University of California, Davis, School of Nursing and Health Care Leadership, California, USA.
University of California, Davis, School of Nursing and Health Care Leadership, California, USA.
Burns. 2024 May;50(4):813-822. doi: 10.1016/j.burns.2024.03.002. Epub 2024 Mar 6.
Throughout the world, burn injury is a major cause of death and disability. In resource-limited countries, burn injury is one of the leading causes of permanent disability among children who survive traumatic injuries, and burn injury is the fourth leading cause of disability worldwide. This study applied Andersen's model of health care access to evaluate if patient characteristics (predisposing factors), burn care service availability (enabling factors) and injury characteristics (need) are associated with physical impairment at hospital discharge for patients surviving burn injuries globally. Specifically, access to rehabilitation, nutrition, operating theatre, specialized burn unit services, and critical care were investigated as enabling factors. The secondary aim was to determine whether associations between burn care service availability and impairment differed by country income level.
This is a cross-sectional secondary analysis of prospectively collected data from the World Health Organization, Global Burn Registry. The outcome of interest was physical impairment at discharge. Simple and multivariable logistic regressions were used to test the unadjusted and adjusted associations between the availability of burn care services and impairment at hospital discharge, controlling for patient and injury characteristics. Effect modification was analyzed with service by country income level interaction terms added to the models and, if significant, the models were stratified by income.
The sample included 6622 patients from 20 countries, with 11.2% classified with physical impairment at discharge. In the fully adjusted model, patients had 89% lower odds impairment at discharge if the treatment facility provided reliable rehabilitation services compared to providing limited or no rehabilitation services (OR.11, 95%CI.08,.16, p < .01). However, this effect was modified by county income with the strong and significant association only present in high/upper middle-income countries. Sophisticated nutritional services were also significantly associated with less impairment in high/upper middle-income countries (OR=.04, 95% CI 0.203, 0.05, p < .01), but significantly more impairment in lower middle/low-income countries (OR=2.01, 95% CI 1.50, 2.69, p < .01). Patients had 444% greater odds of impairment if treated at a center with specialty burn unit services (OR 5.44, 95%CI 3.71, 7.99, p < .01), possibly due to a selection effect.
Access to reliable rehabilitation services and sophisticated nutritional services were strongly associated with less physical impairment at discharge, but only in resource-rich countries. Although these findings support the importance of rehabilitation and nutrition after burn injury, they also highlight potential disparities in the quantity or quality of services available to burn survivors in poorer countries.
在全球范围内，烧伤是导致死亡和残疾的主要原因之一。在资源有限的国家，烧伤是创伤后幸存儿童永久性残疾的主要原因之一，也是全球导致残疾的第四大原因。本研究应用安德森卫生保健获取模型评估患者特征（倾向因素）、烧伤护理服务的可及性（促成因素）和损伤特征（需要）是否与全球烧伤幸存者出院时的身体损伤有关。具体而言，将获得康复、营养、手术室、专门烧伤病房服务和重症监护作为促成因素进行研究。次要目的是确定烧伤护理服务的可及性与损伤之间的关联是否因国家收入水平而异。
这是对世界卫生组织全球烧伤登记处前瞻性收集数据的横断面二次分析。感兴趣的结果是出院时的身体损伤。简单和多变量逻辑回归用于测试烧伤护理服务的可用性与出院时损伤之间的调整后关联，同时控制患者和损伤特征。通过向模型中添加服务与国家收入水平的交互项来分析效应修饰，如果显著，则按收入分层模型。
该样本包括来自 20 个国家的 6622 名患者，其中 11.2%的患者出院时存在身体损伤。在完全调整后的模型中，与提供有限或无康复服务的治疗机构相比，提供可靠康复服务的患者出院时损伤的可能性低 89%（OR.11，95%CI.08，.16，p <.01）。然而，这种效应受到国家收入的影响，只有在高/中上收入国家才存在强烈且显著的关联。在高/中上收入国家，复杂的营养服务也与较少的损伤显著相关（OR=.04，95%CI 0.203，0.05，p <.01），但在中下等/低收入国家则与更多的损伤显著相关（OR=2.01，95%CI 1.50，2.69，p <.01）。如果患者在具有专业烧伤病房服务的中心接受治疗，其损伤的可能性增加 444%（OR 5.44，95%CI 3.71，7.99，p <.01），这可能是由于选择效应。
可靠的康复服务和复杂的营养服务的可及性与出院时的身体损伤程度显著降低有关，但仅在资源丰富的国家。尽管这些发现支持烧伤后康复和营养的重要性，但它们也突出了资源贫乏国家的烧伤幸存者获得的服务数量或质量可能存在差异。
