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Objective: Insufficient nutritional intake can impair wound healing and increase the risk of complications post burn. The overall aim of this thesis was to examine nutritional therapy post burn in relation to the extent of the burn. This was accomplished by examining adherence to nutritional guidelines (Study I), documented interventions and barriers (Study II), and symptoms affecting appetite and eating post injury (Study III-IV).

Methods: Study I evaluated documented nutritional therapy in relation to guidelines during first 12 days post burn by conducting medical record review. Study II explored differences in documentation of nutritional interventions and barriers between patients post-minor and major burn by performing medical record review and content analysis. Study III modified questionnaires Disease Related Appetite Questionnaire (DRAQ) and Eating Symptom Questionnaire (ESQ) to measure nutrition impact symptoms (NIS) 6-12 months post burn by undertaken expert panel review, cognitive interviews and expert consultation on terminology. Study IV investigated the differences in prevalence of NIS using questionnaires DRAQ-burn and ESQ-burn.

Results: Study I found low adherence to nutritional guidelines and low adequacy of intake compared to individual goals, particularly after minor burns. Study II showed that interventions targeting meal and meal support were rarely documented compared to medical nutritional therapy, despite most patients having oral intake. Barriers to nutritional therapy were common with fasting and gastrointestinal symptoms being the most frequently documented. Significantly more interventions and barriers were documented for patients post-major burn compared to post-minor burn. In Study III high expert consensus on the adapted questionnaires DRAQ-burn and ESQ-burn was achieved. Study IV revealed prevalences of median 1-2 NIS at 6 months that persisted up to 12 months post injury. There was no difference in the prevalence of NIS post-minor compared to post-major burn.

Conclusions: The overall low adherence to nutritional guidelines, inadequate achievement of individual intake goals, the frequent documentation of barriers to nutritional interventions, and the persistent prevalence of nutrition impact symptoms indicate a risk of insufficient nutritional therapy following burn. The findings highlight the need for continuous nutritional assessment, evaluation and monitoring of nutritional therapy throughout the burn care trajectory regardless of burn extent.