title: Time to rehabilitation in the burn population: incidence of zero onset days in the UDSMR national dataset.
abstract: A preliminary investigation of the burn rehabilitation population found a large variability of zero onset day frequency between facilities. Onset days is defined as the time from injury to inpatient rehabilitation admission; this variable has not been investigated in burn patients previously. This study explored if this finding was a facility-based phenomena or characteristic of burn inpatient rehabilitation patients. This study was a secondary analysis of Uniform Data System for Medical Rehabilitation (UDSmr) data from 2002 to 2007 examining inpatient rehabilitation characteristics among patients with burn injuries. Exclusion criteria were age less than 18 years and discharge against medical advice. Comparisons of demographic, medical and functional data were made between facilities with a high frequency of zero onset days versus facilities with a low frequency of zero onset days. A total of 4738 patients from 455 inpatient rehabilitation facilities were included. Twenty-three percent of the population exhibited zero onset days (n = 1103). Sixteen facilities contained zero onset patients; two facilities accounted for 97% of the zero onset subgroup. Facilities with a high frequency of zero onset day patients demonstrated significant differences in demographic, medical, and functional variables compared to the remainder of the study population. There were significantly more zero onset day admissions among burn patients (23%) than other diagnostic groups (0.5- 3.6%) in the Uniform Data System for Medical Rehabilitation database, but the majority (97%) came from two inpatient rehabilitation facilities. It is unexpected for patients with significant burn injury to be admitted to a rehabilitation facility on the day of injury. Future studies investigating burn rehabilitation outcomes using the Uniform Data System for Medical Rehabilitation database should exclude facilities with a high percentage of zero onset days, which are not representative of the burn inpatient rehabilitation population.
authors.affiliation: *Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; †Uniform Data System for Medical Rehabilitation Amherst, New York; ‡Daemen College, Health Care Studies Department, Amherst, New York; §Sumner Redstone Burn Center, Surgical Services, Massachusetts General Hospital, Harvard Medical School, Boston; ‖Shriners Burns Hospital, Boston; ¶Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Schneider
authors.forename: Wei-Han
authors.initials: WH
authors.lastname: Tan
authors.forename: Richard
authors.initials: R
authors.lastname: Goldstein
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Mix
authors.forename: Paulette
authors.initials: P
authors.lastname: Niewczyk
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Divita
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Ryan
authors.forename: Paul B
authors.initials: PB
authors.lastname: Gerrard
authors.forename: Karen
authors.initials: K
authors.lastname: Kowalske
authors.forename: Ross
authors.initials: R
authors.lastname: Zafonte
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D002053:Burn Units; D002056:Burns / Q000534:rehabilitation*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015994:Incidence; D007297:Inpatients; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome