Ryan Colleen M, Lee Austin, Kazis Lewis E, Schneider Jeffrey C, Shapiro Gabriel D, Sheridan Robert L, Meyer Walter J, Palmieri Tina, Pidcock Frank S, Reilly Debra, Tompkins Ronald G
From the *Massachusetts General Hospital, Boston; †Harvard Medical School, Boston, Massachusetts; ‡Shriners Hospitals for Children-Boston, Massachusetts; §Center for the Assessment of Pharmaceutical Practices (CAPP), Department of Health Policy and Management, Boston University School of Public Health, Massachusetts; ‖Spaulding Rehabilitation Hospital, Boston, Massachusetts; ¶Sainte-Justine University Health Centre, Montreal, Canada; #University of Montreal, Canada; **Shriners Hospital for Children, Galveston, Texas; ††University of Texas Medical Branch, Galveston; ‡‡Shriners Hospital for Children, Sacramento, California; §§University of California at Davis, Los Angeles; ‖‖Kennedy Krieger Institute, Baltimore, Maryland; ¶¶University of Nebraska, Omaha; and ##Xi'an University for Finance and Economics, Research Center for Medical Statistics and Actuarial Science, China, and Bentley University, Department of Mathematical Sciences, Waltham, Massachusetts.
J Burn Care Res. 2015 Jan-Feb;36(1):118-29. doi: 10.1097/BCR.0000000000000214.
The impact of burn size on mortality is well known, but the association of burn size with the trajectories of long-term functional outcomes remains poorly studied. This prospective multi-center study included burned adults ages 19 to 30 years who completed the Young Adult Burn Outcome Questionnaire at initial baseline contact, 2 weeks, and at 6 and 12 months after initial questionnaire administration. Non-burned adults of comparable ages also completed the questionnaire as a reference group. The association between functional recovery and TBSA burned was analyzed longitudinally using generalized linear models with the generalized estimation equation technique. Functional status was characterized in 15 domains: physical function, fine motor function, pain, itch, social function limited by physical function, perceived appearance, social function limited by appearance, sexual function, emotion, family function, family concern, satisfaction with symptom relief, satisfaction with role, work reintegration, and religion. Scores were standardized to a mean of 50 and a SD of 10 based on non-burned controls. There were 153 burned and 112 non-burned subjects with a total of 620 questionnaires. TBSA burned was 11 ± 14% (mean ± SD); 31% had face involvement and 57% had hand involvement. The lag time from burn injury to questionnaire administration was on average 7 ± 7.7 months, with a maximum of 36 months. Lower recovery levels were associated with increasing burn size for physical function, pain, itch, work reintegration, emotion, satisfaction with symptom relief, satisfaction with role, family function, and family concern (P value ranged from .04-<.0001). No significant differences in recovery levels were found with increasing burn size for fine motor function, social function limited by physical function, sexual function, and religion; these areas tracked toward the age-matched non-burned group regardless of burn size. Perceived appearance and social function limited by appearance remained below the non-burn levels throughout the 3-year period regardless of burn size. Three-year recovery trajectories of survivors with larger burn size showed improvements in most areas, but these improvements lagged behind those with smaller burns. Poor perceived appearance was persistent and prevalent regardless of burn size and was found to limit social function in these young adult burn survivors. Expectations for multidimensional recovery from burns in young adults can be benchmarked based on burn size with important implications for patient monitoring and intervening in clinical care.
烧伤面积对死亡率的影响众所周知，但烧伤面积与长期功能预后轨迹之间的关联仍研究不足。这项前瞻性多中心研究纳入了19至30岁的成年烧伤患者，他们在初次基线接触时、2周时以及初次问卷调查后的6个月和12个月完成了青年成人烧伤结局问卷。年龄相仿的未烧伤成年人也完成了该问卷作为参照组。使用广义估计方程技术的广义线性模型纵向分析功能恢复与烧伤总面积（TBSA）之间的关联。从15个领域对功能状态进行了描述：身体功能、精细运动功能、疼痛、瘙痒、因身体功能受限的社会功能、自我认知外貌、因外貌受限的社会功能、性功能、情绪、家庭功能、家人关心、对症状缓解的满意度、对角色的满意度、重返工作岗位以及宗教信仰。基于未烧伤对照组，分数标准化为均值50和标准差10。共有153名烧伤受试者和112名未烧伤受试者，共收集到620份问卷。烧伤总面积为11±14%（均值±标准差）；31%的患者面部烧伤，57%的患者手部烧伤。从烧伤到进行问卷调查的平均间隔时间为7±7.7个月，最长为36个月。身体功能、疼痛、瘙痒、重返工作岗位、情绪、对症状缓解的满意度、对角色的满意度、家庭功能和家人关心等方面的恢复水平较低与烧伤面积增加相关（P值范围为0.04 - <0.0001）。对于精细运动功能、因身体功能受限的社会功能、性功能和宗教信仰，未发现随着烧伤面积增加恢复水平有显著差异；无论烧伤面积大小，这些领域的恢复情况均趋向于年龄匹配的未烧伤组。无论烧伤面积大小，自我认知外貌和因外貌受限的社会功能在整个3年期间均低于未烧伤水平。烧伤面积较大的幸存者3年的恢复轨迹显示，大多数领域都有改善，但这些改善落后于烧伤面积较小者。无论烧伤面积大小，较差的自我认知外貌都持续存在且普遍存在，并且发现这会限制这些年轻成人烧伤幸存者的社会功能。基于烧伤面积可以为年轻成人烧伤后的多维恢复预期设定基准，这对临床护理中的患者监测和干预具有重要意义。
