The physical and psychological outcomes following burn injury: a 12-month follow-up study

2017-03-01T01:39:52Z (GMT) by Wasiak, Jason
A burn injury represents perhaps the widest spectrum of any form of trauma. Burns occur in all age groups, and the impact on general health outcomes may range from the minor requiring no treatment, through to the very severe, where the highest levels of intensive care and surgery are required. As the majority of burn injuries result in survival, the goal of a multidisciplinary burns team is to provide the best possible care leading to optimal functional outcomes. A high proportion of patients presenting to the Victorian Adult Burns Service (VABS) located at The Alfred Hospital, in Victoria, Australia, have sustained minor burns, defined as injuries affecting less than 10% of total body surface area (%TBSA). In particular, these patients generally have a relatively straightforward treatment and recovery pathway. Unfortunately, there is a smaller subset of patients who present with moderate to severe burn injuries, defined here as greater than 10 %TBSA, where much of the burn care treatments can extend over many days, weeks and months after the initial insult, and can result in various impaired physical and psychosocial health outcomes. As a result, little is known about the trends and long-term consequences of those with moderate to severe burn injury at a population level or at discharge from a burns service, including their overall impact on wider health outcomes. To begin the process of detailing burn injury characteristics along with understanding the potential impact hospital burn care interventions may have on overall generalised health and well-being, there was an urgent need to maintain and improve standardised burn injury surveillance programs. In particular, the aim of this thesis was to use existing datasets from state-wide and hospital administrative datasets, along with collecting generalised and burn-specific health outcomes at various time-points post-hospital discharge, to describe overall trends and outcomes in those with burn injury. Our results showed that rates of emergency data presentations, hospital admissions and deaths remained the same over a 7-year time frame. However, when collecting generalised health and burn-specific data using various outcome measures and the instruments contained in this thesis, the majority of patients hospitalised with burn injuries at 12-months were still reporting levels of physical functioning that were significantly below pre-injury levels. When examining a subset of patients affected by a natural disaster, psychological distress was still present at 12-months after injury. This suggests that a more goal-directed therapy and a consistent evaluation of interventions would be required in order to continue improving the physical and psychosocial functioning, particularly at time points where patients were considered to be at their greatest physical and psychosocial risk. More importantly, the rich information gleaned from patient insights and reported in this thesis showcase the need to consider extending the monitoring period beyond the initial period of 12-months post-injury as set out in this thesis.