Time Of Burn Injury Research Articles

Barriers Impacting Employment After Burn Injury

This study investigates the barriers to return to work after burn injury. The electronic records of burn survivors treated at a Regional Burn Center outpatient clinic from 2001 to 2007 were retrospectively reviewed. Inclusion criteria included employment at the time of burn injury and age 18 years or older. Documentation of barriers to return to work were reviewed and classified into eight categories. Logistic regression analysis was used to determine predictors of return to work at more than 1 year. Ordered logistic regression analysis was performed to determine barrier predictors of employment. The authors identified 197 patients for inclusion in the study. The age was 37 +/- 0.8 (mean +/- SEM) and total body surface area burned was 16 +/- 1.3%. Two thirds (n = 132) of subjects returned to work by 1 year. The most common barriers included pain (n = 79), neurologic problems (n = 69), impaired mobility (n = 58), and psychiatric issues (n = 51). Pain was the most frequent barrier to return to work at all time intervals. Significant predictors of return to work at more than 12 months included length of hospital stay, inpatient rehabilitation, electric etiology, and burn at work (P < .05). Impaired mobility was a statistically significant (P < .05) barrier and other medical issues showed a trend toward statistical significance (P = .054) in predicting return to work at more than 12 months. There are many barriers that impede return to work in the burn population, including pain, neurologic problems, impaired mobility, and psychiatric issues. Early identification of those at risk for prolonged unemployment should prompt expeditious referral to comprehensive rehabilitation services that include work hardening and vocational training programs.

Association between socioeconomic status and burn injury severity

Background It has been previously established that the incidence of burn is higher in lower socioeconomic (SES) groups. What is not clear, however, is whether or not the severity of burn is also higher in lower SES groups. The purpose of this study is to establish a relationship between household-level socioeconomic status (SES) and severity-based incidence of burn. Methods A burn injury database was generated from the National Injury Database (2001–2003) with a 1-year follow-up period containing information about the date and time of burn injury, the International Classification of Disease 10th Edition-based (ICD-10) diagnostic codes, gender, age, residence, and type of insurance. In addition, we calculated the severity of each burn using the Excess Mortality Ratio-adjusted Injury Severity Score (EMR-ISS), which is similar to the New Injury Severity Score. Socioeconomic status was measured on the basis of quintiles of premiums for National Health Insurance, which was decided on a household-level either by monthly salary (Employee Insurance, EI) or by owned property (Self-Employed Insurance, SEI). Medical Aid (MA) population was regarded as a reference. After calculation of 5 year-gender specific standardized incidence rates (SIRs) of burn by SES groups, the association of SES and severity of burn was evaluated using a multivariate logistic regression model and the Cox-proportional hazard regression analysis. Results A total of 870,411 burn cases were examined. The standardized incident rates (SIRs) of mild(1 ≤ EMR-ISS ≤ 8), moderate(9 ≤ EMR-ISS ≤ 24), severe(25 ≤ EMR-ISS ≤ 74), critical(EMR-ISS = 75 or death), and total burn injury were 4951, 951, 124, 20, and 6046 per 1,000,000 person-years, respectively. Meaningful changes of relative risk by severity were found: it was greater in higher SES groups (0.67 in the highest SEI, 0.58 in the highest EI) compared to the Medical Aid (MA) population. For injuries classified to be greater than severe (25 ≤ EMR-ISS), odds ratios according to increase of SES level were significantly decreased to 0.77 in SEI and 0.63 in EI. For critical injuries, hazard ratios were also significantly decreased to 0.51 in the highest SEI and 0.32 in the highest EI. Conclusions Severity-based incidence of burn was significantly affected by household-level SES in a nationwide cohort study, with more severe injuries noted in the lower socioeconomic groups.

Adverse Clinical Outcomes Associated With Elevated Blood Alcohol Levels at the Time of Burn Injury

Adverse Clinical Outcomes Associated With Elevated Blood Alcohol Levels at the Time of Burn Injury

Adverse Clinical Outcomes Associated With Elevated Blood Alcohol Levels at the Time of Burn Injury

Elevated blood alcohol content (BAC) on admission is associated with poorer outcomes, larger burns and more inhalation injury. This study's purpose was to examine the effects of alcohol through a matched case-controlled study, measuring early and extended markers of clinical outcomes. The hypothesis was that patients with an elevated admission BAC would require more resuscitation and have a longer hospital stay. Admissions 16 to 75 years of age with 15 to 75% TBSA and admission BACs were identified. Patients with BAC >30 mg/dl (BAC+, cases) were matched with patients with undetectable BAC (BAC-, controls), according to age, sex, TBSA, inhalation injury and mechanism. Screening identified 258 patients, 146 with admission BACs. Twenty-seven had a BAC > or = 30 mg/dl. There were 24 matched pairs. At 24 hours, BAC+ group had larger acute physiology and chronic health evaluation II scores (23.33 vs 18.75, P < .05), fluid requirements (5.25 vs 3.82 L (cc/kg/TBSA), P < .05), and base deficit (11.15 vs 7.15, P < .05). The duration of mechanical ventilation (14.85 vs 4.23 days, P < .05), intensive care unit length of stay (22.85 vs 9.38, P < .05), hospital length of stay (28.95 vs 15.68, P < .05), and mean hospital charges ($239,507 vs $144,598, P < .05) were increased in the BAC+ patients. Despite matched baseline injury characteristics, elevated BAC was associated with poorer short term and extended clinical outcomes, illustrating the impact of alcohol intoxication on physiologic derangement after burn injury.

