Predictive validity of short term scar quality on final burn scar outcome using the Patient and Observer Scar Assessment Scale in patients with minor to moderate burn severity.

BACKGROUND: The aim of this study was to assess the predictive validity of the Patient and Observer Assessment Scale (POSAS), in order to determine whether it can be used to predict final scar quality. METHODS: Patients with a maximum TBSA burned of 20% who were treated in a Dutch burn center and participated in two scar assessments at 3 months and >18 months post-burn were included. Scar quality assessment consisted of the POSAS, Dermaspectrometer® (color) and Cutometer® (elasticity). Predictive validity was determined in three ways: (1) the discriminative ability to distinguish good from reduced long term scar quality, (2) correlations between POSAS items score at the two subsequent assessments and (3) linear regression was conducted to identify POSAS items as independent predictors. Additionally, reliability, construct validity and interpretability were assessed. RESULTS: A total of 141 patients were included with a mean TBSA burned of 5.2% (±4.5). The ability of the Patient scale to discriminate between good and reduced long term scar quality was adequate with an area under the curve (AUC) of 0.728 (CI 0.640-0.804), the ability of the Observer scale was good with an AUC of 0.854 (CI 0.781-0.911). Correlations between items scored T3 and T>18 were at least adequate. On item level, pain and stiffness (Patient) and pliability and relief (Observer) were identified as significant predictors for reduced long term scar quality. The POSAS was reliable, construct validity was adequate at three months but declined at >18 months. CONCLUSION: This study found that final scar quality can be adequately predicted by an early POSAS assessment at three months.

Return to work after specialised burn care: A two-year prospective follow-up study of the prevalence, predictors and related costs.

BACKGROUND: Burn injuries may cause long-term disability and work absence, and therefore result in high healthcare and productivity costs. Up to now, detailed information on return to work (RTW) and productivity costs after burns is lacking. AIMS: The aim of this study was to accurately assess RTW after burn injuries, to identify predictors of absenteeism and to calculate healthcare and productivity costs from a societal perspective. METHODS: A prospective cohort study was conducted in the burn centre of Rotterdam, the Netherlands, including all admitted working-age patients from 1 August 2011 to 31 July 2012. At 3, 12 and 24 months post-burn, patients were sent a questionnaire: including the Work and Medical Consumption questionnaire for the assessment of work absence and medical consumption and the EQ-5D-3L plus a cognitive dimension to assess post-burn and pre-burn quality of life (QOL). Cost analyses were from a societal perspective according the micro-costing method and the friction cost method was applied for the calculation of productivity loss. Univariate logistic regression was used to identify predictors of absenteeism at three months. RESULTS: A total of 104 patients were included in the study with a mean total body surface area (TBSA) burned of 8% (median 4%). 66 respondents were pre-employed, at 3 months 70% was back at work, at 12 months 92% and 8% had not returned to work at time of final follow-up at 24 months. Predictors of absenteeism at 3 months were: TBSA, length of stay, ICU-admission and surgery. Mean costs related to loss in productivity were €11.916 [95% CI 8.930-14.902] and accounted for 30% of total costs in pre-employed respondents in the first two years. CONCLUSION: This two-year follow-up study demonstrates that burn injuries cause substantial and prolonged productivity loss amongst burn survivors with mixed burn severity. This absenteeism contributes to already high societal costs of burn injuries. Predictors of absenteeism found in this study were primarily fixed patient and treatment related factors, future studies should focus on modifiable factors, in order to improve RTW outcomes. Also, more attention in the rehabilitation trajectory is needed to optimally support RTW in burn survivors.

Epidemiology and costs of patients with toxic epidermal necrolysis: a 27-year retrospective study.

BACKGROUND: Recently, the importance of reporting the results and principles of management in Toxic epidermal necrolysis (TEN) patients was underscored. Treatment of TEN focuses on supportive care, often provided in a burn centre setting. Mortality in TEN patients can be high; the SCORTEN score is a scoring system that predicts mortality in patients with TEN. The predictive value of the SCORTEN score in our setting is unclear, as are the treatment costs of TEN patients. OBJECTIVE: To describe patient characteristics, treatment, outcome and direct medical costs of patients with TEN treated in one Dutch burn centre in a 27-year period. In addition, determinants of mortality and the predictive value of the SCORTEN score were assessed. METHODS: A retrospective study was conducted in all patients with TEN (including Stevens-Johnson syndrome (SJS) and overlap SJS-TEN) admitted to the burn centre Rotterdam between January 1987 and December 2013. The discriminative value of the SCORTEN score was assessed by receiver-operator characteristics curve analysis. RESULTS: A total of 63 patients were admitted in 27-year period. Overall mortality was 39.7%, mortality in TEN patients (>30%TBSA) was 37.1%. A higher age (OR = 1.04, 95%CI: 1.02-1.07) and comorbidity (OR = 4.25, 95%CI: 1.2-14.7) were associated with mortality. The discriminative value of the SCORTEN prediction model in our population was limited (AUC=0.72, 95%CI: 0.57-0.86). The mean direct medical hospital-based costs was €41.361. CONCLUSION: Toxic epidermal necrolysis is a severe adverse drug reaction, with a high mortality. Elderly patients and patients with comorbidity, especially circulatory comorbidity, have a relatively high risk of decease. The SCORTEN score, a frequently used prediction model in patients with TEN, underestimated the mortality in our study, mainly due to limited availability in patients with a good prognosis. The treatment of patient with TEN is associated with high direct medical hospital-based costs, also compared to burn patients in general.

[Determining burn depth: clinical assessment and laser Doppler imaging]. / Bepaling van brandwondendiepte: klinische inschatting en laser-doppler-imaging.

Early accurate determination of burn depth is important to determine the optimal treatment of burns. The method most used to determine burn depth is clinical assessment. This is a cheap method, but not the most accurate. Laser Doppler imaging (LDI) is a technique with which a more accurate (>95%) estimate of burn depth can be made by measuring the dermal perfusion. It is hypothesised that the introduction of LDI will lead to quicker decisions as to whether or not to operate, possibly leading to a shorter length of hospital stay and lower medical costs. To test this hypothesis, a multicentre randomized controlled trial is presently being conducted in the Dutch burn centres.