Child Housing Assessment for a Safe Environment (CHASE): a new tool for injury prevention inside the home.

OBJECTIVE: To develop a tool to assess the safety of the home environment that could produce valid measures of a child's risk of suffering an injury. METHODS: Tool development: A four-step process was used to develop the CHASE (Child Housing Assessment for a Safe Environment) tool, including (1) a literature scan, (2) reviewing of existing housing inspection tools, (3) key informants interviews, and (4) reviewing the National Electronic Injury Surveillance System to determine the leading housing elements associated with paediatric injury. Retrospective case-control study to validate the CHASE tool: Recruitment included case (injured) and control (sick but not injured) children and their families from a large, urban paediatric emergency department in Baltimore, Maryland in 2012. Trained inspectors applied both the well-known Home Quality Standard (HQS) and the CHASE tool to each enrollee's home, and we compared scores on individual and summary items between cases and controls. RESULTS: Twenty-five items organised around 12 subdomains were included on the CHASE tool. 71 matched pairs were enrolled and included in the analytic sample. Comparisons between cases and controls revealed statistically significant differences in scores on individual items of the CHASE tool as well as on the overall score, with the cases systematically having worse scores. No differences were found between groups on the HQS measures. CONCLUSION: Programmes conducting housing inspections in the homes of children should consider including the CHASE tool as part of their inspection measures. Future study of the CHASE inspection tool in a prospective trial would help assess its efficacy in preventing injuries and reducing medical costs.

Improving hand hygiene compliance in child daycare centres: a randomized controlled trial.

Gastrointestinal and respiratory infections in children attending daycare centres (DCCs) are common and compliance with hand hygiene (HH) guidelines to prevent infections is generally low. An intervention was developed to increase HH compliance and reduce infections in DCCs. The objective of this paper was to evaluate the effectiveness of this intervention on HH compliance. The intervention was evaluated in a two-arm cluster randomized controlled trial in 71 DCCs in The Netherlands. Thirty-six DCCs received the intervention including: (1) HH products; (2) training about HH guidelines; (3) two team training sessions aimed at goal setting and formulating HH improvement activities; and (4) reminders and cues for action (posters/stickers). Intervention DCCs were compared to 35 control DCCs that continued usual practice. HH compliance of caregivers and children was observed at baseline and at 1, 3 and 6 months follow-up. Using multilevel logistic regression, odds ratios (ORs) with 95% confidence intervals (CIs) were obtained for the intervention effect. Of 795 caregivers, 5042 HH opportunities for caregivers and 5606 opportunities for supervising children's HH were observed. At 1 month follow-up caregivers' compliance in intervention DCCs was 66% vs. 43% in control DCCs (OR 6·33, 95% CI 3·71-10·80), and at 6 months 59% vs. 44% (OR 4·13, 95% CI 2·33-7·32). No effect of the intervention was found on supervising children's HH (36% vs. 32%; OR 0·64, 95% CI 0·18-2·33). In conclusion, HH compliance of caregivers increased due to the intervention, therefore dissemination of the intervention can be considered.

A hand hygiene intervention to reduce infections in child daycare: a randomized controlled trial.

Infections are common in children attending daycare centres (DCCs). We evaluated the effect of a hand hygiene (HH) intervention for caregivers on the incidence of gastrointestinal and respiratory infections in children. The intervention was evaluated in a two-arm cluster randomized controlled trial. Thirty-six DCCs received the intervention including HH products, training sessions, and posters/stickers. Thirty-five control DCCs continued usual practice. Incidence of episodes of diarrhoea and the common cold in children was monitored by parents during 6 months. Using multilevel Poisson regression, incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were obtained. Diarrhoeal incidence was monitored in 545 children for 91 937 days. During follow-up, the incidence was 3·0 episodes per child-year in intervention DCCs vs. 3·4 in control DCCs (IRR 0·90, 95% CI 0·73-1·11). Incidence of the common cold was monitored in 541 children for 91 373 days. During follow-up, the incidence was 8·2 episodes per child-year in intervention DCCs vs. 7·4 in control DCCs (IRR 1·07, 95% CI 0·97-1·19). In this study, no evidence for an effect of the intervention was demonstrated on the incidence of episodes of diarrhoea and the common cold.

