was to systematically evaluate the available literature addressing the use of orthoses (splints and casts) with adult and pediatric burn survivors and determine whether practice guidelines could be proposed. This review provides evidence-based recommendations specifically for rehabilitation professionals who are responsible for burn survivor rehabilitation. A summary recommendation was made after the literature was retrieved using a systematic review and critical appraisal by multiple authors. The level of evidence of the literature was determined in accordance with the Oxford Centre for Evidence-based Medicine criteria. Due to the low level of evidence in the available literature, only one practice guideline could be recommended: orthotic use should be considered as a treatment choice for improving range of motion or reducing contracture in adults who have sustained a burn injury. To address the rehabilitation-specific gaps found in the literature regarding orthotic use in burn rehabilitation and provide guidance to clinicians, a formal expert consensus exercise was conducted as a final step to the project. The resultant manuscript provides a summary of the literature regarding orthotic use with burn patients, one practice guideline, proposed orthotic terminology and additional practice recommendations based on expert opinion. The limitations in the current literature are also discussed, and suggestions are made for future studies in the area of orthotic use after burn injury.

Temperature sensitivity after burn injury: A Burn Model System National Database Hot Topic

BACKGROUND

People living with burn injury often report temperature sensitivity. However, its epidemiology and associations with health-related quality of life (HRQOL) are unknown. We aimed to characterize temperature sensitivity and determine its impact on HRQOL to inform patient education after recovery from burn injury.

METHODS

We used the multicenter, longitudinal Burn Model System National Database to assess temperature sensitivity at 6, 12 and 24 months after burn injury. Chi-square and Kruskal-Wallis tests determined differences in patient and injury characteristics. Multivariable, multi-level generalized linear regression models determined the association of temperature sensitivity with Satisfaction with Life Scale (SWL) scores and Veterans RAND 12 (VR-12) physical (PCS) and mental health summary (MCS) component scores.

RESULTS

The cohort comprised 637 participants. Two thirds (66%) experienced temperature sensitivity. They had larger burns (12% TBSA, IQR 4-30 vs 5% TBSA, IQR 2-15; p<0.0001), required more grafting (5% TBSA, IQR 1-19 vs 2% TBSA, IQR 0-6; p<0.0001), and had higher intensity of pruritus at discharge (11% severe vs 5% severe; p=0.002). After adjusting for confounding variables, temperature sensitivity was strongly associated with lower SWL (OR -3.2, 95% CI -5.2, -1.1) and MCS (OR -4.0, 95% CI -6.9, -1.2) at 6-months. Temperature sensitivity decreased over time (43% at discharge, 4% at 24-months) and was not associated with poorer HRQOL at 12 and 24 months.

CONCLUSION

Temperature sensitivity is common after burn injury and associated with worse SWL and MCS during the first year after injury. However, temperature sensitivity seems to improve and be less intrusive over time.

Development of the School-Aged Life Impact Burn Recovery Evaluation (SA-LIBRE5-12) Profile: A Conceptual Framework

Pediatric burn injuries can alter the trajectory of the survivor's entire life. Patient-centered outcome measures are helpful to assess unique physical and psychosocial needs and long-term recovery. This study aimed to develop a conceptual framework to measure pediatric burn outcomes in survivors aged 5 to 12 years as a part of the School-Aged Life Impact Burn Recovery Evaluation Computer Adaptive Test (SA-LIBRE5-12 CAT) development. This study conducted a systematic literature review guided by the WHO International Classification of Functioning - Child and Youth and domains in the American Burn Association/Shriners Hospitals for Children Burn Outcomes Questionnaire5-18. Interviews with eight parents and seven clinicians were conducted to identify important domains in child recovery. One clinician focus group with four clinicians was completed to identify gaps in the preliminary framework, and semi-weekly expert consensus meetings were conducted with three experts to solidify the framework. Qualitative data were analyzed by grounded theory methodology. Three major thematic outcome domains emerged: 1) Physical Functioning: fine motor and upper extremity, gross motor and lower extremity, pain, skin symptoms, sleep and fatigue, and physical resilience; 2) Psychological Functioning: cognitive, behavioral, emotional, resilience, and body image; and 3) Family and Social Functioning: family relationships, and parental satisfaction, school, peer relations and community participation. The framework will be used to develop item banks for a CAT-based assessment of school-aged children's health and developmental outcomes, which will be designed for clinical and research use to optimize interventions, personalize care, and improve long-term health outcomes for burned children.

Contracture Severity at Hospital Discharge in Children: A Burn Model System Database Study

Contractures can complicate burn recovery. There are limited studies examining the prevalence of contractures following burns in pediatrics. This study investigates contracture outcomes by location, injury, severity, length of stay, and developmental stage. Data were obtained from the Burn Model System between 1994 and 2003. All patients younger than the age of 18 with at least one joint contracture at hospital discharge were included. Sixteen areas of impaired movement from the shoulder, elbow, wrist, hand, hip, knee, and ankle joints were examined. Analysis of variance was used to assess the association between contracture severity, burn size, and length of stay. Age groupings were evaluated for developmental patterns. A P value of less than .05 was considered statistically significant. Data from 225 patients yielded 1597 contractures (758 in the hand) with a mean of 7.1 contractures (median 4) per patient. Mean contracture severity ranged from 17% (elbow extension) to 41% (ankle plantarflexion) loss of movement. Statistically significant associations were found between active range of motion loss and burn size, length of stay, and age groupings. The data illustrate quantitative assessment of burn contractures in pediatric patients at discharge in a multicenter database. Size of injury correlates with range of motion loss for many joint motions, reflecting the anticipated morbidity of contracture for pediatric burn survivors. These results serve as a potential reference for range of motion outcomes in the pediatric burn population, which could serve as a comparison for local practices, quality improvement measures, and future research.