Long-Term Outcomes after Burn Injuries: Strategies to Optimize Recovery

A special issue of European Burn Journal (ISSN 2673-1991).

Deadline for manuscript submissions: 31 December 2024 | Viewed by 5304

Special Issue Editors


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Guest Editor
Professor Emeritus, UW Medicine Department of Surgery, Harborview Medical Center, Seattle, WA 98104, USA
Interests: hypertrophic scarring; neuropathic pain; return to work/school; functional recovery

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Co-Guest Editor
1. Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
2. LAC+ USC Medical Center, Los Angeles, CA 90033, USA
Interests: reconstructive surgery; burn rehabilitation; disparities of care

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Co-Guest Editor
UW Medicine Department of Surgery, Harborview Medical Center, Seattle, WA 98104, USA
Interests: functional recovery after burn injury; return to work; nursing education; itch/ neuropathic pain

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Co-Guest Editor
1. Department of Surgery, UT Southwestern Medical Center, Dallas, TX 75390, USA
2. Burn Center, Parkland Hospital, Dallas, TX 75235, USA
Interests: comprehensive care of the burn-injured patient; quality improvement/ process improvement; extracorporeal membrane oxygenation (ECMO); burn critical care; scar reconstructive surgery

Special Issue Information

Dear Colleagues,

Over the past 50 years, survival after a major burn injury has exponentially increased. The single intervention that is most responsible for this improvement involves early excision and grafting, which closes the wound and mitigates the inflammatory and anabolic responses after injury. As burn providers, we too often myopically congratulate ourselves on survival, reduced lengths of hospital stay, and lower complication rates. However, patients and families invariably view the return to pre-injury lifestyles and roles, including recreational and vocational activities, as optimal an outcome. For too long, patient and medical provider views of successful burn outcomes have been incongruous.

It is time for the international burn community to acknowledge that burn injury may represent a chronic condition that benefits from long-term coordinated care focused on functional recovery.

Prof. Dr. Nicole S. Gibran
Dr. Haig Yenikomshian
Gretchen Carrougher
Dr. Samuel Mandell
Guest Editors

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Keywords

  • psychological recovery trajectories
  • physical recovery trajectories
  • neuropathic pain
  • burns as a chronic condition
  • return to work/ school/ productivity
  • community re-integration
  • metabolic recovery
  • psychometric instruments
  • underserved populations
  • genetic determinants of long-term recovery

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Published Papers (3 papers)

