Karen Kowalske

The global demographic shift toward an aging population is transforming burn care, yet the “oldest old” (adults ≥80 years) remain poorly understood. Standard geriatric guidelines are not specific to this subgroup, a group exhibiting unique physiological needs and vulnerabilities. We conducted a retrospective analysis of the Burn Model System (BMS) National Database for adults aged 80 years or older (N=104).1 Physical Function, Ability to Participate in Social Roles, and Pain Interference were assessed at 6 and 12 months post-burn and compared to pre-burn and US population norm (aged ≥75 years) data. Despite sustaining moderate injuries (Mean TBSA: 11.7%), our cohort required prolonged hospitalization (Mean: 26.9 days). We identified a functional recovery paradox: while Physical Function scores were low (40.1) at 12 months, Social Roles scores were average (50.0 at 6 months and 51.9 at 12 months). Notably, referral to inpatient rehabilitation (IPR) was highly variable (8.6% to 42.1%) and correlated strongly with social support; patients living alone were three times less likely to receive IPR than those with co-habitants (17.7% vs 61.7%). In conclusion, burn survivors aged 80 years and older face persistent reduction in physical function but demonstrate resilience in maintaining social roles, suggesting that slow physical recovery does not preclude quality of life. Prolonged acute hospitalizations and variable IPR access highlight the need for geriatric-specific guidelines to address the unique physiological, social, and systemic barriers that challenge the "oldest old."

Introduction: While pain and pruritus are well-established sequelae of burn injury, their downstream impact on pediatric burn survivors is poorly characterized. This project addresses this gap by evaluating associations of pain and pruritus with functional and psychosocial symptoms at 12 months post-injury in pediatric burn survivors. Methods: Using a multicenter longitudinal database (injured between 2014 and 2024), this retrospective review identified pediatric burn survivors aged 8-17 years who completed a self-reported survey assessing pain and pruritus at 12-months post-injury. Patient-Reported Outcomes Measurement Information System domains included pain intensity, pruritus, physical function, anxiety, depression, and fatigue. General linear models were fitted at the 12-month follow-up to evaluate independent associations between pain and pruritus scores and demographic, functional, and psychosocial variables. Results: The study included 67 pediatric burn survivors with a mean age of 11.8 ± 2.9 years. In multivariate regression models at 12 months post-injury, demographic and burn characteristics were not significant predictors of pain or pruritus. Both higher pain and itch were significantly associated with greater anxiety (P = .0109; P < .0001), depression (P = .0021; P = .0006), and fatigue (P = .0053; P = .0096); higher itch was additionally associated with worse physical function (P = .0396). Conclusions: This review shows that even 1 year after injury, pain and pruritus remain strongly associated with psychosocial distress, with pruritus additionally linked to impaired physical function. These findings highlight that pain and itch are interrelated drivers of impaired quality of life in children.

Adult burn survivors are at risk for developing anxiety and reduced health-related quality of life. The purpose of the study was to investigate predictors of anxiety at 1- and 2-years post-injury. Data from 266 patients were queried from the Burn Model System National Database between 2015 and 2020. Patient-reported outcomes at 1- and 2-years post-injury were analyzed using the Patient-Reported Outcomes Measurement Information System for anxiety severity, and the Mental Component Summary (MCS) and Physical Component Summary (PCS) for mental and physical health-related quality of life, respectively. Logistic models were computed to determine predictors of anxiety at 1- and 2-years post-injury. Results showed that at 1-year post-injury, burns to specific body regions and pre-existing diagnoses of mental health disorders predict high anxiety severity scores and low MCS scores, whereas burns at perineum area predict low PCS scores. At 2-years post-injury, younger age predicted low MCS scores, and burns to the leg area, older age, and pre-existing diagnosis of diabetes predict low PCS scores. Findings from this study showed that burns to visible areas, pre-existing mental health disorders, and younger age predict increased anxiety and lower mental health-related quality of life, whereas burns to the perineum and lower limbs, and older age predict lower physical health-related quality of life. Therefore, allocating mental and physical health-related resources to burn survivors based on burn area, age, and comorbidities is crucial for quality of life after burn injury.

Although survival after major burn injury is increasingly common, persistent psychosocial morbidity often remains prevalent, and the relationship between burn severity and long-term psychosocial recovery is less understood. We aimed to evaluate longitudinal trajectories of mental health and social recovery across large burn-size strata to examine whether injury severity differentially influences internal psychological outcomes vs external social participation. We conducted a retrospective, multicenter longitudinal analysis of adults with ≥ 20% total body surface area burns enrolled in the Burn Model System National Longitudinal Database, using outcome measures available across their respective collection periods. Participants were stratified by total body surface area groups of large (20%-49.9%), very large (50%-69.9%), or massive (≥70%). Outcomes included Patient-Reported Outcomes Measurement Information System domains of Depression, Anxiety, and Ability to Participate in Social Roles; Community Integration Questionnaire-Social Integration; and employment status assessed at 6-, 12-, and 24-month postinjury. Mixed-effects linear regression models adjusted for demographic and clinical covariables. Among 815 participants, depression and anxiety remained elevated relative to population norms, while social participation improved across all burn sizes longitudinally. Survivors with massive burns demonstrated the greatest improvement in mental health over 24 months, with changes reaching clinically meaningful magnitude, and their community integration at 24 months was comparatively preserved, coming closest to preinjury burn levels despite lower perceived social role ability and employment. These findings demonstrate that psychosocial recovery over the first 24 months does not worsen in proportion to injury severity, indicating that injury severity alone should not define prognosis. Rather, survival and rehabilitation after massive burn injury can translate into meaningful psychological adaptation and social integration that benefits from sustained, multidisciplinary follow-up across all burn severities.