Marjolin Ulcer of the Scalp

Childhood burn accidents are still a problem all over the world. Besides the contractures and hypertrophic scar conditions, malignant transformation in the burn scar is one of the primary concerns later in adulthood. Marjolin ulcer, commonly seen after burn scar, is a neoplastic change in the scar tissue. The scalp region necessitates additional attention because of the inevitable structures it protects. The long-standing ulcers with malignant transformation may cause invasion of different layers of the scalp. As the cranium is invaded, reconstruction after wide excision of these tumors becomes more difficult to deal with. Scalp invasion of Marjolin ulcers with different levels is presented in the following study. Consistent with the literature, histopathology of the tumors was squamous cell carcinoma in most patients. Although rare, mesenchymal tumor is involved in 2 of 9 patients. The latent period of the tumor is inversely proportional to the age at the time of burn injury. As the patient is younger at the time of injury, the occurrence of the ulcer is longer than expected. Lag period as long as 81 years is detected in the study. The delayed diagnosis due to social considerations such as financial limitations increases the likelihood of cranial invasion. A single huge scalp flap is often sufficient for soft tissue defects, and cranioplasty with methyl methacrylate is an appropriate option for reconstruction.

Alcohol, drug intoxication, or both at the time of burn injury as a predictor of complications and mortality in hospitalized patients with burns.

The objective of this study was to characterize the association between drug and alcohol intoxication at the time of injury and subsequent complications and mortality in hospitalized patients with burns. A computerized burn database was used to analyze data on 3047 consecutive adult (21 to 75 years) hospitalized patients with burns admitted between January 1982 and August 1994. Data for intoxicated (by history, blood alcohol content, or positive drug screen) and nonintoxicated patients were compared. The same analysis was also conducted on 429 consecutive adolescent patients with burns (ages 14 to 20 years) admitted during the same time period. The incidence of intoxication at the time of burn was 6.9%. No significant differences in age, sex, race, or burn size were noted. Intoxicated patients had a higher incidence of associated injuries. Skin graft loss, cellulitis, donor site conversion, hypotension, and pneumonia were more common in the intoxicated group. They also had more intensive care unit admissions, ventilator days, operations, transfusions, and total hospital days. Intoxicated patients had a lower mortality (7.1%) than patients in the control group (10.9%). Intoxication at the time of burn injury is an important predictor of complications in adult patients with burns.

Psychologic adjustment after childhood burn injuries as predicted by personality traits.

The purpose of this study was to examine the nature of psychologic adjustment in persons who have survived childhood burn injuries. It was hypothesized that survivors who were well-adjusted psychologically would possess specific personality traits that would differentiate them from their poorly adjusted peers. Thirty-two subjects were given a standardized assessment of psychologic adjustment and a standardized personality inventory. The subjects were assigned to either a "poorly adjusted" group or a "well-adjusted" group, on the basis of each subject's score on a standardized measure of adjustment. There were no significant differences between the two groups in variables of gender, age, time since burn, or age at time of burn injury. The results indicate three personality traits that seem to be related to psychologic adjustment after a severe burn injury in pediatric patients.

Long-term psychosocial adjustment in patients with severe burn injuries: a follow-up study

An investigation of the long-term psychosocial adjustment of patients with severe burn injuries is presented. In the selected 13-year period (1968-80) 46 patients fulfilled the entry criteria: burns covering more than 30 per cent body surface area (deep dermal or full skin thickness). Seventeen patients died early and one later. Of the remaining 28 patients, contact was made with 25 (89.3 per cent) who all participated. The observation time ranged between 7 and 21 years. The patients received a semi-standardized interview adjusted for age at the time of burn injury, a psychiatric interview and a physical examination to assess the permanent character and functional loss. The principal findings were: no correlation could be found between degree of disfiguration/function loss and the long-term psychosocial adaptation after severe burn injuries. The determinant factor was the premorbid psychiatric/psychological integration and, to some extent, support from staff and relatives.

Incidence of hepatitis C virus infection in burn patients: detection of anti-C100, anti-C33c and anti-Core antibodies

Anti-hepatitis C virus antibodies were searched for in 45 burnt patients, at the time of burn injury and more than 6 months after burn injury. HCV infection was detected in 18% as a consequence of the numerous transfusions of blood or blood derivatives used during the post-burn treatment. Five patients displayed evidence of anti-C100, anti-C33c and anti-Core antibodies together; two patients had only anti-C100 and anti-C33c antibodies, and the last one showed only anti-Core antibodies. Chronic hepatitis was observed in 83% of HCV infections. Kinetics of appearance of anti-HCV antibodies varied between patterns. Anti-Core is generally the first to be detected at high levels; however, in at least one case it was detected only two and a half months after C100 and C33c antibodies.

Comparative statistical methods in the analysis of burn victims

Data on 70 burn patients aged 60 years or more who were treated at a regional burn centre were analysed using both univariate and multivariate methods. The univariate analyses provide information on ways in which individual patient characteristics are independently related to mortality and morbidity. These analyses result in simplistic understandings of the role each variable plays in subsequent patient outcomes but no information is provided on how these measures interact with one another. Even probit analysis, while providing useful estimates of mortality rates, traditionally considers only one variable at a time or must duplicate the procedure for separate subgroups of the sample. However, discriminant analysis permits the assessment of the overall contribution of various factors that are mutually present. Additionally, these techniques provide a mechanism to predict individual outcomes for each patient. The present study demonstrates that discriminant analysis of information easily available at the time of burn injury is useful in predicting mortality but not morbidity. The fact that morbidity is not predicted suggests the search for other factors that predispose a patient to subsequent complications.