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Research

10 pages, 251 KiB  
Article
Establishing a Collaborative Genomic Repository for Adult Burn Survivors: A Burn Model System Feasibility Study
by Stephen Sibbett, Jamie Oh, Gretchen Carrougher, Lara Muffley, Nathaniel Ashford, Maiya Pacleb, Samuel Mandell, Jeffrey Schneider, Steven Wolf, Barclay Stewart and Nicole S. Gibran
Eur. Burn J. 2024, 5(4), 389-398; https://doi.org/10.3390/ebj5040034 - 6 Nov 2024
Viewed by 671
Abstract
In this study, we aimed to integrate a genetic repository with an existing longitudinal national burn database. We set out two primary objectives, namely (1) to develop standard operating procedures for genetic sample collection and storage, DNA isolation, and data integration into an [...] Read more.
In this study, we aimed to integrate a genetic repository with an existing longitudinal national burn database. We set out two primary objectives, namely (1) to develop standard operating procedures for genetic sample collection and storage, DNA isolation, and data integration into an existing multicenter database; and (2) to demonstrate the feasibility of correlating genetic variation to functional outcomes in a pilot study, using the catechol-O-methyltransferase (COMT) gene. Dubbed the worrier/warrior gene, COMT variants have been associated with varying phenotypes of post-traumatic stress, wellbeing, and resilience. Between August 2018 and July 2020, COMT variants were identified for 111 participants from three sites and correlated with their outcome data. We found no association between COMT variants and functional outcomes, likely due to the inadequate sample size. We also asked all potential participants why they consented to or refused genetic analysis. A thematic analysis of responses revealed altruism and personal interest/enthusiasm in the study as top reasons for consenting. Privacy concerns were the most common reason for refusal. In conclusion, we successfully developed standard operating procedures for genetic sample collection and storage, DNA isolation, and data integration into an existing database, and we demonstrated the feasibility of conducting a multicenter collaborative study using a centralized lab location. Full article
12 pages, 940 KiB  
Article
Outcomes of Patients with Amputation following Electrical Burn Injuries
by Eunyeop Kim, Bingchun Wan, Kyra Jeanine Solis-Beach and Karen Kowalske
Eur. Burn J. 2023, 4(3), 318-329; https://doi.org/10.3390/ebj4030029 - 17 Aug 2023
Cited by 1 | Viewed by 1640
Abstract
This study aimed to examine patients who sustained amputation as a result of electrical burns and to evaluate their long-term health outcomes compared to non-electrical burn patients with amputation. A retrospective analysis was conducted on burn patients from 1993 to 2021, utilizing the [...] Read more.
This study aimed to examine patients who sustained amputation as a result of electrical burns and to evaluate their long-term health outcomes compared to non-electrical burn patients with amputation. A retrospective analysis was conducted on burn patients from 1993 to 2021, utilizing the Burn Model System National Database, which includes the Veterans RAND 12-Item Health Survey and the Patient-Reported Outcomes Measurement Information System 29. The data was collected at discharge, 6 months, and 12 months after the burns occurred. The findings revealed that the rate of amputation was significantly higher in electrical burn patients (30.3%) compared to non-electrical burn patients (6.6%) (p < 0.0001). At the time of discharge, electrical burn patients with amputation exhibited significantly lower physical component scores (PCS = 34.00 ± 8.98) than electrical burn patients without amputation (PCS = 44.66 ± 9.90) (p < 0.05). However, there were no significant differences in mental component scores observed between patients, regardless of the burn type or amputation. Among all patient groups, non-electrical burn survivors with amputation faced the greatest challenges in terms of physical and social well-being, likely due to larger total body surface area burns. This study emphasizes the importance of early rehabilitation for electrical burn patients with amputation and highlights the need for ongoing support, both physically and socially, for non-electrical burn survivors with amputation. These findings, consistent with previous studies, underscore the necessity of providing psychological support to all burn survivors. Full article
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11 pages, 282 KiB  
Article
Post-Burn Psychosocial Outcomes in Pediatric Minority Patients in the United States: An Observational Cohort Burn Model System Study
by Paul Won, Li Ding, Kara McMullen and Haig A. Yenikomshian
Eur. Burn J. 2023, 4(2), 173-183; https://doi.org/10.3390/ebj4020015 - 3 Apr 2023
Cited by 1 | Viewed by 1840
Abstract
Racial and ethnic minority burn patients face barriers to longitudinal psychosocial support after injury. Studies utilizing the Burn Model System (BMS) National Database report adult minority patients experience worse psychosocial outcomes in domains such as body image during burn recovery. No study to [...] Read more.
Racial and ethnic minority burn patients face barriers to longitudinal psychosocial support after injury. Studies utilizing the Burn Model System (BMS) National Database report adult minority patients experience worse psychosocial outcomes in domains such as body image during burn recovery. No study to date has investigated disparities in psychosocial outcomes by racial or ethnic category in the pediatric population using the BMS database. This observational cohort study addresses this gap and examines seven psychosocial outcomes (levels of anger, sadness, depression, anxiety, fatigue, peer relationships, and pain) in pediatric burn patients. The BMS database is a national collection of burn patient outcomes from four centers in the United States. BMS outcomes collected were analyzed using multi-level, linear mixed effects regression modeling to examine associations between race/ethnicity and outcomes at discharge after index hospitalization, and 6- and 12-months post-injury. A total of 275 pediatric patients were included, of which 199 (72.3%) were Hispanic. After burn injury, of which the total body surface area was significantly associated with racial/ethnicity category (p < 0.01), minority patients more often reported higher levels of sadness, fatigue, and pain interference and lower levels of peer relationships compared to Non-Hispanic, White patients, although no significant differences existed. Black patients reported significantly increased sadness at six months (β = 9.31, p = 0.02) compared to discharge. Following burn injury, adult minority patients report significantly worse psychosocial outcomes than non-minority patients. However, these differences are less profound in pediatric populations. Further investigation is needed to understand why this change happens as individuals become adults. Full article
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