25: Burn Rehabilitation

INTRODUCTION

Burn care and injury management continue to advance throughout the developed world, leading to improved survival and rehabilitation of individuals who suffer burn injuries. These individuals require a comprehensive approach to care to help them achieve full independence and maximum recovery from their injuries. Current estimates suggest that more than 1.2 million individuals in the United States require care for burn injuries annually, and this number is significantly higher in many other countries throughout the world. Successful rehabilitation of a person with a burn injury requires a team approach in which each member provides essential resources and skills to help the individual transition from being a “victim” of a burn to being a functionally independent “survivor.”

EPIDEMIOLOGY

Burns cause approximately 60,000 hospitalizations and over 6000 deaths annually in the United States. Burn injuries are most common among males (∼70% of cases) between the ages of 16 and 40 years; however, both young and old are highly susceptible to burn injury. Burns are the second most common form of abuse among children aged 1–12 years, and the second leading cause of accidental death among adults older than 60 years.

Mortality from major burns has been significantly reduced in North America. Nonetheless, according to the American Burn Association National Burn Repository, the mortality rate for the median lethal dose (LD₅₀) for burns is 80%. This median is even higher in the pediatric population between the ages of 1 and 15 years, where the rate reaches just over 95%. Several negative predictors influence burn survival, including the presence of inhalation injury, increased age, presence of other medical comorbidities (eg, diabetes mellitus or chronic obstructive pulmonary disease), and higher overall surface area injury.

The most common burn injuries affect approximately 10% of total body surface area (TBSA) and are the result of flame contact or scald. Of patients with these types of burns, approximately 95% survive their injuries and hospitalizations. Burns can also result from electrical contact, chemical contact, radiation exposure, and, to a lesser degree, various skin syndromes. Depending on the cause, patients with these injuries will require varying amounts of wound care, surgery, rehabilitation, and aftercare to recover.