Modern burn care is a resource intensive endeavor requiring specialized equipment, personnel, and facilities in order to provide optimum care. The costs associated with burn injury to both patients and society as a whole can be multifaceted and large. The purpose of this study was to evaluate the association between hospital costs, patient characteristics, and injury factors in a cohort of pediatric patients admitted to a regional burn center. We performed a review of the hospital charges accrued by pediatric patients (age <16 years) admitted to our burn center from 1994 to 2004 and explored the relationship between baseline patient, injury and hospital course characteristics and total costs. Hospital charges were converted to 2005 dollar costs using an inflation index and a cost to charge ratio. Univariate and multivariate regressions were performed to identify the factors most significantly associated with cost. In addition, we performed a subset cost analysis for patients with burns more than 20% TBSA. A total of 1443 pediatric patients (age <16) were admitted to our burn center during the study period. The overall mean hospital cost in 2005 dollars was $9026 (SD = $25,483; median = $2138). Area of full thickness burn was the only patient or injury factor significantly associated with greater hospital costs (P < .05) on multivariate analysis. No single anatomic area was associated with increased hospital costs when adjusted for total overall burn size. Injury severity was the most significant factor impacting index hospitalization costs following pediatric burn injury. Further studies defining the long-term societal costs impact of burn injury are needed as are studies that evaluate the impact of burn injury on quality of life.Modern burn care is a resource intensive endeavor requiring specialized equipment, multidisciplinary personnel, and facilities. The costs associated with burn injury to both patients and society can be multifaceted and large. Given that the sequelae of burn injury may require ongoing physical, occupational, and psychological therapy as well as repeated in-patient surgical procedures, the costs associated with burn care may persist for years after the initial injury.These long-term care and cost considerations are perhaps even more significant in the pediatric population. Children who sustain severe burn injury can typically expect medical and psychological care that extends years beyond their injury. In addition, pediatric injuries impact parents and/or other caregivers, as well as siblings in the family. During the, often lengthy, postinjury hospitalization, parents often miss prolonged periods of work in order to be at their children's bedside. Following discharge, arrangements for home care also need to be made which frequently result in more missed work days for parents.Although the costs associated with other illnesses, such as chronic pulmonary disease, spinal cord injury, and diabetes have been well studied, [1][2][3][4][5] little is known about the costs of either the in...
Objective-Little is known about how pain and depression after burn injury may influence longterm outcomes such as physical functioning. This prospective study examined associations between pain, depression, and physical functioning in a sample of burn injury survivors.Design and Participants-Questionnaires assessing pain, depression, and physical functioning were completed by 64 (52% of original sample) adult burn survivors shortly after discharge from burn care and at 1-and 2-year follow-ups.Results-Pain and physical functioning improved over the 2 years of the study, whereas depression levels were stable. Pain and depression were associated with poorer physical functioning over time, but associations varied according to the time span under consideration. Also, the association between pain and physical functioning was strongest among persons with higher depression scores.Conclusions-Pain and depression may contribute independently to compromises in physical functioning. The co-occurrence of pain and depression represents even greater risk for reduced physical functioning over time among burn survivors. Keywordspain; depression; burn injury; functioning; quality of life Advances in emergency services and acute burn care in recent decades have led to extraordinary improvements in survival rates following burn injury. Nearly 95% of the approximately 40,000 persons who are hospitalized for burn injuries annually in United States will survive (American Burn Association, 2007) Much greater variability is found when outcomes beyond surviv ability are considered. For example, depression is well recognized as a significant problem following burn injury Patterson et al., 1993). For most burn survivors, average scores on depression indices fall within the mild to moderate range (Choniere, Melzack, Rondeau, Girard, & Paquin, 1989;Thombs, Haines, Bresnick, Magyar-Russell, Fauerbach, & Spence, 2007;Wiechman et al., 2001). However, moderate to severe symptoms of depression have been found in 18% to 45% of burn survivors years after their physical injuries have healed (Pallua, Künsebeck, & Noah, 2003;Wiechman et al., 2001).Pain is another serious problem for burn survivors, particularly during the early phases of burn care when open wounds are being subjected to debridement and movement therapies (Summer, Puntillo, Miaskowski, Green, & Levine, 2007). In addition, pain remain a concern for years after burn injury wounds have closed Choniere and colleagues (1989) found ongoing pain concerns 35% of a sample of burn survivors who were at least 1 year after injury. Similarly, Dauber, Osgood, Breslau, Vernon, and Carr (2002) an average of 10 years after injury reported the presence of pain. Of those with pain, 45% reported that pain interfered with their daily lives (Dauber et al., 2002). Malenfant and colleagues (1996) found pain in over 36% of their sample and demonstrated that pain prevalence, did not vary greatly between 1 and 4 years after injury. Although noting that the average severity of pain was mild (3.4 on a ...
For decades, research on long-term adjustment to burn injuries has adopted a deficit model of focusing solely on negative emotions. The presence of positive emotion and the experience of growth in the aftermath of a trauma have been virtually ignored in this field. Researchers and clinicians of other health and trauma populations have frequently observed that, following a trauma, there were positive emotions and growth. This growth occurs in areas such as a greater appreciation of life and changed priorities; warmer, more intimate relations with others; a greater sense of personal strength, recognition of new possibilities, and spiritual development. In addition, surveys of trauma survivors report that spiritual or religious beliefs played an important part in their recovery and they wished more healthcare providers were comfortable talking about these issues. Further evidence suggests that trauma survivors who rely on spiritual or religious beliefs for coping may show a greater ability for post-traumatic growth (PTG). This article reviews the literature on these two constructs as it relates to burn survivors. We also provide recommendations for clinicians on how to create an environment that fosters PTG and encourages patients to explore their spiritual and religious beliefs in the context of the trauma.
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