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For deep partial-thickness burns no consensus on the optimal treatment has been reached due to conflicting study outcomes with low quality evidence. Treatment options in high- and middle-income countries include conservative treatment with delayed excision and grafting if needed; and early excision and grafting. The majority of timing of surgery studies focus on survival rather than on quality of life. This study protocol describes a study that aims to compare long-term scar quality, clinical outcomes, and patient-reported outcomes between the treatment options. A multicentre prospective study will be conducted in the three Dutch burn centres (Rotterdam, Beverwijk, and Groningen). All adult patients with acute deep-partial thickness burns, based on healing potential with Laser Doppler Imaging, are eligible for inclusion. During a nine-month baseline period, standard practice will be monitored. This includes conservative treatment with dressings and topical agents, and excision and grafting of residual defects if needed 14-21 days post-burn. The subsequent nine months, early surgery is advocated, involving excision and grafting in the first week to ten days post-burn. The primary outcome compared between the two groups is long-term scar quality assessed by the Patient and Observer Scar Assessment Scale 3.0 twelve months after discharge. Secondary outcomes include clinical outcomes and patient-reported outcomes like quality of life and return to work. The aim of the study is to assess long-term scar quality in deep partial-thickness burns after conservative treatment with delayed excision and grafting if needed, compared to early excision and grafting. Adding to the ongoing debate on the optimal treatment of these burns. The broad range of studied outcomes will be used for the development of a decision aid for deep partial-thickness burns, to fully inform patients at the point of consent to surgery and support optimal person-centred care.

Background: The population of elderly patients with burn injuries is growing. Insight into long-term mortality rates of elderly after burn injury and predictors affecting outcome is limited. This study aimed to provide this information. Methods: A multicentre observational retrospective cohort study was conducted in all three Dutch burn centres. Patients aged ≥65 years, admitted with burn injuries between 2009 and 2018, were included. Data were retrieved from electronic patient records and the Dutch Burn Repository R3. Mortality rates and standardized mortality ratios (SMRs) were calculated. Multivariable logistic regression was used to assess predictors for in-hospital mortality and mortality after discharge at 1 year and five-year. Survival analysis was used to assess predictors of five-year mortality. Results: In total, 682/771 admitted patients were discharged. One-year and five-year mortality rates were 8.1 and 23.4%. The SMRs were 1.9(95%CI 1.5–2.5) and 1.4(95%CI 1.2–1.6), respectively. The SMRs were highest in patients aged 75–80 years at 1 year (SMRs 2.7, 95%CI 1.82–3.87) and five-year in patients aged 65–74 years (SMRs 10.1, 95%CI 7.7–13.0). Independent predictors for mortality at 1 year after discharge were higher age (OR 1.1, 95%CI 1.0–1.1), severe comorbidity, (ASA-score ≥ 3) (OR 4.8, 95%CI 2.3–9.7), and a non-home discharge location (OR 2.0, 95%CI 1.1–3.8). The relative risk of dying up to five-year was increased by age (HR 1.1, 95%CI 1.0–1.1), severe comorbidity (HR 2.3, 95%CI 1.6–3.5), and non-home discharge location (HR 2.1, 95%CI 1.4–3.2). Conclusion: Long-term mortality until five-year after burn injury was higher than the age and sex-matched general Dutch population, and predicted by higher age, severe comorbidity, and a non-home discharge destination. Next to pre-injury characteristics, potential long-lasting systemic consequences on biological mechanisms following burn injuries probably play a role in increased mortality. Decreased health sta

The EQ-5D is increasingly used to assess the health-related quality of life (HRQL) of adult patients with intermediate burns. However, this generic instrument may lack sensitivity, as important problems for burn patients, such as itching and cognition problems are not included in this instrument. This retrospective observational study investigates the value of adding an itching and cognition item to the EQ-5D-3L. Patients completed the EQ-5D-3L, and the Patient and Observer Scar Assessment Scale (POSAS), including an itching item and an extra cognition item three months postburn. The potential added value of an itching and cognition item was studied by distribution, informativity, convergent validity, dimension dependency, and explanatory analyses. In total, 120 patients were included of whom 65% reported itching and 23% reported cognition problems. Adding an itching item to the EQ-5D improved the discriminatory power and informativity of the EQ-5D-3L, but barely increased the explanatory power (0.4%) and decreased the convergent validity (r = −0.529 vs. r = −0.612). In contrast, adding a cognition item slightly improved the informativity and discriminatory power. Moreover, convergent validity (r = −0.617 vs. r = −0.612) and explanatory power increased (4.0%). In conclusion, adding an itching item to the EQ-5D-3L provides some additional information, however, the added value is small, whereas adding a cognition item improved the measurement properties of the EQ-5D-3L in our sample and should be considered when assessing HRQL in adult patients with intermediate burns.

Background: Research to date has mainly focused on burn injuries treated in secondary care. This study aims to provide knowledge on the epidemiology of burn injuries in primary care, to give directions for burn prevention. Methods: Data were derived from routine electronic health records of general practices and their out-of-hours service organisations in the Netherlands that participated in the Nivel Primary Care Database 2010–2015. We studied risk factors and trends. Results: The average burn injury prevalence rate was 4.40 (95% CI 4.27–4.53) per 1000 person-years in daytime general practice care and 1.47 (95% CI 1.46–1.49) per 1000 inhabitants in out-of-hours care. Children of 0−4 years old, especially boys, and young adult women had a higher risk. Burn injury risk was higher during the summer months and around New Year’s Eve. Living in low socioeconomic and strongly urbanised neighbourhoods was associated with a higher risk of burn injury than living in other neighbourhoods. Conclusion: Dutch general practitioners have a large share in burn care and therefore can play a significant role in burn prevention. Prevention may be most effective in the summer and around New Year’s Eve, and specific attention seems to be warranted for low socioeconomic groups and strongly urbanised neighbourhoods.

Background A prominent outcome measure within burn care is health related quality of life (HRQL). Until now, no model for long-term recovery of HRQL exists for adult burn patients which requires large samples with repeated measurements. Re-use and the combination of existing data is a way to achieve larger data samples that enable the estimation of long-term recovery models. The aim of this secondary data analysis was to assess the recovery of HRQL after a burn injury over time. Methods and findings Data from ten European studies on generic HRQL assessed in adult burn patients (either with the EQ-5D or SF-36) from five different countries were merged into one dataset. SF-36 outcomes were transformed into EQ-5D outcomes. A 24-month recovery of HRQL (EQ-5D utility) was modeled using a linear mixed-effects model and adjusted for important patient and burn characteristics. Subgroups of patients with mild and intermediate burns (<= 20% total body surface area (TBSA) burned) and with major burns (>20% TBSA burned) were compared. The combined database included 1687 patients with a mean age of 43 (SD 15) years and a median %TBSA burned of 9% (IQR 4-18). There was large improvement in HRQL up to six months after burns, and HRQL remained relatively stable afterwards (studied up to 24 months post burn). However, the estimated EQ-5D utility scores remained below the norm scores of the general population. In this large sample, females, patients with a long hospital stay and patients with major burns had a delayed and worse recovery. The proportion of patients that reported problems for the EQ-5D dimensions ranged from 100% (pain/discomfort at baseline in patients with major burns) to 10% (self-care >= 3 months after injury in patients with mild and intermediate burns). After 24 months, both subgroups of burn patients did not reach the level of the general population in the dimensions pain/discomfort and anxiety/depression, and patients with major burns in the dimension