With a reduction in the mortality rate of burn patients, length of stay (LOS) has been increasingly adopted as an outcome measure. Some studies have attempted to identify factors that explain a burn patient’s LOS. However, few have investigated the association between LOS and a patient’s mental and socioeconomic status. There is anecdotal evidence for links between these factors; uncovering these will aid in better addressing the specific physical and emotional needs of burn patients and facilitate the planning of scarce hospital resources. Here, we employ machine learning (clustering) and statistical models (regression) to investigate whether segmentation by socioeconomic/mental status can improve the performance and interpretability of an upstream predictive model, relative to a unitary model. Although we found no significant difference in the unitary model’s performance and the segment-specific models, the interpretation of the segment-specific models reveals a reduced impact of burn severity in LOS prediction with increasing adverse socioeconomic and mental status. Furthermore, the socioeconomic segments’ models highlight an increased influence of living circumstances and source of injury on LOS. These findings suggest that in addition to ensuring that patients’ physical needs are met, management of their mental status is crucial for delivering an effective care plan.

https://www.mdpi.com/1660-4601/18/2/761/pdf

Surviving Burn Injury: Drivers of Length of Hospital Stay.

Disparities affecting incarcerated burn-injured patients: Insight from the National Burn Repository.

This study was conducted to examine the effects of the coronavirus disease 2019 (COVID‐19) pandemic on the epidemiological characteristics and causes of burns in patients admitted to burns services. A total of 629 patients who applied to the burn center of our hospital on March 11 to June 11, 2019, and March 11 to June 11, 2020, were included in this single‐center, retrospective study. The demographic information of the patients, causes of burns, burn degrees, affected anatomical areas, admission times and burn surface areas were recorded retrospectively according to patient records. The findings of our study suggest that gender, age, causes of burns, affected anatomical areas and application times did not differ before and after the COVID‐19 pandemic. The number of cases has significantly decreased during the COVID‐19 pandemic compared with that of the previous year. As a result, burn trauma is an emergency; it is preventable and cannot be ignored. The COVID‐19 pandemic has had many effects on social, cultural and economic fields, as well as on the field of health.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9434328

The effect of COVID‐19 pandemic on the number of patients in burns services

Disparities affecting incarcerated burn-injured patients: Insight from the National Burn Repository

INTRODUCTION
Post-burn scarring is often cosmetically unappealing and create discomfort. This makes it crucial to understand the experience of individuals living with scars which can offer insights into their recovery. This review sought to develop an in-depth understanding of living with post-burn scars.


DESIGN
A systematic review and meta-ethnography approach were employed. We utilized an interpretive approach to inductively generate codes. These codes were examined iteratively using a constant comparison strategy following which they were re-interpreted to formulate themes which formed the basis of undertaking a narrative synthesis.


RESULTS
Twenty-five studies were retained. The analytical process yielded two themes: emergence of a new identity and living with the redefined self. The experience of living with scars is entwined with the initial trauma as the scars served as a permanent reminder of the injury. Emergence of a new identity involved a process of meaning making, mourning the loss of the old self, confronting the new self, reconciling the remains of the old self with the new, rebuilding a new identity, and navigating through functional restrictions. These processes were particularly challenging for persons involved in self-immolation. Positive coping and changing one's perspective emerged as strategies to facilitate living with the redefined self.


CONCLUSION
Living with scars is a challenging process which is more difficult for persons whose injuries are due to self-immolation (act of burning oneself). The findings highlight a latent yet ongoing process towards subjective recovery. Clinicians need to be aware of the processes and incorporate these into rehabilitation programmes.


CLINICAL RELEVANCE
Burn survivors need ongoing professional support to adjust to and live with the scars. Victims of self-immolation should be considered for early psychosocial support.

A meta-ethnography of developing and living with post-burn scars.

Patient casemix is a system of defining groups of patients. For reimbursement purposes, these groups should be clinically meaningful and share similar resource usage during their hospital stay. In the UK National Health Service (NHS) these groups are known as health resource groups (HRGs), and are predominantly derived based on expert advice and checked for homogeneity afterwards, typically using length of stay (LOS) to assess similarity in resource consumption. LOS does not fully capture the actual resource usage of patients, and assurances on the accuracy of HRG as a basis of payment rate derivation are therefore difficult to give. Also, with complex patient groups such as those encountered in burn care, expert advice will often reflect average patients only, therefore not capturing the complexity and severity of many patients’ injury profile. The data-driven development of a grouper may support the identification of features and segments that more accurately account for patient complexity and resource use. In this paper, we describe the development of such a grouper using established techniques for dimensionality reduction and cluster analysis. We argue that a data-driven approach minimises bias in feature selection. Using a registry of patients from 23 burn services in England and Wales, we demonstrate a reduction of within cluster cost-variation in the identified groups, when compared to the original casemix.

/pdf/a-clustering-based-patient-grouper-for-burn-care-3trfwpeirj.pdf

A Clustering-Based Patient Grouper for Burn Care

The adoption of the Prospective Payment System (PPS) in the UK National Health Service (NHS) has led to the creation of patient groups called Health Resource Groups (HRG). HRGs aim to identify groups of clinically similar patients that share similar resource usage for reimbursement purposes. These groups are predominantly identified based on expert advice, with homogeneity checked using the length of stay (LOS). However, for complex patients such as those encountered in burn care, LOS is not a perfect proxy of resource usage, leading to incomplete homogeneity checks. To improve homogeneity in resource usage and severity, we propose a data-driven model and the inclusion of patient-level costing. We investigate whether a data-driven approach that considers additional measures of resource usage can lead to a more comprehensive model. In particular, a cost-sensitive decision tree model is adopted to identify features of importance and rules that allow for a focused segmentation on resource usage (LOS and patient-level cost) and clinical similarity (severity of burn). The proposed approach identified groups with increased homogeneity compared to the current HRG groups, allowing for a more equitable reimbursement of hospital care costs if adopted.

/pdf/towards-a-fairer-reimbursement-system-for-burn-patients-38btsm2aah.pdf

Kenneth W. Dunn

Papers

Surviving Burn Injury: Drivers of Length of Hospital Stay.

A Clustering-Based Patient Grouper for Burn Care

Towards a fairer reimbursement system for burn patients using cost-sensitive classification