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Long-term outcome after burn: Pruritus, pain, personality and perceived health
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
2019 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

This thesis investigated the role of burn-specific and individual-related factors for long-term outcome after burn with emphasis on pruritus, pain, personality and perceived health.

Consecutive adult patients, admitted to the Uppsala University Burn Center between 2000 and 2009, were included. Patients were assessed during hospitalization, at 3, 6, 12 and 24 months and finally at 2-7 and 10-17 years post-burn.

Pruritus was prevalent in half of the patients 2-7 years post-burn. Of the patients with pruritus, half had severe pruritus, which was independently related to full thickness burn and health-related quality of life (HRQoL) at 3 months post-burn. One third scratched to the point of bleeding. Such scratching was independently related to full thickness burns and the personality trait Impulsiveness, but did not necessarily imply more severe pruritus. Results suggest that many patients lack adequate treatment.

 Pain was prevalent in one third of the patients 2-7 years post-burn. Severity levels generally decreased over time and was at follow-up mostly regarded as mild to moderate. Post-burn pain has a negative effect on HRQoL and at 3 months post-burn, HRQoL was independently related to the reporting of post-burn pain at 2-7 years.

Personality trait scores in burn patients deviated little from norm values. Personality traits remained largely stable the first year after burn injury, except for an increase in the trait Stress Susceptibility, which was scored lower during the acute care phase but normalized at 12 months post-burn.

In qualitative interviews 10-17 years post-burn, participants reported living a near normal life. The subscales of the burn-specific health scale brief were in general still applicable at this time point. Additional areas playing an important role for post-burn health and outcome were skin-related problems, morphine de-escalation, the importance of work, stress and avoidance, mentality and the healthcare system.

Certain subgroups of burn patients are more vulnerable and likely to develop post-burn sequalae and this is dependent on both burn severity and individual characteristics. In general, however, many former burn patients recover well in the long run.

Ort, förlag, år, upplaga, sidor
Uppsala: Acta Universitatis Upsaliensis, 2019. , s. 65
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1569
Nyckelord [en]
Burns, Pruritus, Pain, Personality, Quality of Life, Health Status, Wounds and injuries, Patient Reported Outcome Measures, Rehabilitation
Nationell ämneskategori
Medicin och hälsovetenskap
Forskningsämne
Psykiatri; Kirurgi
Identifikatorer
URN: urn:nbn:se:uu:diva-381618ISBN: 978-91-513-0643-8 (tryckt)OAI: oai:DiVA.org:uu-381618DiVA, id: diva2:1304281
Disputation
2019-06-05, Gunnesalen, Entrance 10, Akademiska sjukhuset, Uppsala, 13:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2019-05-15 Skapad: 2019-04-12 Senast uppdaterad: 2019-06-17
Delarbeten
1. Prevalence and prediction of prolonged pruritus after severe burns
Öppna denna publikation i ny flik eller fönster >>Prevalence and prediction of prolonged pruritus after severe burns
2015 (Engelska)Ingår i: Journal of Burn Care & Research, ISSN 1559-047X, E-ISSN 1559-0488, Vol. 36, nr 3, s. 405-413Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Years after injury, pruritus is a common and severe problem for many burn patients. However, its characteristics and consequences are often only partially described. The authors therefore performed a prospective detailed examination of burn- and individual-related factors and considered those in relation to pruritus severity. Sixty-seven consecutive burn patients were assessed during acute care, and at 3 and 12 months postburn regarding preburn psychiatric disorders, health-related quality of life, post traumatic stress disorder, and personality traits. Postburn pruritus was subsequently assessed 2 to 7 years postburn using the Questionnaire for Pruritus Assessment. Fifty-one individuals, 76% of the participants, reported burn pruritus any time after the burn. Thirty-three individuals, 49% of the participants, reported ongoing pruritus the last 2 months. Information on the characteristics of pruritus was obtained from 32 of these individuals. Most perceived pruritus as bothersome or annoying and as present every day, 16 (50 %) were considered to have severe pruritus, and 11 (34 %) scratched themselves to the point of bleeding. In logistic regressions, this was independently related to TBSA full-thickness burn and health-related quality of life at 3 months, and to TBSA full thickness burn and the personality trait impulsiveness, respectively. About half of the previous burn patients experienced ongoing pruritus on an average of 4.5 years after injury, and half of them had severe pruritus. Scratching oneself to the point of bleeding is linked both to a certain personality and to pruritus. It is suspected that many patients are left without access to the best available treatment.

Nationell ämneskategori
Dermatologi och venereologi Kirurgi
Identifikatorer
urn:nbn:se:uu:diva-244772 (URN)10.1097/BCR.0000000000000152 (DOI)000369707000022 ()25162945 (PubMedID)
Forskningsfinansiär
VetenskapsrådetForte, Forskningsrådet för hälsa, arbetsliv och välfärd
Tillgänglig från: 2015-02-20 Skapad: 2015-02-20 Senast uppdaterad: 2019-04-12Bibliografiskt granskad
2. Health-related quality of life (EQ-5D) early after injury predicts long-term pain after burn
Öppna denna publikation i ny flik eller fönster >>Health-related quality of life (EQ-5D) early after injury predicts long-term pain after burn
Visa övriga...
2016 (Engelska)Ingår i: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 42, nr 8, s. 1781-1788Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Chronic pain after burn can have severe physical and psychological effects on former patients years after the initial injury. Although the issue of pain after burn has gained increased attention over the past years, prospective, longitudinal studies are scarce. Our aim was to prospectively investigate consecutive burn patients for pain severity over time and to evaluate the prevalence and characteristics of post-burn pain to 2-7 years after the burn. As an additional aim, the effects of burn and individual-related factors, especially health related Quality of Life (HRQoL), were investigated.

