Predictors of moderate to severe fatigue 12 months following admission to hospital for burn: Results from the Burns Registry of Australia and New Zealand (BRANZ) Long Term Outcomes project.
BACKGROUND
Fatigue has been identified as an outcome of concern following burn but is rarely captured in outcomes studies. We aimed to: (i) describe the prevalence, and predictors, of moderate to severe fatigue in the first 12 months following burn, and (ii) establish the association between fatigue and health-related quality of life and work outcomes.


METHODS
Adult burns patients, admitted >24h, were recruited from five BRANZ sites. Participants were followed-up at 1-, 6-, and 12-months after injury using the Brief Fatigue Inventory (BFI), 36-item Short Form Health Survey (SF-36) and the Sickness Impact Profile (SIP)-work scale. Moderate to severe fatigue was defined as a global BFI score of 4-10. Multivariable mixed effects regression modelling was used to identify demographic, socioeconomic, burn size and severity predictors of moderate/severe fatigue at follow-up.


RESULTS
The mean±SD age of the 328 participants was 42.1±16.7years, 70% were male, 47% were flame burns, and the mean±SD %TBSA was 8.7±11.2. The prevalence of moderate/severe fatigue decreased from 37% at 1-month, to 32% at 6-months and 26% at 12-months. The adjusted odds of moderate/severe fatigue were 2.62 (95% CI: 1.27, 5.42) times higher for women compared to men, and 2.64 (95% CI: 1.03, 6.79) times higher in patients with a %TBSA≥20. Compared to patients in major cities, the adjusted odds of reporting moderate/severe fatigue were 2.48 fold higher (95% CI: 1.17, 5.24) for patients residing in inner regional areas, and 3.60 fold (95% CI: 1.43, 9.05) higher for patients living in remote/very remote areas. At each time point, the physical and mental health summary scores, and each sub-scale score, of the SF-36 were significantly lower in patients reporting moderate/severe fatigue. Patients experiencing moderate to severe fatigue reported higher work-related disability on the SIP work scale at each time point after injury.


CONCLUSIONS
More than a quarter of participants reported moderate to severe fatigue on the BFI at 12-months and fatigue was strongly associated with poorer health-related quality of life and greater work-related disability.
Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia; Farr Institute, College of Medicine, Swansea University, Singleton Park, Swansea, Wales SA28PP, United Kingdom. Electronic address: belinda.gabbe@monash.edu.
Belinda J
BJ
Gabbe
Victorian Adult Burns Service, The Alfred, Commercial Road, Melbourne 3004, Australia; Department of Surgery, Monash University, The Alfred Centre, Commercial Road, Melbourne 3004, Australia.
Heather
H
Cleland
Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia; Allied Health, Alfred Health, Commercial Road, Melbourne 3004, Australia.
Dina
D
Watterson
Tasmanian Burns Unit, Royal Hobart Hospital, Burns & Surgical Specialities Unit 5A, GPO Box 1061, Hobart 7001, Australia.
Rebecca
R
Schrale
Burns Unit, Royal Adelaide Hospital, North Terrace, Adelaide, Australia.
Sally
S
McRae
Burns Unit, Concord Repatriation General Hospital, Hospital Road, Concord 2139, Australia.
Susan
S
Taggart
Statewide Burn Injury Service, Agency for Clinical Innovation, Royal North Shore Hospital, Reserve Road, St Leonards, 2065, Australia.
Anne
A
Darton
State Adult Burn Unit, Fiona Stanley Hospital, 11 Warren Drive, Murdoch, 6150, Australia.
Fiona
F
Wood
State Adult Burn Unit, Fiona Stanley Hospital, 11 Warren Drive, Murdoch, 6150, Australia; Burn Injury Research Node, The University of Notre Dame, 19 Mouat Street, Fremantle 6959, Australia.
Dale W
DW
Edgar
D000328:Adult; D001315:Australia / Q000453:epidemiology; D002056:Burns / Q000523:psychology*; D005221:Fatigue / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D011788:Quality of Life; D012044:Regression Analysis; D012307:Risk Factors; D012737:Sex Factors; D018434:Sickness Impact Profile; D055815:Young Adult
Burn registry; Cohort study; Fatigue; Outcomes; Quality of life