Increase in upper extremity fractures in young male soccer players in the Netherlands, 1998-2009.

Young male soccer players have been identified as a target group for injury prevention, but studies addressing trends and determinants of injuries within this group are scarce. The goal of this study was to analyze age-specific trends in hospital-treated upper extremity fractures (UEF) among boys playing soccer in the Netherlands and to explore associated soccer-related factors. Data were obtained from a national database for the period 1998-2009. Rates were expressed as the annual number of UEF per 1000 soccer players. Poisson's regression was used to explore the association of UEF with the number of artificial turf fields and the number of injuries by physical contact. UEF rates increased significantly by 19.4% in boys 5-10 years, 73.2% in boys 11-14 years, and 38.8% in boys 15-18 years old. The number of injuries by physical contact showed a significant univariate association with UEF in boys 15-18 years old. The number of artificial turf fields showed a significant univariate association with UEF in all age groups, and remained significant for boys aged 15-18 years in a multivariate model. This study showed an increase of UEF rates in boys playing soccer, and an independent association between artificial turf fields and UEF in the oldest boys.

Four-wheeled walker related injuries in older adults in the Netherlands.

BACKGROUND: With ageing populations worldwide, mobility devices are used more than ever. In the current literature there is no consensus whether the available mobility devices safely improve the mobility of their users. Also, evidence is lacking concerning the risks and types of injuries sustained while using a four-wheeled walker. OBJECTIVE: To assess injury risks and injury patterns in older adults (≥65 years) who presented at Emergency Departments (ED) in the Netherlands with an injury due to using a four-wheeled walker. DESIGN AND SETTING: In this study, the Dutch Injury Surveillance System was used to obtain a national representative sample of annual ED visits in the Netherlands in the adult population (≥65 years) sustaining an injury while using a four-wheeled walker. The numbers of four-wheeled walker users in the Netherlands were obtained from the national insurance board. The numbers of ED visits were divided by the numbers of four-wheeled walker users to calculate age- and sex-specific injury risks. RESULTS: Annually 1869 older adults visited an ED after sustaining an injury while using a four-wheeled walker. Falls were the main cause of injury (96%). The injury risk was 3.1 per 100 users of four-wheeled walkers. Women (3.5 per 100 users) had a higher risk than men (2.0 per 100 users). Injury risk was the highest in women aged 85 years and older (6.2 per 100 users). The majority of injuries were fractures (60%) with hip fracture (25%) being the most common injury. Nearly half of all four-wheeled walker related injuries required hospitalisation, mostly due to hip fractures. Healthcare costs per injury were approximately €12 000. CONCLUSIONS: This study presents evidence that older adults experiencing a fall while using a four-wheeled walker are at high risk to suffer severe injuries.

Validity of self-reported compliance and behavioural determinants of observed compliance: an application of the COM-B hand hygiene questionnaire in nine Dutch hospitals.

BACKGROUND: Hand hygiene compliance (HHC) can be influenced by behavioural determinants, but knowledge on this remains scarce. The Capability, Opportunity, Motivation-Behaviour (COM-B) hand hygiene questionnaire was developed by Lydon et al. to gain insight into self-reported behavioural determinants and self-reported HHC. AIMS: To determine the validity of self-reported HHC using the COM-B questionnaire; and investigate the influence of self-reported behavioural determinants on observed HHC, taking environmental determinants into account. METHODS: This was a cross-sectional study, from September to November 2019, in nine hospitals in the Netherlands. Healthcare workers (HCWs) completed the COM-B questionnaire, and direct hand hygiene observations were performed. In addition, information on environmental determinants (workload, ward category, hospital type and ward infrastructure) was collected. Validity of self-reported HHC was determined using the intraclass correlation coefficient (ICC). Univariable and multi-variable regression analyses were performed to investigate the relationship between behavioural and environmental determinants and observed HHC. FINDINGS: The ICC showed no association between self-reported HHC and observed HHC [0.04, 95% CI -0.14 to 0.21]. In univariable regression analyses, ward category and the opportunity and motivation subscales were significantly associated with observed HHC. In multi-variable regression analysis, only ward category and the motivation subscale remained significant. CONCLUSION: Self-reported HHC is not a valid substitute for direct hand hygiene observations. Motivation (behavioural determinant) was significantly associated with HCC, while almost none of the environmental determinants had an effect on observed HHC. In further development of hand hygiene interventions, increasing the intrinsic motivation of HCWs should receive extra attention.

