Health related quality of life 5–7 years after minor and severe burn injuries: a multicentre cross-sectional study

Abstract

Introduction Burn injury can affect health-related quality of life (HRQL). Knowledge concerning long-term HRQL in burn patients is limited. Therefore, our aim was to evaluate long-term HRQL and to study predictors of impaired long-term HRQL. Methods All adults with a length of stay (LOS) of ≥1 day (2011-2012) were invited. Also, adults with severe burns, i.e. >20% total body surface area (TBSA) burned or TBSA full thickness>5% (2010-2013) were invited. Participants completed the EuroQol(EQ)-5D-5L+C and visual analogue scale (EQ-VAS) 5-7 years after burns. Results This study included 256 patients (mean %TBSA 10%); 187 patients with minor burns and 69 patients with severe burns. Mean EQ-5D summary was 0.90 and EQ-VAS 83.2 in the minor burn patients, and 0.79 and 78.1 in the severe burn patients. Some problems in at least one dimension were experienced by 81% of patients with severe burns and 45% of those with minor burns. However, a minority reported severe or extreme problems; 15% of those with severe burns and 6% of those with minor burns. Patients with severe burns reported significantly more problems, except for anxiety/depression. In both patient groups most problems were reported on pain/discomfort. Length of hospital stay, gender and age were associated with lower long-term HRQL (EQ-VAS) in multivariate analyses, whereas only length of stay was associated with a lower summary score. Conclusions The majority of patients experienced some problems with HRQL 5-7 years post burn. This emphasizes that burns can have a negative impact on an individual's HRQL, particularly in more severely burned patients, that persists for years. The HRQL dimensions most frequently affected include pain/discomfort and anxiety/depression. Patients with a prolonged hospital stay, females and older patients are at higher risk of poor HRQL in the long-term. cognitive impairments, had sufficient knowledge of the Dutch language, and contact details were available. Study procedure This study is part of a larger cross-sectional study that assessed the long-term consequences of burns in the Netherlands: the Burden of Burn Injuries study. Participants completed two surveys. The first survey was a short survey on generic health-related quality of life and scar quality, the second one was a more extensive survey on other long-term consequences of burns. Between 03/2017 and 03/2018 eligible patients were invited to participate by a postal invitation including an information letter explaining the nature of the study. This letter was accompanied by an informed consent form and the first survey. Patients received a telephone call or postal reminder to increase the participation rate. The study was performed according to the principles of the Declaration of Helsinki, registered at the Netherlands Trial Register (NTR6407), and approved by the Ethics Committee (registration number NL59981). Measures Patient and injury characteristics were derived from the Dutch Burn Repository R3 12. Patient characteristics included age at injury and gender, and inju...

Recovery of health-related quality of life after burn injuries: An individual participant data meta-analysis

“…HRQL data from the ten different studies originated from five countries, namely Belgium, Germany, Norway, Sweden and The Netherlands [4,9,10,24,25,[31][32][33][34][35]. Data was collected between 1995 and 2018.…”

“…Studies focusing on other outcomes in burns found that female burn patients had higher levels of fatigue, a worse opinion about their scars, more difficulties with social participation, and mortality rates are higher than in male patients [46][47][48][49]. With respect to longer LOS, many studies have shown that patients with a prolonged hospital stay have a diminished HRQL, both shortly and longer after burns [10,41]. This is also in line with results from the general trauma population, where LOS has also been found to influence HRQL after injury [50,51].…”

“…However, such a model does not exist for adult burn patients [2,9]. Information on the expected recovery of HRQL over time in adult burn patients adjusted for factors that showed to influence HRQL outcomes after burn injuries, including age, gender, percentage total body surface area (%TBSA) burned and length of stay (LOS) can inform the burn clinicians [2,10].…”

Improved and standardized method for assessing years lived with disability after burns and its application to estimate the non-fatal burden of disease of burn injuries in Australia, New Zealand and the Netherlands

“…Lifelong disability was assumed when a patient reported a severe problem (level 3 EQ-5D-3 L) in any of the five EQ-5D-3 L dimensions or mild problems (level 2 EQ-5D-3 L) for both the dimensions pain/discomfort and anxiety/depression at two-year follow-up. These two dimensions were chosen based on literature; these dimensions are most often affected by burns [13,15]. The percentage of patients with lifelong disabilities was assessed from the combined dataset.…”

“…Up to 24 months post-burn, most limitations improve, however, some remain highly prevalent in a subset of patients in the long-term, like psychological functioning [13]. Moreover, there are apparent latent limitations, like participation restrictions due to mental well-being, which tend to develop after physical symptoms subside [13][14][15]. In the recent Global Burden of Disease (GBD) study the burden associated with burn injuries has been included [16].…”