Gabbe Belinda J, Cleland Heather, Watterson Dina M, Schrale Rebecca, McRae Sally, Parker Christine, Taggart Susan, Edgar Dale W
Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, Commercial Road, Melbourne 3004, Australia; Farr Institute - CIPHER, College of Medicine, Swansea University, Singleton Park, Swansea, Wales SA28PP, United Kingdom.
Victorian Adult Burns Service, The Alfred, Commercial Road, Melbourne 3004, Australia; Department of Surgery, Monash University, The Alfred Centre, Commercial Road, Melbourne 3004, Australia.
Burns. 2015 Dec;41(8):1732-1740. doi: 10.1016/j.burns.2015.09.005. Epub 2015 Oct 4.
Incorporating routine and standardised collection of long term outcomes following burn into burn registries would improve the capacity to quantify burn burden and evaluate care.
To evaluate methods for collecting the long term functional and quality of life outcomes of burns patients and establish the feasibility of implementing these outcomes into a multi-centre burns registry.
Five Burns Registry of Australia and New Zealand (BRANZ) centres participated in this prospective, longitudinal study. Patients admitted to the centres between November 2009 and November 2010 were followed-up at 1, 6, 12 and 24-months after injury using measures of burn specific health, health status, fatigue, itch and return to work. Participants in the study were compared to BRANZ registered patients at the centres over the study timeframe to identify participation bias, predictors of successful follow-up were established using a Generalised Estimating Equation model, and the completion rates by mode of administration were assessed.
463 patients participated in the study, representing 24% of all BRANZ admissions in the same timeframe. Compared to all BRANZ patients in the same timeframe, the median %TBSA and hospital length of stay was greater in the study participants. The follow-up rates were 63% at 1-month, 47% at 6-months; 40% at 12-months, and 21% at 24-months after injury, and there was marked variation in follow-up rates between the centres. Increasing age, greater %TBSA and opt-in centres were associated with greater follow-up. Centres which predominantly used one mode of administration experienced better follow-up rates.
The low participation rates, high loss to follow-up and responder bias observed indicate that greater consideration needs to be given to alternative models for follow-up, including tailoring the follow-up protocol to burn severity or type.
将烧伤后长期预后的常规和标准化收集纳入烧伤登记系统，将提高量化烧伤负担和评估治疗效果的能力。
评估收集烧伤患者长期功能和生活质量预后的方法，并确定将这些预后纳入多中心烧伤登记系统的可行性。
澳大利亚和新西兰烧伤登记系统（BRANZ）的五个中心参与了这项前瞻性纵向研究。2009年11月至2010年11月期间入住这些中心的患者在受伤后1、6、12和24个月接受随访，采用烧伤特异性健康、健康状况、疲劳、瘙痒和重返工作等指标。将研究中的参与者与同一时间段内BRANZ在各中心登记的患者进行比较，以确定参与偏倚，使用广义估计方程模型确定成功随访的预测因素，并评估不同管理方式的完成率。
463名患者参与了该研究，占同一时间段内BRANZ所有入院患者的24%。与同一时间段内所有BRANZ患者相比，研究参与者的中位烧伤总面积百分比和住院时间更长。随访率在受伤后1个月为63%，6个月为47%；12个月为40%，24个月为21%，各中心之间的随访率存在显著差异。年龄增加、烧伤总面积百分比增加和选择加入的中心与更高的随访率相关。主要采用单一管理方式的中心随访率更高。
观察到的低参与率、高失访率和应答者偏倚表明，需要更多地考虑替代随访模式，包括根据烧伤严重程度或类型调整随访方案。