Compliance with a novel hand hygiene protocol tailored to non-sterile healthcare workers in the operating theatre.

BACKGROUND: Observing hand hygiene compliance (HHC) among non-sterile healthcare workers (HCWs) in the operating theatre (OT) is challenging as there are no tailored protocols or observation tools. AIM: To develop and test a hand hygiene protocol tailored to non-sterile HCWs in the OT. METHODS: In this prospective observational study, nine hospitals in the Rotterdam-Rijnmond region provided input on a draft protocol on hand hygiene in the OT, resulting in a new consensus protocol for the region. An observation tool based on the protocol was developed and tested. HHC rates with 95% confidence intervals (CI) were calculated by type of hospital and type of HCW. FINDINGS: The protocol has three sections: (1) written general hand hygiene rules; (2) written hand hygiene rules specific for anaesthesia and surgery; and (3) visual representation of the OT, divided into four hand hygiene areas. Hand hygiene should be applied when changing area. Average HHC of 48.0% (95% CI 45.2-61.2%) was observed in OTs across all hospitals. HHC was highest in the two specialized hospitals (64.0%, 95% CI 30.6-89.8%; 76.7%, 95% CI 62.8-84.5%) and lowest in the academic teaching hospital (23.1%, 95% CI 0.0-45.8%). In terms of type of HCW, HHC was lowest among anaesthesiologists (31.6%, 95% CI 19.2-62.4%) and highest among OT assistants (57.4%, 95% CI 50.1-78.2%). CONCLUSION: This uniform way of observing HHC in the OT enables evaluation of the effectiveness of interventions in the OT and facilitates friendly competition. In the Rotterdam-Rijnmond region, HHC in the OT was below 50%; this needs to be addressed, particularly in teaching hospitals and among physicians.

Epidemiological burden of minor, major and fatal trauma in a national injury pyramid.

BACKGROUND: The impact of trauma on population health is underestimated because comprehensive overviews of the entire severity spectrum of injuries are scarce. The aim of this study was to measure the total health impact of fatal and non-fatal unintentional injury in the Netherlands. METHODS: Epidemiological data for the four levels of the injury pyramid (general practitioner (GP) registry, emergency department (ED) registers, hospital discharge and mortality data) were obtained for the whole country. For all levels, the incidence and years of life lost (YLL) owing to premature death, years lived with disability (YLD) and disability-adjusted life-years (DALYs) were calculated. RESULTS: Unintentional injury resulted in 67 547 YLL and 161 775 YLD respectively, amounting to 229 322 DALYs (14.1 per 1000 inhabitants). Home and leisure, and traffic injuries caused most DALYs. Minor injury (GP and ED treatment) contributed 37.3 per cent (85 504 DALYs; 5.2 per 1000) to the total burden of injury, whereas injuries requiring hospital admission contributed 33.3 per cent (76 271 DALYs; 4.7 per 1000) and fatalities contributed 29.5 per cent (67 547 DALYs; 4.1 per 1000). Men aged 15-65 years had the greatest burden of injury, resulting in a share of 39.6 per cent for total DALYs owing to unintentional injury. The highest individual burden resulted from death (19 DALYs per patient). CONCLUSION: Trauma causes a major burden to society. For priority setting in public health and the identification of opportunities for prevention it is important that burden-of-injury estimates cover the entire spectrum of injuries, ranging from minor injury to death.

