A 365-Day View of the Difficult Patients Treated in an Australian Adult Burn Center

Abstract

Although the effect of burns on mental health has been well examined, the aims of this study were to determine the prevalence of pre-existing mental health, drug and alcohol, and forensic problems in an Australian burn patient population; examine differences between these groups in terms of burns characteristics and healing; and also establish any patterns of presentation amongst these groups. Retrospective case notes of all the acute burn admissions, 273 patients, into a busy tertiary adults burn center in a full year were reviewed. Almost half of the patients admitted had underlying complex issues. Those with psychotic, forensic, and/or drug and alcohol problems tended to stay longer in hospital and required more procedures, despite burn sizes comparable with those in the general population. These patients also tended to sustain their burn injuries, and present to hospital, on a Saturday, Sunday, or Monday, rarely coming later in the week. Those with depression/anxiety had similar lengths of stay, number of procedures and random temporal presentations to the general burns population. Burn centers should be well staffed and educated in how to deal with patients with complex needs; this staffing should be actively structured to deal with a clear pattern of presentation over the weekend and Monday.

The Effect of Illicit Drug Use on Outcomes Following Burn Injury

“…As in the other studies on drug and alcohol use among burn patients, we found that intoxicated patients were more likely to have a flame burn than their sober counterparts. [3, 7, 11, 12] Moreover, patients who used illicit drugs of any sort had a significantly larger burden of injury, and were also more likely to sustain an inhalation injury than those who did not use drugs. In particular, the effect on burn size seems to be due more to drugs other than marijuana, as average burn size among those who used marijuana only was quite similar to that of nondrug users at around 9-9.5% TBSA, while those who used other drugs (with or without marijuana) had burn sizes of 11.5-11.9% TBSA.…”

“…[3] On unadjusted analysis, patients who abused any illicit drugs had longer hospital and intensive care unit stays, but not a higher risk of mortality. After stratifying based on the pattern of drug use, marijuana alone does not appear to worsen outcomes, while use of other drugs seem to result in the longest hospitalization and highest risk of death.…”

“…Unfortunately, pre-existing psychiatric illness may also make it more difficult for patients to adjust following their injuries and to handle the sequelae (including painful, prolonged wound care regimens and the diminished ability to function independently). [3] Moreover a prolonged hospital ICU length of stay may actually result in an increased risk of post traumatic stress disorder among those patients with a history of pre-existing mental illness or prior unemployment. [4] We believe that these more vulnerable patients may benefit from more aggressive interventions by a multidisciplinary team, including social workers and mental health professionals, to both delineate the nature and extent of pre-existing mental health conditions, as well as to mitigate the potential negative psychological consequences of a burn injury.…”

“…[2-4] Many patients with psychiatric and substance abuse comorbidities will remain in hospital longer due inability to care for their own wounds and/or lack of a reliable care giver. [3] Other studies have suggested that acute intoxication reduces both motor coordination and reaction times, resulting in a more extensive injury and/or an inhalation injury. [2] However, alcohol intoxication has also been shown to lead to increased intestinal bacterial overgrowth and translocation, leading to an increased risk sepsis and multi-system organ failure.…”

A clinical update on posttraumatic stress disorder in burn injury survivors

“…[1][2][3] As physical treatments have improved survival, attention has increasingly turned to psychosocial outcomes with a growing call for psychosocial screening, psychosocial support and treatment of psychiatric sequelae such as posttraumatic stress disorder (PTSD), depression, anxiety and substance use. [4][5][6][7][8] In parallel, research, both qualitative and quantitative, has examined risk factors for poorer coping and changes to body image and protective factors that foster resilience, recovery and posttraumatic growth. [2][3][4][5][6][7][8][9][10][11][12][13] Furthermore, injuries do not occur in a vacuum; many patients have prior mental health issues, complex trauma, substance use or forensic issues that can complicate their treatment and progress.…”