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.

Advances in burn care have markedly improved survival after major injuries. However, survivors often experience significant physical and psychosocial sequelae. We aimed to characterize long-term health-related quality of life (HRQoL) among burn survivors to inform expected trajectories, rehabilitation needs, and common impairments. Adult burn survivors from a multicenter, longitudinal cohort study were stratified into 20.0%-49.9%, 50.0%-69.9%, and ≥70.0% total body surface area burn size groups. Patient-reported HRQoL and life satisfaction were assessed using validated outcome measures at discharge (pre-injury recall), 6, 12, 24 months, and 5 years post-injury. Standardized summary scores were derived using validated bridges. Mixed-effects linear regression models evaluated longitudinal changes and between-group differences. A total of 1113 participants were analyzed. All outcomes declined early after injury but improved progressively thereafter. Notably, by 24 months, mental-HRQoL and life satisfaction approached pre-injury levels across all burn size groups. Physical-HRQoL deficits were greater with increasing burn size, with significant net differences relative to the 20.0%-49.9% reference group (P < .0001). Mental-HRQoL and life satisfaction outcomes showed minimal between-group differences overall, though individuals with the largest burns exhibited significantly better relative mental-HRQoL at 24 months (P < .05). Although outcomes improve over time following major burn injury, persistent physical deficits support the classification of major burns as a chronic condition. These findings characterize burn size–specific recovery trajectories and demonstrate that, despite persistent physical deficits, mental health and life satisfaction can return to near pre-injury levels even after the most extensive injuries.

Despite improved safety standards, motor vehicle collisions remain a significant source of flame burn injury. The objective of this study is to characterize differences in demographics and outcomes between patients with burn injuries related to motor vehicle collisions and patients with flame burn injuries not involved in motor vehicle collisions. The analysis included participants enrolled in the Burn Model Systems from 2015 to 2023. Conveyance burn participants had more amputations than patients with non-conveyance burn injuries (15% vs 4.9%, P < .001), with an increase in lower extremity amputations (2.5% vs 0.7%, P = .027). In addition, conveyance burns involved a greater total body surface area (TBSA) (26% vs 23%, P < .034) and were associated with longer hospital stays (40 days vs 33 days, P < .006). Participants who sustained injuries during conveyance demonstrated significantly lower global physical health t-scores (42.3 vs 44.1, P = .037) and physical function t-scores (42.0 vs 46.1, P = .002) at 6 months postinjury compared with those with non-conveyance flame burns. In addition, conveyance burn participants reported significantly lower t-scores for their ability to participate in social roles at 6 months (48.8 vs 50.8, P = .044) and 12 months postinjury (49.9 vs 54.0, P = .015). This study highlights the significant impact of conveyance-related burn injuries, particularly with respect to higher amputation rates and poorer early physical outcomes, compared with non-conveyance flame burns. This supports the need for targeted preventive strategies, especially those focused on vehicle maintenance and safety among younger and underrepresented populations.

Introduction: There is growing awareness of the indirect trauma exposure experienced by healthcare providers and the resulting development of secondary traumatic stress (STS). However, STS in burn care clinicians has not been examined thoroughly. The current study aimed to examine feasibility of study procedures in this population, estimate the prevalence of STS, and examine the relationship between STS and additional factors. Material and Methods: Cross-sectional data were collected from 103 burn clinicians from 15 different occupations working in a large civilian burn center in the United States. Participants completed measures of STS, burnout, demographics, and occupation-related information. Results: Study procedures were feasible. Over 40% (42.16%) of participants met criteria for moderate to severe STS. Secondary traumatic stress was significantly correlated with younger age and burnout subscales. Binomial logistic regression analyses showed that the overall model containing burnout subscales was statistically significant and able to distinguish between respondents who endorsed symptoms consistent with post-traumatic stress disorder due to STS and those that did not endorse them. Results regarding STS and time spent with patients with burn injuries varied. Nonsignificant results were found regarding STS and the remaining demographic and occupational variables. Conclusions: Results support the feasibility of studying STS in this population, and the prevalence of STS among burn care clinicians warrants attention. Important information was added to the extant literature on related risk and protective factors. Increased knowledge about STS in this population will help to inform prevention efforts and interventions at both the individual and organizational level to prioritize staff well-being and improve patient care.

Childhood burn injuries can lead to physical and psychosocial challenges that linger well beyond the initial phases of the trauma. This study explores the interrelated roles of pain, body image, and physical function in children living with burn injuries using data from the Burn Model System National Longitudinal Database. A cohort of 110 children aged 8-17 was assessed 6 months postinjury. Descriptive and regression analyses revealed that, on average, pediatric burn survivors reported significantly lower pain interference compared with the general pediatric population. However, higher pain interference and number of surgical operations were negatively associated with physical function. Body image was not significantly associated with clinical variables, thus suggesting a more multifaceted nature of psychosocial recovery. These findings underscore the importance of comprehensive pain management and family-centered rehabilitation to foster resilience and enhance functional and emotional outcomes in pediatric burn survivors.