Improved and standardized method for assessing years lived with disability after injury.

OBJECTIVE: To develop a standardized method for calculating years lived with disability (YLD) after injury. METHODS: The method developed consists of obtaining data on injury cases seen in emergency departments as well as injury-related hospital admissions, using the EUROCOST system to link the injury cases to disability information and employing empirical data to describe functional outcomes in injured patients. FINDINGS: Overall, 87 weights and proportions for 27 injury diagnoses involving lifelong consequences were included in the method. Almost all of the injuries investigated (96-100%) could be assigned to EUROCOST categories. The mean number of YLD per case of injury varied with the country studied. Use of the novel method resulted in estimated burdens of injury that were 3 to 8 times higher, in terms of YLD, than the corresponding estimates produced using the conventional methods employed in global burden of disease studies, which employ disability-adjusted life years. CONCLUSION: The novel method for calculating YLD after injury can be applied in different settings, overcomes some limitations of the method used to calculate the global burden of disease, and allows more accurate estimates of the population burden of injury.

Health-related quality of life in preschool children in five health conditions.

OBJECTIVE: To test the responsiveness of the Infant/Toddler Quality of Life Questionnaire (ITQOL) to five health conditions. In addition, to evaluate the impact of the child's age and gender on the ITQOL domain scores. METHODS: Observational study of 494 Dutch preschool-aged children with five clinical conditions and 410 healthy preschool children randomly sampled from the general population. The clinical conditions included neurofibromatosis type 1, wheezing illness, bronchiolitis, functional abdominal complaints, and burns. Health-related quality of life (HRQoL) was assessed by a mailed parent-completed ITQOL. Mean ITQOL scale scores for all conditions were compared with scores obtained from the reference sample. The effect of patient's age and gender on ITQOL scores was assessed using multi-variable regression analysis. RESULTS: In all health conditions, substantially lower scores were found for several ITQOL scales. The conditions had a variable effect on the type of ITQOL domains and a different magnitude of effect. Scores for 'physical functioning', 'bodily pain', and 'general health perceptions' showed the greatest range. Parental impact scales were equally affected by all conditions. In addition to disease type, the child's age and gender had an impact on HRQoL. CONCLUSIONS: The five health conditions (each with a distinct clinical profile) affected the ITQOL scales differently. These results indicate that the ITQOL is sensitive to specific characteristics and symptom expression of the childhood health conditions investigated. This insight into the sensitivity of the ITQOL to health conditions with different symptom expression may help in the interpretation of HRQoL results in future applications.

Trends in wrist fractures in children and adolescents, 1997-2009.

PURPOSE: Distal radius and carpal fractures in children and adolescents represent approximately 25% of all pediatric fractures. Incidence rates and causes of these fractures change over time owing to changes in activities and risk factors. The purpose of this study was to examine recent population-based trends in incidence and causes of wrist fractures in children and adolescents. METHODS: We obtained data from the Dutch Injury Surveillance System of emergency department visits of 15 geographically distributed hospitals, and from the National Hospital Discharge Registry. This included a representative sample of outpatients and inpatients, respectively. We calculated incidence rates of wrist fractures per 100,000 person-years for each year between 1997 and 2009. Using Poisson's regression, we analyzed trends for children and adolescents 5 to 9, 10 to 14, and 15 to 19 years of age separately for boys and girls. RESULTS: During the study period, incidence rates increased significantly in boys and girls 5 to 9 and 10 to 14 years of age, with the strongest increase in the age group 10 to 14 years. The observed increases were mainly due to increased incidence rates during soccer and gymnastics at school. CONCLUSIONS: This population-based study revealed a substantial sports-related increase in the incidence rate of wrist fractures in boys and girls aged 5 to 9 and 10 to 14 years in the period 1997 to 2009. CLINICAL RELEVANCE: With knowledge of the epidemiology of wrist fractures, prevention programs can be improved. From this study, we know that the incidence rate of wrist fractures in childhood is increasing, mainly as a result of soccer and gymnastics at school. Future sport injury research and surveillance data are necessary to develop new prevention programs based on identifying and addressing specific risk factors, especially in young athletes.

