Physical morbidity after burns: A cross-sectional analysis of chronic sequelae and patient-reported outcomes from the Burn Model System National Database.

Abstract

Burn injury is increasingly recognized as a chronic condition, yet healthcare systems and payors rarely allocate resources for long-term sequelae. While functional and psychosocial outcomes are well studied, persistent physical morbidities remain underappreciated. A clearer understanding of these complications and their impact on survivorship is critical for guiding follow-up care and resource allocation. Accordingly, this study aimed to characterize long-term morbidity among adult burn survivors and evaluate how chronic complications influence patient-reported outcomes. Data were obtained from a large multi-institutional database. Adults (≥18 years) with burns sustained during or after 2015 who had both review-of-systems (ROS) data and PROMIS outcomes at 12 months were included. Descriptive statistics summarized demographics and morbidity prevalence. Multivariable linear regression models assessed associations between chronic conditions (composite ROS variable) and PROMIS outcomes, adjusting for demographics, injury characteristics, insurance, and site. Of 1765 eligible participants, 705 met inclusion criteria. The cohort was 68% male and 79% White, with mean age 47.5 years and median TBSA 10%. At 12 months, chronic sequelae were common: neuropathic symptoms (65%), joint pain (41%), memory difficulty (27%), cold intolerance (32%), and vision problems (16%). Non-responder analysis demonstrated that participants with complete data were significantly older, had larger burns (%TBSA), and longer hospital stays than those without complete data (all p < 0.05), with no differences by sex or race. In this subset of participants with complete 12-month data, chronic conditions were significantly associated with worse outcomes, including lower physical function (β = -5.37, p < 0.001) and social participation (β = -6.18, p < 0.001), and greater anxiety, depression, fatigue, sleep disturbance, and pain interference (all p < 0.001). Burn survivors experience a high burden of chronic morbidity that impairs long-term quality of life, underscoring the need for sustained, multidisciplinary survivorship care.