Outcomes of Patients with Amputation following Electrical Burn Injuries

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 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

Outcomes and predictors in burn rehabilitation

Advances in burn care in recent decades have resulted in a growing population of burn survivors and an increased need for inpatient rehabilitation. Burn survivors who require inpatient rehabilitation typically experience severe and complicated injuries. The purpose of this study is to examine burn rehabilitation outcomes and their predictor variables. Data are obtained from the Uniform Data System for Medical Rehabilitation from 2002 to 2007. Inclusion criterion is primary diagnosis of burn injury. Predictor variables include demographic, medical, and facility data. Outcome measures are length of stay efficiency, FIM® gain, community discharge, and FIM® discharge of at least 78. Linear and logistic regression analyses are used to determine significant predictors of outcomes. There are 2920 patients who meet inclusion criteria. The mean age of the population is 51 years, 33% of the population is female, 73% is Caucasian, and 40% are married. The median TBSA decile is 20 to 29%. The population exhibits a mean FIM® gain of 28 and length of stay efficiency of 2.1. A majority of the population is discharged to the community (76%) and has a FIM® discharge of at least 78 (81%). Significant predictors of outcomes in burn rehabilitation include age, FIM® admission, onset days, employment status, and marital status. Inpatient rehabilitation is critical to community reintegration of burn survivors. Survivors who are young, married, employed, and higher functioning at the time of admission to rehabilitation demonstrate the best outcomes. This research will help assess the rehabilitation potential of burn survivors and inform resource allocation. Copyright © 2012 by the American Burn Association

The Impact of Comorbidities and Complications on Burn Injury Inpatient Rehabilitation Outcomes

Objective To examine the impact of comorbidities and complications on burn inpatient rehabilitation facilities (IRF) outcomes. Design A retrospective cross-sectional study Setting Inpatient rehabilitation hospitals.Patients A total of 4572 patients with a primary diagnosis of burn injury from the Uniform Data System for Medical Rehabilitation database from 2002 to 2010. Methods or Interventions Regression analyses were used to determine whether 3 different comorbidity measures (Charlson Comorbidity Index, Elixhauser Comoribidity Index, Centers for Medicare and Medicaid Services Comorbidity Tiers) and 1 complication measure improved the predictive model (c-statistic) for each outcome measure. Main Outcome Measurements Community discharge, Functional Independence Measure (FIM) gain, length of stay efficiency, transfer to acute care within the first 3 days of IRF stay, and transfer to acute care for all time periods. Results For all outcomes, there was no difference between the Standard Model and the models that include the comorbidity and complication variables as measured by the c-statistic confidence intervals. Comorbidities and complications did not significantly affect burn IRF outcomes. Future research is needed to examine the impact of comorbidities and complications on outcomes of other IRF populations to better understand the implications for current and future health care policy. © 2013 American Academy of Physical Medicine and Rehabilitation

Predictors of transfer from rehabilitation to acute care in burn injuries

BACKGROUND: Transfer to acute care from rehabilitation represents an interruption in a patient\u27s recovery and a potential deficiency in quality of care. The objective of this study was to examine predictors of transfer to acute care in the inpatient burn rehabilitation population. METHODS: Data are obtained from Uniform Data System for Medical Rehabilitation from 2002 to 2010 for patients with a primary diagnosis of burn injury. Predictor variables include demographic, medical, and facility data. Descriptive statistics are calculated for acute and nonacute transfer patients. Logistic regression analysis is used to determine significant predictors of acute transfer within the first 3 days. A scoring system is developed to determine the risk of acute transfer. RESULTS: There were 78 acute transfers in the first 3 days of a total of 4,572 burn admissions. Functional level at admission, age, and admission classification are significant predictors of transfer to acute care (p \u3c 0.05). Total body surface area burned and medical comorbidities were not significantly associated with acute transfer risk. A 12-point acute transfer risk scoring system was developed, which demonstrates validity. CONCLUSION: Efforts to reduce readmissions to acute care should include greater scrutiny of older, lower-functioning patients with burn injury who are evaluated for admission to inpatient rehabilitation. This acute transfer scoring system may be useful to clinicians, health care institutions, and policymakers to help predict those patients at highest risk for early transfer to the acute hospital from rehabilitation. LEVEL OF EVIDENCE: Prognostic/diagnostic study, level II. © 2012 by Lippincott Williams & Wilkins