Costs and benefits of multifactorial falls prevention in nursing homes in the Netherlands.

OBJECTIVES: To investigate whether the implementation of a multifactorial falls intervention in nursing homes is cost-beneficial and alleviates the professional workload. DESIGN: A comprehensive quantitative model was developed to calculate the impact of investments in multifactorial falls prevention in nursing homes in the Netherlands, comparing the fall incidence using intervention strategies in 1000 nursing home residents with the conditions of usual care over a five-year timeline. SETTING AND PARTICIPANTS: We built a model combining several data sources regarding falls and injury prevalence in nursing home residents, health care costs, intervention costs and effectiveness, and demographic statistics. MEASURES: The primary outcomes were number of falls and injuries, treatment hours and cost. RESULTS: In the nursing home setting, a baseline scenario was calculated with 1471 falls incidents resulting in 345 injuries per year. The mean cost of injury related treatment and care was calculated 860 thousand euro per year and €4.63 million in five years. Implementing multifactorial intervention over five years, costing 702 thousand euro, resulted in savings in health care costs of €2.0 million, of which €1.6 million was saved in nursing home injury care. The benefits outweighed the costs: each euro invested was compensated by 2.86 euro benefit in total care, 2.31 benefit in nursing home care. Yearly 3050 nursing hours, 3100 paramedical care hours and 760 h of physician care were saved. CONCLUSION AND IMPLICATIONS: Implementation of customized multifactorial interventions provided by multidisciplinary teams is cost-beneficial in reduction of falls in nursing homes. The CBA model gives valuable information about the advantageous consequences (i.e. health benefits, financial benefits and reduced workload of staff) of falls prevention in nursing homes and can provide guidance to the management in structural implementation of multifactorial falls prevention.

Cost-effectiveness and quality-of-life analysis of physician-staffed helicopter emergency medical services.

BACKGROUND: The long-term health outcomes and costs of helicopter emergency medical services (HEMS) assistance remain uncertain. The aim of this study was to investigate the cost-effectiveness of HEMS assistance compared with emergency medical services (EMS). METHODS: A prospective cohort study was performed at a level I trauma centre. Quality-of-life measurements were obtained at 2 years after trauma, using the EuroQol-Five Dimensions (EQ-5D) as generic measure to determine health status. Health outcomes and costs were combined into costs per quality-adjusted life year (QALY). RESULTS: The study population receiving HEMS assistance was more severely injured than that receiving EMS assistance only. Over the 4-year study interval, HEMS assistance saved a total of 29 additional lives. No statistically significant differences in quality of life were found between assistance with HEMS or with EMS. Two years after trauma the mean EQ-5D utility score was 0.70 versus 0.71 respectively. The incremental cost-effectiveness ratio for HEMS versus EMS was 28,327 Euro per QALY. The sensitivity analysis showed a cost-effectiveness ratio between 16,000 and 62,000 Euro. CONCLUSION: In the Netherlands, the costs of HEMS assistance per QALY remain below the acceptance threshold. HEMS should therefore be considered as cost effective.

Alternative approaches to derive disability weights in injuries: do they make a difference?

BACKGROUND: In burden of disease studies, several approaches are used to assess disability weights, a scaling factor necessary to compute years lived with disability (YLD). The aim of this study was to quantify disability weights for injury consequences with two competing approaches, (a) standard QALY/DALY model (SQM) which derives disability weights from patient survey data and (b) the annual profile model (APM) which derives weights for the same patient data valued by a panel. METHODS: Disability weights were assessed using (a) EQ-5D data from a postal survey among 8,564 injury patients 2(1/2), 5, and 9 months after attending the Emergency Department, and (b) preferences of 143 laymen elicited with the time trade-off method. RESULTS: Compared with APM, SQM disability weights were consistently higher. YLD calculated with SQM disability weights was more than three times higher compared with YLD calculated with APM disability weights, for mild injuries with short duration, this increase was six fold. CONCLUSIONS: The APM seems the preferred method in burden of injury studies that includes mild conditions with a rapid course, since the SQM approach might overestimate the impact of the latter. The APM, however, might underestimate the impact of injury consequences, especially in case of severe injuries.

