Chronic Use of Prescription Pain Medication and Outcomes in Patients with Burn Injury: A Burn Model System National Database Study.

OBJECTIVE: This study attempts to examine long-term pain medication usage after burn injury and its association with functional and psychosocial outcomes. DESIGN: This is a multi-center retrospective cohort study utilizing the Burn Model System National Longitudinal Database. Participants injured from 2015 to 2021 were divided into two groups, those taking and not taking prescription pain medication at 12 months after injury. Regression analyses examined associations between pain medication use and outcomes at 12 months, adjusting for demographics, burn size, length of hospital stay, and pre-injury pain medication use and employment status. Outcomes included VR-12 Physical and Mental Component Summary scores (PCS and MCS), Patient-Reported Outcomes Measurement Information System (PROMIS-29) Anxiety and Depression scores, Satisfaction with Life Scale (SWLS), and employment status. RESULTS: Of 358 participants analyzed, prescription pain medication use was associated with worse outcomes at 12 months: PCS (ß = -7.11, p < 0.001), MCS (ß = -6.01, p < 0.001), and PROMIS-29 Depression (ß = 4.88, p < 0.001) and Anxiety (ß = 6.16, p < 0.001). SWLS was not significantly associated with pain medication use (p = 0.069) and those taking pain medication were 52% less likely to be employed at 12 months (p = 0.035). CONCLUSION: There is a significant association between prescription pain medication use and worse physical, mental, and employment outcomes at 12 months after burn injury.

Trajectory Curves for Purposes of Benchmarking and Predicting Clinical Outcomes: A Scoping Review.

Trajectory curves are valuable tools to benchmark patient health status and predict future outcomes. A longitudinal study is underway to examine social participation after burn injury using the Life Impact Burn Recovery Evaluation (LIBRE) Profile with the goal of developing trajectory curves for specific domains that focus on social reintegration. We conducted a scoping review to inform and understand trajectory curves applied in clinical settings to compare outcomes for an individual to a matched cohort of comparable patients or predicted expected outcomes over time. This scoping review utilized a PubMed search from January 2014 to August 2019 for the following terms: "trajectory curves" or "trajectory models" and "clinic" or "clinical." Only articles that specifically referenced longitudinal and clinical research designs were included in the scoping review. Articles were assessed using standard scoping review methods and categorized based on clinical application of trajectory curves for either benchmarking or prediction. The initial literature review identified 141 manuscripts and 34 met initial inclusion criteria. The reviewed articles support the clinical use of trajectory curves. Findings provide insight into several key determinants involved with the successful development and implementation of trajectory curves in clinical settings. These findings will inform efforts to use the LIBRE Profile to model social participation recovery and assist in developing effective strategies using trajectory curves to promote social reintegration after burn injury.