Burn Injury Research Unit, University of Western Australia, Western Australia, Australia.
Centre for Data Linkage, Curtin University, Western Australia, Australia.
Burns. 2019 Aug;45(5):1041-1050. doi: 10.1016/j.burns.2018.06.006. Epub 2019 May 2.
Burns cause acute damage to the peripheral nervous system with published reports identifying that neurological changes after injury remain for a prolonged period. To shed some light on potential mechanisms, we assessed injury etiology and patterns of nervous system morbidity after injury by comparing long-term hospital admissions data of burns patients and other non-burn trauma patients with uninjured people.
Linked hospital and death data of a burn patient cohort (n=30,997) in Western Australia during the period 1980-2012 were analysed along with two age and gender frequency matched comparison cohorts: non-burn trauma patients (n=28,647) and; non-injured people (n=123,399). The number of annual NS disease admissions and length of stay (LOS) were used as outcome measures. Multivariable negative binomial regression modelling was used to derive adjusted incidence rate ratios and 95% confidence intervals (IRR, 95% CI) and adjusted Cox regression models and hazard ratios (HR) were used to examine time to first nervous system admission after burn and incident admission rates.
The most common peripheral nervous system condition identified in each cohort (burn, non-burn trauma, uninjured) were episodic and paroxysmal disorders followed by nerve root and plexus disorders and polyneuropathies/peripheral NS conditions. Significantly elevated admission rates for NS conditions (IRR, 95% CI) were found for the burn (2.20, 1.86-2.61) and non-burn trauma (1.85, 1.51-2.27), compared to uninjured. Peripheral nervous system admission rates after injury (IRR, 95% CI) were significantly higher regardless of age at time of injury for the burn (<15years: 1.97, 1.49-2.61; 15-45: 2.70, 2.016-3.55; ≥45year: 1.62, 1.33-1.97) and non-burn trauma cohorts (<15years: 1.91, 1.55-2.35; 15-45: 1.94, 1.51-2.49; ≥45year: 1.42, 1.18-1.72), when compared to the uninjured. Significantly higher rates of incident NS hospitalisations were found for the burn cohort vs. uninjured cohort for a period of 15-years after discharge (0-5 years: HR, 95% CI: 1.97, 1.75-2.22; 5-15 years; HR, 95% CI: 1.44, 1.28-1.63). The non-burn trauma cohort had significantly higher incident nervous system admissions for 10 years after discharge (0-30 days: HR, 95% CI: 4.75, 2.44-9.23; 30days to 1-year HR, 95% CI: 2.95, 2.34-3.74; 1-5 years; HR, 95% CI: 1.47, 1.26-1.70; 5-10 years; HR, 95% CI: 1.34, 1.13-1.58).
Results suggest that injury patients are at increased risk of peripheral nervous system morbidity after discharge for a prolonged period of time. The time patterns associated with incident nervous system conditions suggest possible differences in underlying pathology and long-term patient care needs. Further research is needed to elucidate the underlying neuropathology.
烧伤会对周围神经系统造成急性损伤，已有研究报道指出，损伤后的神经变化会持续很长一段时间。为了深入了解潜在的机制，我们通过比较烧伤患者和其他非烧伤创伤患者与未受伤人群的长期住院数据，评估了损伤病因和神经系统发病率模式。
分析了 1980 年至 2012 年期间澳大利亚西部的烧伤患者队列（n=30997）的关联医院和死亡数据，以及两个年龄和性别匹配的对照队列：非烧伤创伤患者（n=28647）和未受伤人群（n=123399）。使用年度神经疾病入院人数和住院时间（LOS）作为结果指标。采用多变量负二项回归模型得出调整后的发病率比值和 95%置信区间（IRR，95%CI），采用调整后的 Cox 回归模型和风险比（HR）分析烧伤后首次发生神经系统疾病入院和发病的时间。
在每个队列（烧伤、非烧伤创伤、未受伤）中，最常见的周围神经系统疾病是发作性和阵发性疾病，其次是神经根和神经丛疾病以及多发性神经病/周围神经系统疾病。烧伤（IRR，95%CI）和非烧伤创伤（IRR，95%CI）患者的神经疾病入院率显著升高（烧伤：2.20，1.86-2.61；非烧伤创伤：1.85，1.51-2.27），与未受伤人群相比。烧伤和非烧伤创伤患者受伤后（IRR，95%CI）的周围神经系统入院率无论受伤时的年龄如何均显著升高（烧伤：<15 岁：1.97，1.49-2.61；15-45 岁：2.70，2.016-3.55；≥45 岁：1.62，1.33-1.97）和非烧伤创伤队列（<15 岁：1.91，1.55-2.35；15-45 岁：1.94，1.51-2.49；≥45 岁：1.42，1.18-1.72），与未受伤人群相比。与未受伤人群相比，烧伤队列在出院后 15 年内发生神经疾病住院的发生率显著更高（0-5 年：HR，95%CI：1.97，1.75-2.22；5-15 年：HR，95%CI：1.44，1.28-1.63）。非烧伤创伤队列在出院后 10 年内发生神经疾病入院的发生率显著更高（0-30 天：HR，95%CI：4.75，2.44-9.23；30 天至 1 年：HR，95%CI：2.95，2.34-3.74；1-5 年：HR，95%CI：1.47，1.26-1.70；5-10 年：HR，95%CI：1.34，1.13-1.58）。
结果表明，烧伤患者在出院后很长一段时间内发生周围神经系统发病率的风险增加。与发生神经系统疾病相关的时间模式表明，潜在的病理学和长期患者护理需求可能存在差异。需要进一步研究阐明潜在的神经病理学。
