title: Recovery trajectories after burn injury in young adults: does burn size matter?
abstract: The impact of burn size on mortality is well known, but the association of burn size with the trajectories of long-term functional outcomes remains poorly studied. This prospective multi-center study included burned adults ages 19 to 30 years who completed the Young Adult Burn Outcome Questionnaire at initial baseline contact, 2 weeks, and at 6 and 12 months after initial questionnaire administration. Non-burned adults of comparable ages also completed the questionnaire as a reference group. The association between functional recovery and TBSA burned was analyzed longitudinally using generalized linear models with the generalized estimation equation technique. Functional status was characterized in 15 domains: physical function, fine motor function, pain, itch, social function limited by physical function, perceived appearance, social function limited by appearance, sexual function, emotion, family function, family concern, satisfaction with symptom relief, satisfaction with role, work reintegration, and religion. Scores were standardized to a mean of 50 and a SD of 10 based on non-burned controls. There were 153 burned and 112 non-burned subjects with a total of 620 questionnaires. TBSA burned was 11 ± 14% (mean ± SD); 31% had face involvement and 57% had hand involvement. The lag time from burn injury to questionnaire administration was on average 7 ± 7.7 months, with a maximum of 36 months. Lower recovery levels were associated with increasing burn size for physical function, pain, itch, work reintegration, emotion, satisfaction with symptom relief, satisfaction with role, family function, and family concern (P value ranged from .04-<.0001). No significant differences in recovery levels were found with increasing burn size for fine motor function, social function limited by physical function, sexual function, and religion; these areas tracked toward the age-matched non-burned group regardless of burn size. Perceived appearance and social function limited by appearance remained below the non-burn levels throughout the 3-year period regardless of burn size. Three-year recovery trajectories of survivors with larger burn size showed improvements in most areas, but these improvements lagged behind those with smaller burns. Poor perceived appearance was persistent and prevalent regardless of burn size and was found to limit social function in these young adult burn survivors. Expectations for multidimensional recovery from burns in young adults can be benchmarked based on burn size with important implications for patient monitoring and intervening in clinical care.
authors.affiliation: From the *Massachusetts General Hospital, Boston; †Harvard Medical School, Boston, Massachusetts; ‡Shriners Hospitals for Children-Boston, Massachusetts; §Center for the Assessment of Pharmaceutical Practices (CAPP), Department of Health Policy and Management, Boston University School of Public Health, Massachusetts; ‖Spaulding Rehabilitation Hospital, Boston, Massachusetts; ¶Sainte-Justine University Health Centre, Montreal, Canada; #University of Montreal, Canada; **Shriners Hospital for Children, Galveston, Texas; ††University of Texas Medical Branch, Galveston; ‡‡Shriners Hospital for Children, Sacramento, California; §§University of California at Davis, Los Angeles; ‖‖Kennedy Krieger Institute, Baltimore, Maryland; ¶¶University of Nebraska, Omaha; and ##Xi'an University for Finance and Economics, Research Center for Medical Statistics and Actuarial Science, China, and Bentley University, Department of Mathematical Sciences, Waltham, Massachusetts.
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Ryan
authors.forename: Austin
authors.initials: A
authors.lastname: Lee
authors.forename: Lewis E
authors.initials: LE
authors.lastname: Kazis
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Schneider
authors.forename: Gabriel D
authors.initials: GD
authors.lastname: Shapiro
authors.forename: Robert L
authors.initials: RL
authors.lastname: Sheridan
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Meyer
authors.forename: Tina
authors.initials: T
authors.lastname: Palmieri
authors.forename: Frank S
authors.initials: FS
authors.lastname: Pidcock
authors.forename: Debra
authors.initials: D
authors.lastname: Reilly
authors.forename: Ronald G
authors.initials: RG
authors.lastname: Tompkins
mesh_terms: D000328:Adult; D019985:Benchmarking; D002056:Burns / Q000473:pathology / Q000503:physiopathology* / Q000523:psychology*; D016022:Case-Control Studies; D004644:Emotions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009048:Motor Skills / Q000502:physiology; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function / Q000502:physiology; D012919:Social Behavior; D011795:Surveys and Questionnaires; D055815:Young Adult