26 Oct 2016

Female burns patients fare badly after discharge

Female burns victims have poorer quality
of life than their male counterparts.
Photo: Sunday Night 7 News
by Anne Crawford

Monash University and Alfred Hospital researchers have called for measures to urgently improve the long-term care of female burns patients after a study showed they experienced significantly reduced quality of life compared to men after burn injury.

The study was conducted by School of Public Health and Preventive Medicine student Dr Jason Wasiak as part of his PhD, supervised by Professor Belinda Gabbe, who heads a unit in the Department of Epidemiology and Preventive Medicine. It showed that women who had suffered moderate to severe burns fared worse psychologically and in a range of health-related measures compared to their male counterparts.

Head of the Alfred’s Victorian Adult Burns Service, Miss Heather Cleland, who oversaw the study, said previous research focussing on gender differences in burn morbidity and mortality during intensive care treatment – the Burns Evaluation And Mortality Study (BEAMS) – found women had more than double the risk of death compared with men.

However, little data existed to show how women patients who survived coped in the long-term.

“This paper was really an attempt to delineate what the trajectory of recovery was and what happened to people after they were discharged as we don’t have a very good handle on this,” Miss Cleland said.

“Information gathering is very important so we know how to best deliver acute treatment as well as longer-term secondary treatments and rehabilitation.”

Patients with more serious burns often undergo many acute and reconstructive surgeries after their injury and participate in rehabilitation involving medical, nursing and allied health professionals. Surgical and non-surgical burn care interventions can extend many months and sometimes years beyond the acute care phase.

The development of sophisticated trauma care, and high survival rates, has made the focus on mapping the long-term health of survivors more pressing.

The research, part of a suite of studies looking at both acute and long-term outcomes, involved testing and interviewing 114 adults who received treatment through the Victorian Adult Burns Service at three, six and 12 months after injury. It measured generic health status, burns-specific health, psychological distress and alcohol use.

At 12 months after injury, female patients showed greater impairments in generic health status and burn-specific health-related quality of life (HRQoL), as well as greater psychological distress than their male counterparts.

They experienced a greater decline in their mental health from pre-injury levels, which persisted at 12 months post-burn injury. They had greater difficulty with aspects of body image, interpersonal functioning and heat sensitivity. In contrast, male patients mostly returned to their pre-burn levels of physical and mental health at 12 months.

Miss Cleland said researchers could only speculate as to the reasons why women experienced these setbacks.

The study concluded that more research was needed to investigate the biological, psychological and social factors that contributed to the gender difference.

Miss Cleland said it suggested that improved monitoring of patients was needed to make sure they had stabilised and that nothing was being missed in the post-discharge phase.

“Understanding the risks involved in the trajectory of recovery, and when certain problems may start to arise can help you make appropriate targeted intervention post-discharge,” she said. “It can help us advocate for our patients for specific support in the environment where there is a limited number of resources.”

For example, about half the patients seen by the statewide burns unit are from outside metropolitan Melbourne, producing challenges for patients from the country accessing appropriate follow-up health care and stress involved in coming to Melbourne for clinical appointments. Better ways of delivering services to these patients such as telemedicine, could be used, she said.

Wasiak J, Lee SJ, Paul E, Shen A, Tan H, Cleland H, Gabbe B. Female patients display poorer burn-specific quality of life 12 months after a burn injury. Injury. 2016 Jul 21. pii: S0020-1383(16)30328-X. doi: 10.1016/j.injury.2016.07.032. [Epub ahead of print]

Moore EC, Pilcher D, Bailey M, Cleland H. Women are more than twice as likely to die from burns as men in Australia and New Zealand: an unexpected finding of the Burns Evaluation And Mortality (BEAM) Study. J Crit Care. 2014 Aug;29(4):594-8. doi: 10.1016/j.jcrc.2014.03.021. Epub 2014 Apr 2.


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