Using a Biopsychosocial Model to Understand Long-Term Outcomes in Persons With Burn Injuries

Shelley Wiechman; Michael A. Hoyt; David R. Patterson

doi:10.1016/j.apmr.2018.01.029

A Scoping Review on the Long-Term Outcomes in Persons with Adult-Acquired Burn Injuries

Journal of Burn Care & Research ◽

10.1093/jbcr/irz146 ◽

2019 ◽

Vol 41 (3) ◽

pp. 472-502

Author(s):

Stephanie R Cimino ◽

Jorge N Rios ◽

Matthew Godleski ◽

Sander L Hitzig

Keyword(s):

Community Participation ◽

Scoping Review ◽

The United States ◽

Community Dwelling ◽

Burn Injuries ◽

Computer Assisted ◽

Long Term Outcomes ◽

Burn Survivors ◽

The Impact

Abstract Adult-acquired burn injuries are a life-altering event that can lead to debilitating functional or psychological impairments. With advancements in health care resulting in decreased mortality rates, survivors of burn injuries can expect to live longer. This warrants a shift in focus to better understand what happens to adults once they are discharged from the hospital into the community. Therefore, the purpose of this scoping review was to map the literature regarding the long-term outcomes of community-dwelling adult-acquired burn survivors. A computer-assisted literature search was conducted on literature from January 1, 2000 to August 31, 2018 utilizing four large databases (MEDLINE, EMBASE, CINHAL, and PsycINFO). Articles were included if they had a minimum of five individuals with a burn injury as a result of an accidental injury who were at least 18 years of age at the time of injury. Fifty-four articles were found suitable for inclusion in this review. The majority of studies were conducted in the United States and were longitudinal in design. Four themes were apparent from the articles: postburn complications, psychosocial outcomes, quality of life, and community participation. Data are lacking with respect to outcomes more than 5 years postburn as well as qualitative research. Furthermore, more literature is needed to understand the impact of postburn complications, coping strategies, and posttraumatic growth as well as barriers to community participation. Overall, there is an emerging body of literature that describes the long-term outcomes of adult-acquired burn survivors up to 5 years postburn.

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455 The Long-Term Outcomes of Electrical Burn Injuries: A Burn Model Systems National Database Study

Journal of Burn Care & Research ◽

10.1093/jbcr/iry006.377 ◽

2018 ◽

Vol 39 (suppl_1) ◽

pp. S200-S200

Author(s):

L F Espinoza ◽

L C Simko ◽

D N Herndon ◽

M Rosenberg ◽

L Rosenberg ◽

...

Keyword(s):

Burn Injuries ◽

Model Systems ◽

National Database ◽

Long Term Outcomes ◽

Database Study

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547 Long-term Outcomes of Chemical Burn Injuries: A Burn Model System National Database Study

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.175 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S113-S114

Author(s):

Gabrielle G Grant ◽

Olivia Stockly ◽

Audrey E Wolfe ◽

Steven E Wolf ◽

Jeffrey C Schneider ◽

...

Keyword(s):

Employment Status ◽

Satisfaction With Life ◽

Burn Injury ◽

Burn Injuries ◽

National Database ◽

Chemical Burn ◽

Long Term Outcomes ◽

Chemical Injuries ◽

Fire Flame

Abstract Introduction Information on long-term outcomes following chemical burn injury is sparse. This study aims to examine whether or not there are differences in long-term outcomes for individuals with chemical burn injuries compared to those with fire/flame injuries. Methods Data from the Burn Model System (BMS) National Database (1997–2019) were used for analysis. Demographic and clinical characteristics of adult burn survivors with chemical injuries and fire/flame injuries were compared. Regression analyses for the Mental Health Composite Scale (MCS) and the Physical Health Composite Scale (PCS) of the Short Form Health Survey-12, employment status, and Satisfaction with Life Scale (SWLS) were conducted at 12 and 24 months post-burn, adjusting for age, gender, race, and burn size. Results A total of 2,522 database participants (96 with chemical burns; 2,426 with fire/flame injuries) were included in the analyses. Those with chemical injuries had smaller burn sizes, shorter hospital stays, and fewer ventilator days (p< 0.0001, p=0.0034, and p=0.0005, respectively). Chemical burn survivors were more likely to be employed at the time of the burn (p< 0.0001), to have sustained an employment-related injury (p< 0.0001), and to have been discharged to their own home following their acute stay (p< 0.0001). No significant differences in the MCS, PCS, employment status or SWLS were found at either 12 or 24 months post-burn between groups in the regression analyses. Conclusions Chemical burn injuries were not found to have a significant difference on mental health, physical health, employment status, and satisfaction with life outcomes compared to fire/flame injuries. However, the effects of chemical burn injury on long-term outcomes may be difficult to detect due to the relatively small sample size of this population. Applicability of Research to Practice Further investigation is needed to better understand long-term outcomes following chemical injuries. Individuals with chemical burn injuries may require more specific assessment tools to improve how these types of injuries are studied.