[Homeless adults' most frequent cause of death is suicide or murder]. / Daklozen overlijden het vaakst door suïcide of moord.

OBJECTIVE: Get insight into excess mortality in the Rotterdam homeless population according to cause of death and changes in this mortality after introduction of social policies in Rotterdam, the Netherlands, in 2006. DESIGN: Uncontrolled before-and-after study. METHOD: We included homeless adults who visited the Rotterdam shelter in 2001 and followed them for 10 years (2001-2010). We then linked the data of this cohort to Statistics Netherlands mortality figures. We calculated the shares of specific mortality causes in total mortality for the entire study period. We used the 'standardised mortality ratio' (SMR) to compare mortality in the homeless cohort of this period with mortality figures of the general Rotterdam population. In order to be able to compare the homeless death rates according to cause of death in the period before (2001-2005) and after introduction of social policy measures (2006-2010), the hazard ratio (HR) was calculated. RESULTS: Our cohort consisted of 2130 homeless persons with a mean age of 40.3 years. The most important causes of death were unnatural death (26%; 95% CI: 21-32), cardiovascular diseases (22%; 17-27) and cancer (17%; 13-22). Suicide and murder together were responsible for 50% of the unnatural deaths. The largest differences in mortality in comparison with the Rotterdam population were those for unnatural death (SMR: 14.8; 95% CI: 11.5-18.7), infectious diseases (SMR: 10.0; 5.2-17.5) and psychiatric conditions (SMR: 7.7; 4.0-13.5). Mortality due to suicide or murder was significantly different for both study periods (HR: 0.45; 0.20-0.97). CONCLUSION: Prevention of unnatural deaths among the homeless should be one of the priorities in homeless policy. Improvement of their living conditions may reduce the number of murders and suicides in this vulnerable group.

[Injuries resulting from accidents and violence in the Netherlands; results of an Emergency Department register]. / Letsels door ongevallen en geweld in Nederland.

- Injuries from accidents and violence are amongst the most important public health issues in the world, including in Europe and the Netherlands.- Using the Dutch Injury Surveillance System and the Dutch Burden of Injury Model, we describe the incidence and costs associated with injuries in the Netherlands that are registered via Emergency Departments (ED). We also map the main causes of injury by age category.- Annually, 700,000 patients attend the ED of a hospital with an injury; 1 in 6 attendees is admitted.- The societal costs of these injuries totals 3.2 billion euro per year. These costs consist of direct care-related costs and indirect costs through work absence.- Private injuries contribute to more than half of the number of casualties. Injuries occur relatively more often in children and the elderly.- The key underlying causes differ per age category. Common causes in all ages are cycling accidents, falls from heights, and other fall-related incidents.- The government should continue to deliver the public health interventions for prevention of fall injuries and cycling accidents.

[The effects of severe and very severe injuries]. / Gevolgen van ernstige en zeer ernstige letsels.

- The effects of severe injuries can be charted using the International Classification of Functioning, Disability and Health (ICF) model and the burden of disease model, in which the burden of disease is expressed in 'disability-adjusted life years' (DALYs). - Severe accidents cause 10 DALYs per 1000 people, which is comparable with the burden of disease of mood disorders and lung cancer.- In the Netherlands, severe injury victims are often males aged < 40 years, who are often injured in road traffic accidents. - The average hospital stay after a severe injury is one month, after which almost 75% of the patients are discharged home, while one quarter subsequently stay in rehabilitation facilities for 3-6 months. More than half return to their original employment. - Patients with thoracic and abdominal injuries recover relatively well, whereas injuries of the lower extremities, brain and spinal cord give a relatively poor prognosis. Comorbidity increases the chance of a less good recovery. Older people who survive an accident recover relatively well.