Strength and Cardiorespiratory Exercise Rehabilitation for Severely Burned Patients During Intensive Care Units: A Survey of Practice.

Minimizing the deconditioning of burn injury through early rehabilitation programs (RP) in the intensive care unit (ICU) is of importance for improving the recovery time. The aim of this study was to assess current standard of care (SOC) for early ICU exercise programs in major burn centers. We designed a survey investigating exercise RP on the ICU for burn patients with &gt;30% total burned surface area. The survey was composed of 23 questions and submitted electronically via SurveyMonkey® to six major (pediatric and adult) burn centers in Texas and California. All centers responded and reported exercise as part of their RP on the ICU. The characteristics of exercises implemented were not uniform. All centers reported to perform resistive and aerobic exercises but only 83% reported isotonic and isometric exercises. Determination of intensity of exercise varied with 50% of centers using patient tolerance and 17% using vital signs. Frequency of isotonic, isometric, aerobic, and resistive exercise was reported as daily by 80%, 80%, 83%, and 50% of centers, respectively. Duration for all types of exercises was extremely variable. Mobilization was used as a form of exercise by 100% of burn centers. Our results demonstrate that although early RP seem to be integral during burn survivors ICU stay, no SOC exists. Moreover, early RP are inconsistently administered and large variations exist in frequency, intensity, duration, and type of exercise. Thus, future prospective studies investigating the various components of exercise interventions are needed to establish a SOC and determine how and if early exercise benefits the burn survivor

Rehabilitation outcomes among burn injury patients with asecond admission to an inpatient rehabilitation facility

© 2014 American Academy of Physical Medicine and Rehabilitation. Background: Burn survivors tend to have complex medical issues requiring rehabilitation to improve overall function and quality of life. A subset of burn patients treated in inpatient rehabilitation facilities (IRFs) may require more than 1 rehabilitation stay for the same injury. Objective: To compare the rehabilitation outcomes among burn patients admitted to an IRF who were discharged to acute care and then readmitted to an IRF with burn patients admitted to an IRF only 1 time. Design: Retrospective cohort study. Setting: Inpatient rehabilitation facilities. Participants: Burn injury patients aged 18 years or more who were admitted to IRFs between 2002 and 2011. Methods: We performed a secondary analysis of data from Uniform Data System for Medical Rehabilitation, a national data repository. Outcomes of the repeaters\u27 second stay (n= 188) were compared to the nonrepeaters\u27 first and only stay (n= 6,855), using linear regression and logistic regression to determine whether repeater status was associated with rehabilitation outcomes. Main Outcome Measurements: Functional status (using the Functional Independence Measure [FIM] instrument) at admission, discharge and change, length of stay, FIM efficiency (total FIM points gained per day), and discharge disposition. Results: Repeater status was inversely associated with discharge FIM total (coefficient=-3.42, 95% confidence interval=-5.76,-1.07) and FIM change (coefficient=-4.05, 95% CI=-6.34,-1.75) in linear regression models. No other significant differences were found, and those differences in discharge FIM total and FIM change were small. Conclusions: Differences found in rehabilitation outcomes between the repeater and nonrepeater groups were small and may not reflect clinically meaningful differences. Burn injury patients who required a second IRF admission had rehabilitation outcomes similar tothose of burn injury patients who did not require a second IRF admission, emphasizing the value of inpatient rehabilitation for burn injury IRF readmissions