Military Return to Duty and Civilian Return to Work Factors Following Burns With Focus on the Hand And Literature Review

Abstract

Functional recovery and outcome from severe burns is oftentimes judged by the time required for a person to return to work (RTW) in civilian life. The equivalent in military terms is return to active duty. Many factors have been described in the literature as associated with this outcome. Hand function, in particular, is thought to have a great influence on the resumption of preburn activities. The purpose of this investigation was to compare factors associated with civilian RTW with combat injured military personnel. A review of the literature was performed to assimilate the many factors reported as involved with RTW or duty. Additionally, a focus on the influence of hand burns is included. Thirty-four different parameters influencing RTW have been reported inconsistently in the literature. In a military population of combat burns, TBSA burn, length of hospitalization and intensive care and inhalation injury were found as the most significant factors in determining return to duty status. In previous RTW investigations of civilian populations, there exists a scatter of factors reported to influence patient disposition with a mixture of conflicting results. In neither military nor civilian populations was the presence of a hand burn found as a dominant factor. Variety in patient information collected and statistical approaches used to analyze this information were found to influence the results and deter comparisons between patient populations. There is a need for a consensus data set and corresponding statistical approach used to evaluate RTW and duty outcomes after burn injury.

Employment Outcomes After Burn Injury: A Comparison of Those Burned at Work and Those Burned Outside of Work

“…They found that medical factors, such as burn size, length of hospitalization, intensive care, and inhalation injury, were most predictive of return to duty status. 42 These predictors have been demonstrated in studies of civilian employment outcomes. [3][4][5][6][7][8][9][10] Also, hand burns are associated with delayed return to work status.…”

Debrided Skin as a Source of Autologous Stem Cells for Wound Repair

“…Samples were collected from 21 male burn patients with a mean age of 33 years. This study focused on the 20‐ to 30‐year‐old age group, which is the average age of military male burn patients [37]. From this age group, three samples were randomly selected for extensive analysis; and a sample from an older patient (age 49 years) was analyzed for age comparison (Table 1).…”

The Effect of Blast-Related Burn Injuries from Prolonged Field Care to Rehabilitation and Resilience: A Review of the Scientific Literature

“…Severe burns accounted for about 5-20 percent of combatrelated casualties during OIF and OEF (Nuutila et al, 2019;Wolf et al, 2006), including about 10 percent of combat-related injuries to the head and neck (Johnson et al, 2015). Among those evacuated from theater, about one-third did not return to duty, depending on TBSA and inhalation injury (Chapman, Richard, Hedman, Chisholm, et al, 2008). Infection is perhaps the most common and serious blast-burn complication and cause of death, and it is potentially more common after combat blast-related burns than noncombat-related burns.…”

“…Researchers performed a retrospective study of factors associated with military burn injuries that predict failure to return to work. Factors that are most strongly associated with failure to return to duty include length of hospitalization for burn injury, TBSA, and presence of inhalation injury (Chapman, Richard, Hedman, Chisholm, et al, 2008). In a retrospective study to determine the rate at which service members return to duty after upperextremity amputations, Kift and colleagues, 2017, found that patients who sustained burn injuries were more likely to remain on active duty postamputation than were patients with a similar amputation type but without concomitant burn injuries (65 percent compared with 40 percent).…”