BURN-OP: A screening tool for identifying a symptomatically distinct cluster of burn patients with the greatest healthcare needs at discharge

Sarthak Sinha; Caleb Small; Eddie Guo; Myriam Verly; Rohit Arora; Aydin Herik; Eva Lindell Jonsson; A Robertson Harrop; Jeff Biernaskie; Claire Temple-Oberle; Vincent Gabriel

doi:10.1016/j.burns.2024.08.024

BURN-OP: A screening tool for identifying a symptomatically distinct cluster of burn patients with the greatest healthcare needs at discharge

Burns. 2024 Sep 2;51(1):107258. doi: 10.1016/j.burns.2024.08.024. Online ahead of print.

Authors

Affiliations

¹ Leaders in Medicine Program, Cumming School of Medicine, University of Calgary, Canada; Faculty of Veterinary Medicine, University of Calgary, Canada; Department of Clinical Neurosciences, University of Calgary, Canada.
² Faculty of Veterinary Medicine, University of Calgary, Canada.
³ Department of Clinical Neurosciences, University of Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
⁴ Section of Plastic and Reconstructive Surgery, University of Calgary, Canada; Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada.
⁵ Section of Plastic and Reconstructive Surgery, University of Calgary, Canada; Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada; Section of Pediatric Surgery, Alberta Children's Hospital, Calgary, Alberta, Canada.
⁶ Faculty of Veterinary Medicine, University of Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.
⁷ Department of Clinical Neurosciences, University of Calgary, Canada; Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada; Calgary Firefighters' Burn Treatment Centre, Calgary, Canada; McCaig Institute of Bone and Joint Health, University of Calgary, Canada. Electronic address: [email protected].

PMID: 39522136
DOI: 10.1016/j.burns.2024.08.024

Abstract

Objective: To identify burn patients needing intensive rehabilitation based on discharge symptoms.

Methods: We conducted a retrospective analysis of 1049 adult burn patients recruited to the Burn Injury Model System National Database. Using unsupervised hierarchical clustering, we identified three distinct patient clusters based on discharge symptoms and compared their clinical and demographic profiles, long-term rehabilitative needs, and self-reported quality of life. We also developed a weighted BUrn Rehabilitative Needs - OutPatient (BURN-OP) to prospectively identify patients with highest rehabilitative needs.

Results: Three burn patient clusters were identified: Cluster 1 with low, Cluster 2 with moderate, and Cluster 3 with high symptom burdens. Cluster 3, comprising 6 % of discharged patients, had notably longer hospital stays, older age at burn, larger total body surface area (TBSA), increased days on ventilator, a higher number of surgical procedures, concomitant inhalation injury, and higher weight loss from admission to discharge. Cluster 3 patients preferentially utilized a wide spectrum of rehabilitative services (including physiotherapy, occupational therapy, speech-language pathology, social work, psychologic services, vocational services) extending up to 2 years post-discharge. Their self-reported health outcomes were worse, with greater limitations in work/activity and elevated pain interference persisting 5-years post-discharge. BURN-OP demonstrated high specificity (98.99 %) and accuracy (96.19 %, ROC AUC: 0.93) in identifying Cluster 3 patients at discharge.

Conclusions: We identify distinct burn patient clusters based on discharge symptoms, with Cluster 3 exhibiting the highest post-discharge healthcare needs. BURN-OP (https://burn-op.streamlit.app/) identifies high-risk patients, offering a tool for prioritizing interventions and designing trials that mitigate risk of Cluster 3 membership.

Keywords: BURN-OP; Burn Discharge Planning; Burn Injury Model System National Database; Post-Discharge Rehabilitation; Quality of life post-discharge.