Premorbid Mobility Impairments Increase Likelihood of Shelter Discharge After Burn Hospitalization: A Burn Model System Database Study

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Abstract
Burn injuries are functionally limiting, and premorbid mobility impairments may further complicate recovery. Premorbid mobility impairments are associated with worse outcomes in other populations; however, their role in burn recovery remains unclear. This retrospective cohort study included adult burn survivors injured from 2014 to 2025 extracted from the Burn Model System National Burn Database. Premorbid mobility impairment was defined as self-reported preburn physical problems or impairments affecting mobility (difficulty moving the arms, legs, or body). Outcomes included length of stay, discharge disposition, and PROMIS Global Mental Health scores at 6- and 12-month follow-ups postinjury. All regression models were adjusted for age, TBSA, and inhalation injury. The model for Global Mental Health scores additionally adjusted for discharge location, Global Physical Health, preinjury Global Mental Health, and follow-up time. A total of 1372 adult burn survivors were included, with a mean age of 46.2 years. Premorbid mobility impairment was associated with longer hospital stay (incidence rate ratio 1.15; 95% CI, 1.04-1.27; P = .006) and discharge to a shelter (odds ratio 1.75; 95% CI, 1.41-2.19; P < .001). There was also a trend toward lower PROMIS Mental Health scores among survivors with premorbid mobility impairments (β = −1.92, P = .091). Premorbid mobility impairment is associated with poorer burn outcomes, including longer hospital stay and discharge to unstable settings such as shelters, and may also be linked to poorer mental health outcomes. It remains unclear whether shelter discharge reflects premorbid housing instability or a new postburn disposition.
Funding Information
  • National Institute on Disability, Independent Living, and Rehabilitation Research (90DPBU0007)
  • National Institute on Disability, Independent Living, and Rehabilitation Research (90DPBU0008)
  • Administration for Community Living
  • U.S. Department of Health and Human Services

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