Elsevier

Burns

Volume 44, Issue 8, December 2018, Pages 1882-1886
Burns

Trends 10 years after burn injury: A Burn Model System National Database study

https://doi.org/10.1016/j.burns.2018.09.033Get rights and content

Highlights

  • At 10 years after injury, survivors score lower in the domains of heat sensitivity, affect, body image and work.

  • Median scores in affect, body image, and interpersonal relationships are lower for females than males in adults but not pediatric survivors.

  • BSHS-B scores were similar between survivors with and without visibly grafted burns, except in the domain of hand function.

Abstract

Background

The Burn Specific Health Scale-Brief (BSHS-B) evaluates 9 aspects of health and has been validated globally. Existing reports typically focus on outcomes shortly after injury. The purpose of this study is to determine whether quality of life remains a concern for burn survivors ten years after-injury.

Methods

Cross sectional data of survivors admitted from 1994 to 2006 to four US burn centers were collected in the Burn Model System National Database 10 years after injury. Responses to the items in the nine BSHS-B domains range from 0 to 4. Lower scores indicating poorer quality of life. Median scores are reported and differences were compared using Wilcoxon–Mann–Whitney test.

Results

Ten-year survivor injury characteristics suggest a moderate severity of injury. Survivors scored lower in heat sensitivity, affect, body image, and work (median = 3.2, 3.6, 2.8, and 3.6, respectively). Affect, body image, and interpersonal scores were significantly lower for females (median = 3.1, 2.8, 3.8, respectively) than males [median = 3.6, 3.3, 4, respectively (p = 0.008, 0.004, 0.022, respectively)].

Conclusions

Our results suggest certain domains of burn specific health benefit from support at 10 years after injury, and select populations such as females may necessitate additional treatment to restore burn-specific health. These results support that burn injuries represent a chronic condition and long-term medical and psychosocial support may benefit burn survivor recovery.

Introduction

Advances in burn care management and critical care have decreased mortality leading to greater emphasis in functional, social and psychological outcomes for burn survivors. Survivors often have complex multi-faceted rehabilitation issues, which result in significant short-term and long-term changes in quality of life. The World Health Organization (WHO) defines quality of life as: a state of complete physical, mental and social well-being and not just the absence of disease [1]. Burn injury outcomes have shifted from traditional measures of mortality and hospital length of stay to more specific functional and psychological outcomes [2]. Measuring the outcomes of burn survivors requires metrics such as quality of life instruments. The instruments to examine quality of life can be specific to burn injury or general for the population.

Initially developed in 1982, the Burn Specific Health Scale (BSHS) was intended to measure long-term outcomes of adult burn-injured survivors [3]. The initial version included 114 items and over time, the Burn Specific Health Scale was revised to address inconsistencies that were not initially addressed, such as work, pain, itching, and treatment regimens [4]. In the latest revision, the BSHS was simplified and shortened to 40 questions and renamed the Burn Specific Health Scale-Brief (BSHS-B). Each of the 40 questions fall within one of nine domains or sub-scales [5]. These domains are simple abilities (bathing or dressing), heat sensitivity (how bothersome is the sun or hot weather), hand function (writing name, eating with utensils, tying shoelaces), treatment regimens, (caring for the burn), work, body image (if appearance is bothersome), affect (feelings of sadness or loneliness), interpersonal relationships (specifically with family), and sexuality (interest in sex or sexual arousal). The BSHS-B has been validated in multiple languages and across different cultures, suggesting significant global utility [6], [7].

The International Classification of Functioning, Disability, and Health bio-psycho-social framework from the WHO has been used to determine which health related quality of life (HRQOL) aspects are addressed by various self-reported instruments. Within this framework, the unique features of the BSHS-B are heat sensitivity, sexuality, treatment regimens and body image domains. Comparatively, the Medical Outcomes Trust 36-item short-form health survey (SF-36 or Short Form-36), one of the general quality of life instruments, does not include personal factors, which can affect quality of life for burn survivors [8], [9]. Although generic HRQOL instruments, such as the Short Form-36, have been validated in the burn population [10], collectively measuring burn specific outcomes provides better understanding of the long-term effects of burn injury, allowing health care providers to focus on improving care in domains with worse reported outcomes [11]. HRQOL instruments also provide a frame of reference to measure outcomes of interventions and programs for burn survivors.

The purpose of this study is to report BSHS-B findings collected from burn survivors 16 years or older in the United States to determine the effects of injury on quality of life at ten years.

Section snippets

Methods

As part of the National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR) Burn Injury Model System (BMS) program, a comprehensive demographic, injury, and outcomes database was developed to facilitate the study of functional and psychosocial outcomes after burns [12], [13]. This database has been used to report on the prevalence of pruritus at 5 and 10 years after injury, but not for other long-term quality of life indicators [14], [15].

Data for the longitudinal

Results

Ten-year survivor injury characteristics shown in Table 1 demonstrate a moderate severity of injury. The median burn size was 22% TBSA and the median burn size grafted was 14%, a surrogate for third degree burns. Two-thirds of the survivors were male and 38% of the survivors were less than 18 years of age at the time of injury. Only one survivor at 10 years was older than 65 years of age at the time of injury. Nearly 80% of the survivors were Caucasian, while the other survivors were primarily

Discussion

This is the first report from individuals who are 10 years from injury using the nine domains of the Burn Specific Health Scale-Brief (BHSH-B) instrument and the Burn Model System (BMS) national database. The BMS database is supported by the National Institute of Disability, Independent Living, and Rehabilitation Research (NIDILRR) and has been in existence since 1994. This study identifies long-term effects on quality of life specific to a burn injury and can serve as benchmarks of

Conclusion

Certain domains of health may continue to be affected for individuals long after burn injury, and select populations may warrant additional interventions targeting specific domains to restore health and quality of life. These results support the concept that burn injuries represent a chronic condition and long-term medical and psychosocial support may benefit burn survivor recovery. Furthermore, there is a need for measuring long-term recovery and quality of life in burn survivors to better

Acknowledgments

The contents of this report were developed under a grant from the Department of Health and Human Services (HHS), National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR) grant numbers 90DP0029, 90DP0053, 90DP0035 and 90DPBU0001. NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this publication do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not

Conflict of interest

There are no conflicts of interest for any authors.

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