title: Increased admissions for musculoskeletal diseases after burns sustained during childhood and adolescence.
abstract: BACKGROUND
  Severe burn triggers systemic responses that result in reduced muscle mass and bone formation, with recent evidence also suggesting systemic effects on bone after minor burn. The aim of this study was to assess if children and adolescents who are hospitalised with a burn have increased long-term hospital service use for musculoskeletal conditions.
  
  
  METHODS
  A population-based longitudinal study using linked hospital morbidity and death data from Western Australia was undertaken of those younger than 20 years when hospitalized for a first burn (n=13,244) during the period 1980-2012 and a frequency matched non-injury comparison cohort, randomly selected from Western Australia's birth registrations and electoral roll (n=51,021). Crude admission rates and cumulative length of stay for musculoskeletal diseases were calculated. Negative binomial and Cox proportional hazards regression modelling were used to generate incidence rate ratios (IRR) and hazard ratios (HR), respectively.
  
  
  RESULTS
  After adjusting for demographic characteristics and pre-existing health status, those who were hospitalised for a burn had 1.87 times as many hospital admissions for a musculoskeletal disease (95%CI: 1.69-2.08) and spent 2.61 times as long in hospital with musculoskeletal disease (95%CI: 2.09-3.27), than the uninjured comparison cohort. The burn cohort had significantly higher rates of first time admissions over the study period for arthropathies (HR, 95%CI: 1.14, 1.00-1.29, p=0.047), dorsopathies (HR, 95%CL: 1.64, 1.29-2.08) and for soft tissue disorders (HR, 95%CI: 1.33, 1.11-1.60); results were not statistically significant for incident admissions for osteopathies and chrondropathies (HR, 95%CI: 1.07, 0.71-1.59) or connective tissue disorders (HR, 95%CI: 0.54, 0.24-2.09).
  
  
  CONCLUSIONS
  These results identified elevated post-discharge hospital service use for diseases of the musculoskeletal system for a prolonged period after discharge for those with both severe and minor burns.
authors.affiliation: Burn Injury Research Unit, School of Surgery, University of Western Australia, Perth, Western Australia, Australia. Electronic address: janine.duke@uwa.edu.au.
authors.forename: Janine M
authors.initials: JM
authors.lastname: Duke
authors.affiliation: Centre for Data Linkage, Curtin University, Perth, Western Australia, Australia. Electronic address: Sean.Randall@curtin.edu.au.
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. Electronic address: mark@fionawoodfoundation.com.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Fear
authors.affiliation: Centre for Data Linkage, Curtin University, Perth, Western Australia, Australia. Electronic address: j.boyd@curtin.edu.au.
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; Burns Service of Western Australia, Royal Perth Hospital and Princess Margaret Hospital, Perth, Western Australia, Australia. Electronic address: Suzanne.Rea@health.wa.gov.au.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Rea
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. Electronic address: Fiona.Wood@health.wa.gov.au.
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Wood
mesh_terms: D000293:Adolescent; D000328:Adult; D015519:Bone Density; D001847:Bone Diseases / Q000453:epidemiology; D002056:Burns / Q000453:epidemiology*; D002357:Cartilage Diseases / Q000453:epidemiology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D007592:Joint Diseases / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D009135:Muscular Diseases / Q000453:epidemiology; D009140:Musculoskeletal Diseases / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D014904:Western Australia / Q000453:epidemiology; D055815:Young Adult
keywords: Adolescents; Bone; Burns; Children; Cohort; Muscle; Population-based