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The assessment and management of thermal burn injuries in a UK ambulance service: a clinical audit

British Paramedic Journal ◽

10.29045/14784726.2020.12.5.3.52 ◽

2020 ◽

Vol 5 (3) ◽

pp. 52-58

Author(s):

Harriet Ashman ◽

Dean Rigg ◽

Fionna Moore

Keyword(s):

Compliance Rate ◽

Epidemiological Data ◽

Evidence Base ◽

First Aid ◽

Burn Injuries ◽

Ambulance Service ◽

Burn Patients ◽

Long Term Outcomes ◽

Thermal Burn

<sec id="s1">Background: Although burn emergencies are infrequently encountered, the ambulance service is often the first point of contact for patients in these situations. It is therefore important that these potentially devastating injuries are managed in accordance with the evidence base. Appropriate assessment and management of these patients in the pre-hospital phase will have a significant impact upon their long-term outcomes, such as scarring cosmesis and functionality. </sec> <sec id="s2">Aim and objectives: This audit was conducted to determine if patients presenting to one UK ambulance service with thermal burn injuries were managed safely, effectively and in a timely manner. Areas highlighted for improvement will assist in directing future pre-hospital research and educational requirements. Epidemiological data will also be provided. </sec> <sec id="s3">Results: 278 thermal burn incidents occurring from June 2017 to May 2018 (inclusive) were included in this audit. A larger proportion of burn patients were paediatrics who fell into the 0‐10 age category, most burn patients were injured at a home address and only nine of the overall sample were major burns. Only 35% of patients received adequate cooling of their burns, an essential first aid intervention. The assessment of pain (87%) and provision of analgesia (75%) showed a higher compliance rate. However, only 54% had pain reassessed after analgesia. There was a near 100% compliance rate for patients being managed without hydrogel dressings and topical medicines. </sec> <sec id="s4">Conclusion: The results indicate several areas for improvement within the ambulance trust. Of importance is the application of basic first aid, such as cooling. It is important not only to improve education among staff but also to understand non-compliance. It should be acknowledged that assessment of pain and provision of analgesia demonstrated far higher compliance compared to current pre-hospital evidence. Several points for education and research have been identified. </sec>

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Long-Term Outcomes Following Burn Injuries

Handbook of Burns Volume 2 ◽

10.1007/978-3-030-34511-2_2 ◽

2020 ◽

pp. 15-23

Author(s):

Shelley A. Wiechman

Keyword(s):

Burn Injuries ◽

Long Term Outcomes

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Long-term Outcomes after Toe-To-Thumb Transfers for Burn Reconstruction in Children

Journal of Burn Care & Research ◽

10.1093/jbcr/irab101 ◽

2021 ◽

Author(s):

Alfred P Yoon ◽

Neil F Jones

Keyword(s):

Proximal Phalanx ◽

Middle Finger ◽

Burn Injuries ◽

Long Term Outcomes ◽

Thermal Burn ◽

No Donor ◽

Anatomical Structures ◽

Severe Burn Injuries

Abstract Children are one of the most vulnerable populations to burns, and hands are frequently burned anatomical structures. Restoring function in a severely burned pediatric hand is challenging. We present our experience with pediatric toe-to-thumb transfers for burn reconstruction. A retrospective review was conducted of all pediatric toe-to-thumb transfer patients between 2009 and 2014. Children under the age of 18 who underwent secondary reconstruction after electrical or thermal burn injuries with at least 5-year follow-up were included. Functional outcomes were measured with the modified Kapandji score. Complications of the reconstructed hand as well as donor foot were recorded. Four children with 10 toe-to-hand transfers (4 great toes, 2 second toes, and 2 combined second-third toes) met the inclusion criteria. Average follow-up length was 104 months (range 60-144 months) Two children sustained thermal burn injuries and two sustained electrical burn injuries. Three children achieved opposition of the reconstructed toe-to-thumb transfer to the small finger (Kapandji score 5), and one child achieved opposition of the reconstructed toe-to-thumb transfer to the proximal phalanx of the middle finger, the only remaining finger (Kapandji score 3). No donor foot morbidities were noted postoperatively. Toe-to-thumb transfers should be considered the gold standard for thumb reconstruction in children with severe burn injuries of their hands and provide restoration of sensation, pinch, grasp and opposition with minimal morbidity of the donor foot.

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Traumatic Brain Injury: A Trauma Surgeon's Perspective

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders ◽

10.1044/nnsld22.3.82 ◽

2012 ◽

Vol 22 (3) ◽

pp. 82-89

Author(s):

Oscar D. Guillamondegui

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Multidisciplinary Approach ◽

Trauma Team ◽

The United States ◽

Long Term Outcomes ◽

Term Care ◽

Injured Brain ◽

The Moment

Traumatic brain injury (TBI) is a serious epidemic in the United States. It affects patients of all ages, race, and socioeconomic status (SES). The current care of these patients typically manifests after sequelae have been identified after discharge from the hospital, long after the inciting event. The purpose of this article is to introduce the concept of identification and management of the TBI patient from the moment of injury through long-term care as a multidisciplinary approach. By promoting an awareness of the issues that develop around the acutely injured brain and linking them to long-term outcomes, the trauma team can initiate care early to alter the effect on the patient, family, and community. Hopefully, by describing the care afforded at a trauma center and by a multidisciplinary team, we can bring a better understanding to the armamentarium of methods utilized to treat the difficult population of TBI patients.

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