title: Long-term musculoskeletal morbidity after adult burn injury: a population-based cohort study.
abstract: OBJECTIVE
  To investigate if adults who are hospitalised for a burn injury have increased long-term hospital use for musculoskeletal diseases.
  
  
  METHODS
  A population-based retrospective cohort study using linked administrative health data from the Western Australian Data Linkage System.
  
  
  METHODS
  Records of 17,753 persons aged at least 20 years when hospitalised for a first burn injury in Western Australia during the period 1980-2012, and 70,758 persons who were age and gender-frequency matched with no injury admissions randomly selected from Western Australia's electoral roll.
  
  
  METHODS
  Admission rates and cumulative length of stay for musculoskeletal diseases. Negative binomial and Cox proportional hazards regression modelling were used to generate incidence rate ratios (IRR) and HRs with 95% CIs, respectively.
  
  
  RESULTS
  After adjustment for pre-existing health status and demographic characteristics, the burn cohort had almost twice the hospitalisation rate for a musculoskeletal condition (IRR, 95% CI 1.98, 1.86 to 2.10), and spent 3.70 times as long in hospital with a musculoskeletal diagnosis (95% CI 3.10 to 4.42) over the 33-year period, than the uninjured comparison cohort. Adjusted survival analyses of incident post-burn musculoskeletal disease admissions found significant increases for the 15-year post burn discharge period (0-6 months: HR, 95% CI 2.51, 2.04 to 3.11; 6 months-2 years: HR, 95% CI 1.77, 1.53 to 2.05; 2-15 years: HR, 95% CI 1.32, 1.23 to 1.42). Incident admission rates were significantly elevated for 20 years post-burn for minor and severe burn injury for a range of musculoskeletal diseases that included arthropathies, dorsopathies, osteopathies and soft tissue disorders.
  
  
  CONCLUSIONS
  Minor and severe burn injuries were associated with significantly increased post-burn incident admission rates, long-term hospital use and prolonged length of stay for a range of musculoskeletal diseases. Further research is required that facilitates identification of at-risk patients and appropriate treatment pathways, to reduce the long-term morbidity associated with burns.
authors.affiliation: Centre for Data Linkage, Curtin University, Perth, Western Australia, Australia.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Randall
authors.affiliation: Burn Injury Research Unit, School of Surgery, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Fear
authors.affiliation: Burn Injury Research Unit, School of Surgery, University of Western Australia, Perth, Western Australia, Australia Burns Service of Western Australia, Royal Perth Hospital and Princess Margaret Hospital, Perth, Western Australia, Australia.
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Wood
authors.affiliation: Burn Injury Research Unit, School of Surgery, University of Western Australia, Perth, Western Australia, Australia Burns Service of Western Australia, Royal Perth Hospital and Princess Margaret Hospital, Perth, Western Australia, Australia.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Rea
authors.affiliation: Centre for Data Linkage, Curtin University, Perth, Western Australia, Australia.
authors.forename: James H
authors.initials: JH
authors.lastname: Boyd
authors.affiliation: Burn Injury Research Unit, School of Surgery, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Janine M
authors.initials: JM
authors.lastname: Duke
mesh_terms: D000328:Adult; D000368:Aged; D002056:Burns / Q000150:complications*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000453:epidemiology* / Q000209:etiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D016019:Survival Analysis; D014904:Western Australia / Q000453:epidemiology; D055815:Young Adult
keywords: EPIDEMIOLOGY; SURGERY