Elsevier

Injury

Volume 48, Issue 1, January 2017, Pages 87-93
Injury

Female patients display poorer burn-specific quality of life 12 months after a burn injury

https://doi.org/10.1016/j.injury.2016.07.032Get rights and content

Abstract

Introduction

Although gender differences in morbidity and mortality have been measured in patients with moderate to severe burn injury, little attention has been directed at gender effects on health-related quality of life (HRQoL) following burn injury. The current study was therefore conducted to prospectively measure changes in HRQoL for males and females in a sample of burn patients.

Methods

A total of 114 adults who received treatment at a statewide burns service for a sustained burns injury participated in this study. Instruments measuring generic health status (Short Form 36 Medical Outcomes Survey version 2), burn-specific HRQoL (Burns Specific Health Scale-Brief), psychological distress (Kessler Psychological Distress Scale) and alcohol use (Alcohol Use Disorders Identification Tool) were prospectively measured at 3, 6 and 12 months post-burn.

Results

In the 12 months post-injury, female patients showed overall poorer physical (p = 0.01) and mental health status (p < 0.001), greater psychological distress (p < 0.001), and greater difficulty with aspects of burn-specific HRQoL: body image (p < 0.001), affect (p < 0.001), interpersonal functioning (p = 0.005), heat sensitivity (p = 0.01) and treatment regime (p = 0.01). While significant interaction effects suggested that female patients had more improvement in difficulties with treatment regime (p = 0.007), female patients continued to report greater difficulty with multiple aspects of physical and psychosocial health status 12 months post-injury.

Conclusion

Even though demographic variables, injury characteristics and burn care interventions were similar across genders, following burn injury female patients reported greater impairments in generic and burn-specific HRQoL along with psychological morbidity, when compared to male patients. Urgent clinical and research attention utilising an evidence-based research framework, which incorporates the use of larger sample sizes, the use of validated instruments to measure appropriate outcomes, and a commitment to monitoring long-term care, can only improve burn-care.

Introduction

It is not uncommon for patients with moderate to severe burn injury to undergo numerous acute and reconstructive surgeries and participate in a multifaceted burn-specific rehabilitation program involving medical, nursing and allied health professionals. The use of surgical and non-surgical burn care interventions can often extend beyond the immediate acute phase to many months and/or years; with their impact potentially impairing general and burn-specific health related quality of life (HRQoL) [1].

The focus on generic and burn-specific HRQoL has continued to not only gain clinical momentum because of the development of sophisticated trauma care systems [2] and high survival rates [3], [4], but HRQoL focus has played an important role in mapping the long-term health of survivors with burn injury [5], [6], [7], [8], [9]. A further focus for research has also been to better understand the factors that contribute to variations in burn-specific HRQoL, with gender emerging as a potentially influential factor.

Whilst gender differences in health-related HRQoL have been closely examined in other disciplines such as cardiovascular health and trauma [10], [11], the research in burns care has focused heavily on various physiological and immunological differences impacting on burn morbidity and mortality [12], [13], [14], [15], [16], [17]. In more recent times, there has been a number of researchers who have focused on the importance of this emerging field and have found women to experience a reduction in generic and burn-specific HRQoL, independent of injury severity and mechanism [18], [19].

Given these findings and the limited data currently available, this study aimed to examine the relationship between gender and generic and burn-specific HRQoL at 3, 6 and 12 months post-burn, but also ascertain if potential gender-specific outcomes changed and progressed over defined time periods.

Section snippets

Setting

The Victorian Adult Burns Service (VABS) is a state-wide adult burns service located at The Alfred Hospital, one of two designated major trauma services for adults in Victoria, Australia.

Study design and inclusion criteria

A prospective cohort study design was used to recruit patients admitted to VABS between February 2008 and October 2009. Patients who fulfilled the following criteria were recruited during their inpatient stay:

  • Age ≥18years

  • Burns involving >10% total body surface area burned (TBSA) or

  • Burns to the face requiring

Results

Between February 2008 and October 2009, 540 patients with an acute burn injury were admitted to the VABS. Of these, 400 were excluded for the following reasons: TBSA <10% with low potential for functional impairment (n = 241), complex social issues (n = 15), insufficient English (n = 4), previous burn injury requiring re-admission (n = 17), death within 24 h (n = 13), conservative burn wound management (n = 39), other diagnoses (i.e. burn-like conditions such as toxic epidermal necrolysis, n = 17) or missed (n =

Discussion

The aim of this study was to assess gender-based differences in generic and burn specific HRQoL at 3, 6 and 12 months, but also to ascertain if gender altered the trajectory of recovery over time. Despite there being no gender differences in pre-burn physical health status, burn severity and received medical interventions, female patients reported greater impairments in generic health and burn-specific HRQoL as well as greater psychological distress post-injury when compared to their male

Conflict ofinterest

None.

Acknowledgements

This project was kindly supported by a Monash University Faculty Strategic Grant. Belinda Gabbe was supported by a National Health and Medical Research Council of Australia Career Development Fellowship (APP1048731).

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