Method: Sixty-seven consecutive burn patients were assessed during acute care at 3, 6, 12 and 24 months, as well as at 2-7 years post-burn. HRQoL, symptoms of post-traumatic stress disorder (PTSD) and other psychiatric disorders were investigated. During the interviews that took place 2-7 years after the injury (mean 4.6 1.9 years), current chronic post-burn pain was assessed using the Brief Pain Inventory-Short Form (BPI-SF).

Results: One-third of the patients still reported pain 2-7 years after the injury. Pain severity and interference with daily life were mainly mild to moderate though they were found to be associated with significantly lower HRQoL. Chronic pain after bum was associated with both burn- and individual-related factors. In logistic regression analysis HRQoL at 3 and 12 months and symptoms of PTSD at 12 months were independent factors in predicting chronic pain after burn.

Conclusion: Pain after burn becomes a chronic burden for many former burn patients and decreases HRQoL. A novel finding in this study was that HRQoL assessed early after burn was a predictor for the development of chronic pain. This finding may help to predict future pain problems and serve as an indicator for pain preventive measures.

Nyckelord
Burns, Pain, Brief Pain Inventory-Short Form, Health-related quality of life, Post-traumatic stress disorder
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
urn:nbn:se:uu:diva-314419 (URN)10.1016/j.burns.2016.05.016 (DOI)000391073900021 ()
Forskningsfinansiär
VetenskapsrådetForte, Forskningsrådet för hälsa, arbetsliv och välfärd
Tillgänglig från: 2017-02-06 Skapad: 2017-02-02 Senast uppdaterad: 2019-04-12Bibliografiskt granskad
3. Stability in personality after physical trauma
Öppna denna publikation i ny flik eller fönster >>Stability in personality after physical trauma
(Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
Abstract [en]

Background: Although personality traits are considered stable during adult life, the clinical impression is that some persons exposed to severe physical trauma report that they feel different than before the injury. Our aim was therefore to assess the extent of stability in personality in burn patients the first year after injury. 

Method: Eighty-four former burn patients, admitted to a national burn center, were assessed with the Swedish universities Scales of Personality (SSP) during acute care and at 12 months post-burn. Psychiatric disorders were assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I).  

Results: Burn patients scored lower on the trait Stress Susceptibility during the acute care and higher on the traits Somatic Trait AnxietyEmbittermentImpulsiveness and Social Desirability at 12 months post-burn, compared with norm values. While personality domain scores remained stable between acute care and 12 months post-burn, on the trait level there was an increase, and normalization, of Stress Susceptibility scores. 

Conclusion: Personality traits remained relatively stable the first year after trauma. The multidisciplinary burn care during hospitalization might exert a potential stress reducing effect. This effect may however fade with time and the long, stressful load after a physical trauma can have a persisting effect on an individual’s susceptibility to stress.

Nationell ämneskategori
Medicin och hälsovetenskap
Forskningsämne
Psykiatri
Identifikatorer
urn:nbn:se:uu:diva-381161 (URN)
Forskningsfinansiär
VetenskapsrådetStiftelsen Söderström - Königska sjukhemmetFredrik och Ingrid Thurings StiftelseVårdalstiftelsen
Tillgänglig från: 2019-04-04 Skapad: 2019-04-04 Senast uppdaterad: 2019-04-24
4. Patient perception of long-term burn-specific health and congruence with the Burn Specific Health Scale-Brief
Öppna denna publikation i ny flik eller fönster >>Patient perception of long-term burn-specific health and congruence with the Burn Specific Health Scale-Brief
(Engelska)Ingår i: Burns, ISSN 0305-4179, E-ISSN 1879-1409Artikel i tidskrift (Refereegranskat) In press
Abstract [en]

Introduction: This qualitative study aims to explore former burn patients’ perception of burn-specific health and investigate how these experiences correspond to the subscales in the Burn Specific Health Scale-Brief (BSHS-B).

Method: Respondents were former burn patients, admitted to the Uppsala Burn Centre between 2000 and 2007. A total of 20 respondents with a Total Body Surface Area (TBSA) of 20% or larger, were approached at 10 to 17 years post-burn and interviewed using a semi-structured guide. Data was analyzed using thematic analysis.

Results: Despite extensive burn injuries, respondents said they led a close-to-normal life. Their descriptions validated the significance of the existing themes of BSHS-B. Additional themes of importance for post-burn health were skin related problems, morphine de-escalation, the importance of work, stress and avoidance, mentality and the healthcare system.

Conclusion: The BSHS-B alone may not be sufficient in providing a comprehensive picture of former burn patients’ self-perceived health in the long-term perspective. Investigating supplementary areas reflecting former patients’ sociocultural and attitudinal environment, as well as personal factors, may be of great importance. 

Nyckelord
Health Related Quality of Life, Burn Specific Health Scale-Brief (BSHS-B), Qualitative analysis, Burns
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
urn:nbn:se:uu:diva-380413 (URN)
Forskningsfinansiär
VetenskapsrådetForte, Forskningsrådet för hälsa, arbetsliv och välfärd
Tillgänglig från: 2019-03-28 Skapad: 2019-03-28 Senast uppdaterad: 2019-04-12

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