Injury mortality among ethnic minority groups in the Netherlands.

OBJECTIVES: To prepare a comprehensive overview of ethnic differences in injury related mortality in the Netherlands and to determine the role of area income and urbanisation degree. METHODS: Data for the period 1995-2000 were obtained from the population and cause of death registries. Injury related death rates were compared for persons from Turkish, Moroccans, Surinamese, and Antillean/Aruban origin with rates for the native Dutch population. RESULTS: Compared with the native Dutch population, all ethnic minorities combined had an increased mortality for all injuries together (RR = 1.29). Ethnic minorities experienced a significantly higher risk of death from pedestrian accidents (RR = 1.87), drowning (RR = 2.58), poisoning (RR = 1.76), fire and scalds (RR = 1.95), and homicide (RR = 3.24). Mortality for cyclists (RR = 0.53) and motorcycle drivers (RR = 0.47) was significantly lower among ethnic minorities compared with the native Dutch. Adjustment for area income and urbanisation decreased the mortality risk difference for most of the non-traffic injuries, but showed a difference in risk for car driver and passenger accidents (RR = 1.37). Compared with the native Dutch inhabitants, Surinamese and Antillean/Aruban population had a higher risk of total injury mortality (RR = 1.33 and 1.53 respectively), while Turkish and Moroccans had increased risk only for selected conditions. Inequalities in injury mortality were the highest among children and young adults, but persisted in the age group above 50 years old. CONCLUSION: Ethnic differences in injury mortality in the Netherlands strongly depended on type of injury, ethnic group, sex, and age. Policies should be aimed at the prevention of high risk injuries among the most vulnerable ages and ethnic groups.

Functional outcome after burns: a review.

We conducted a Medline search (1966-11/2003) on empirical studies into the consequences of burns. The International Classification of Functioning, disabilities and health (ICF) was used to classify dimensions of functional outcome. We included 50 studies, reporting a wide spectrum of ICF-dimensions. The current state of knowledge on the functional outcome after burns was hard to summarise, due to the wide variety in study designs and outcome assessment methods. Some indications on the major functional problems after burns were gained. Problems in mental function were described in subgroups of patients, both in children/adolescents and adults. Restrictions in range of motion were observed in about one-fifth of burn patients, even 5 years after injury. Problems with appearance were reported often (up to 43%), even in patients with minor burns (14%). Problems with work were reported in 21-50% of the adult patients, with permanent incapacity for work in 1-5%. None of the publications gave sufficient information to fully estimate the functional consequences of burns. We recommend the development of a standard core set for measurement and reporting of functional outcome after burns.

Reliability and validity of the Health Outcomes Burn Questionnaire for infants and children in The Netherlands.

The Health Outcomes Burn Questionnaire (HOBQ) is a self-administered questionnaire to monitor outcome after burns in young children. This study aimed to assess feasibility, reliability and validity of the Dutch version of the HOBQ. The HOBQ was adapted into Dutch and tested in a population of children aged 0-4 years with a primary admission to a Dutch burn centre in March 2001-February 2004. Parents of 413 children were sent a questionnaire. To assess validity, a generic outcome instrument was included, the Infant Toddler Quality of Life Questionnaire (ITQOL). The response rate was 50.0% (n=196). Mean self-reported completion time was 16.7 min. The internal consistency of all the HOBQ-scales was good (Cronbach's alpha's>0.69). Test-retest results showed no differences in 7 out of 10 scales. High correlations between HOBQ-scales and conceptually equivalent ITQOL and scales were found in 5 out of 7 comparisons. The majority of the HOBQ-scales (7 out of 10) showed significant differences in the expected direction between children with a long versus short length of stay. Our data support the reliability and validity of the Dutch HOBQ. The HOBQ can be used as a research tool, to monitor functional outcome after burns in young children. Further research in other samples is recommend to fully establish the reliability and validity of the HOBQ.