2 Rates of Follow up After Burn Injury Are Disturbingly Low and Linked with Social Factors

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S7-S7
Author(s):  
Irina P Karashchuk ◽  
Eve A Solomon ◽  
David G Greenhalgh ◽  
Soman Sen ◽  
Tina L Palmieri ◽  
...  
Keyword(s):  
Low Socioeconomic Status ◽  
Drug Dependence ◽  
Burn Injury ◽  
Retrospective Chart Review ◽  
Missed Appointments ◽  
Poverty Level ◽  
Logistic Regression Models ◽  
Factors Associated ◽  
Burn Center

Abstract Introduction Due to risks of scarring and difficulties with re-socialization, it is important that burn patients attend follow up appointments to minimize adverse sequelae. Studies in trauma and emergency medicine have shown a correlation between reduced follow up and low socioeconomic status. Our goal was to examine the factors leading to missed follow up appointments in the burn center population. Methods Following IRB approval, a retrospective chart review was conducted using electronic medical records of all adult patients admitted to the burn center from 2016–2018. Data collected included information on burn injury, social status, substance use, and zip code demographics. Exclusions included patients with non-burn injuries, who died in the hospital, who were transferred to another hospital, who did not have any scheduled outpatient follow up, who had insurance which precluded follow up at our institution, and prisoners. Data analysis was conducted using chi-square, t-test, linear, and logistic regression models. Results A total of 878 patients (mean age 45.1 ± 16.8 years, 646 males (73.6%), mean burn size (TBSA) 10.16±11.7%) were analyzed. In our population, 96 (10.93%) patients were homeless, 284 (32.35%) had drug dependence, 128 (14.58%) had alcoholism, and the mean poverty level was 17.7±8.34%. Of those analyzed, 224 (25.5%) failed to attend any follow up appointments and 492 (56.0%) had at least one missed appointment. Patients who did not attend any follow up appointments had smaller burns (8.2±9.5% vs. 10.8±12.3%), traveled farther (91.8±101.1 miles vs. 69.0±68.7 miles), were more likely to be homeless (22.8% vs. 6.9%) and to have drug dependence (47.3% vs. 27.2%). Patients who missed at least one appointment were younger (43.8±16.1vs. 46.8±17.4 years), more likely to be homeless (17.5% vs. 2.6%) and have drug dependence (42.5% vs. 19.4%). On multivariate analysis, factors associated with never returning to clinic were: Distance from hospital (odds ratio (OR) 1.004, p=0.0001), TBSA (OR 0.96, p= 0.0001), Drug Dependence (OR 0.49, p< 0.0001), and Homelessness (OR 0.31, p< 0.0001). Factors associated with missing at least one appointment were: Age (OR 0.99 p< 0.03), Drug Dependence (OR 0.51, p< 0.0001), Homelessness (OR 0.20, p< 0.0001), and ED visits (OR 0.57, p< 0.05). Conclusions In our population, a high percentage of patients fail to make any appointment following their injury and an even higher number miss at least one appointment. The factors that influence failure to return and missing at least one appointment are similar but not exactly the same. Both follow up and missed appointments are influenced by social determinants of health.

Follow up after burn injury is disturbingly low and linked with social factors

2021 ◽  
Author(s):  
Irina P Karashchuk ◽  
Eve A Solomon ◽  
David G Greenhalgh ◽  
Soman Sen ◽  
Tina L Palmieri ◽  
...  
Keyword(s):  
Social History ◽  
Drug Dependence ◽  
Burn Injury ◽  
Retrospective Chart Review ◽  
Burn Patients ◽  
Chi Square ◽  
Factors Associated ◽  
Ed Visits ◽  
Zip Code

Abstract For medical and social reasons, it is important that burn patients attend follow up appointments (FUAs). Our goal was to examine the factors leading to missed FUAs in burn patients. A retrospective chart review was conducted of adult patients admitted to the burn center from 2016-2018. Data collected included burn characteristics, social history, and zip code. Data analysis was conducted using chi-square, Wilcox Rank Sum tests, and multivariate regression models. A total of 878 patients were analyzed, with 224 (25.5%) failing to attend any FUAs and 492 (56.0%) missing at least one appointment (MA). Patients who did not attend any FUAs had smaller burns (4.5 (8)% vs. 6.5 (11)% median (inter quartile range)), traveled farther (70.2 (111.8) vs. 52.5 (76.7) miles), and were more likely to be homeless (22.8% vs. 6.9%) and have drug dependence (47.3% vs. 27.2%). Patients who had at least one MA were younger (42 (26) vs. 46 (28) years) and more likely to be homeless (17.5% vs. 2.6%) and have drug dependence (42.5% vs. 19.4%). On multivariate analysis, factors associated with never attending a FUA were: distance from hospital (odds ratio (OR) 1.004), burn size (OR 0.96), and homelessness (OR 0.33). Factors associated with missing at least one FUA : age (OR 0.99), drug dependence (OR 0.46), homelessness (OR 0.22), and ED visits (OR 0.56). A high percentage of patients fail to make any appointment following their injury and/or have at least one MA. Both FUAs and MAs are influenced by social determinants of health.

scholarly journals 101 Homeless Status, Distance from Clinic, and Substance Dependence Associated with Low Follow-Up Rates for Burn-Injured Survey Respondents

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S68-S69
Author(s):  
Eve A Solomon ◽  
Elizabeth Phelan ◽  
Lilia G Tumbaga ◽  
Irina P Karashchuk ◽  
David G Greenhalgh ◽  
...  
Keyword(s):  
Substance Dependence ◽  
Retrospective Chart Review ◽  
Control Group ◽  
Missed Appointments ◽  
Survey Period ◽  
Chi Square ◽  
Logistic Regression Models ◽  
Burn Center ◽  
Before And After

Abstract Introduction Over 25% of burn-injured patients at our institution never attended a follow-up appointment. A quality-improvement discharge survey (QIS) identified potential barriers to follow-up as distance from the clinic, transportation, and time off work. This study compares follow-up rates before and after the QIS was administered and correlates them with patients’ self-identified barriers. Methods Following IRB approval, a retrospective chart review was conducted using electronic medical records of adult burn-center admits who responded to the QIS and were discharged between September 2019 and July 2020. Controls were burn-center admits discharged from 2016–2018, prior to the survey period. Exclusions included patients with non-burn injuries, and those who died in the hospital were transferred to another hospital, did not require follow-up, or followed up elsewhere. Data analysis was conducted using chi-square, t-test, and logistic regression models. Results The post-survey group includes 272 patients (mean age 47 ± 16.8, 201 males (73.6%), mean burn size (TBSA) of 9.3% ± 9.6%). The pre-survey control group includes 878 patients (mean age 45.1 ± 16.8 years, 646 males (73.6%), mean burn size (TBSA) 10.16 ± 11.7%). Compared to the pre-survey group, post-survey patients had a lower frequency of missed appointments (MA) (47.3% post vs. 56% pre), but worse overall follow-up rates (63.7% post vs. 74.5% pre). Per multivariate analysis, different factors were associated with follow-up and MA in the two groups (Table 1). Rates of follow-up and MA were not significantly different before and after the onset of the Covid-19 pandemic. Conclusions Patients who were surveyed to identify barriers to follow-up had fewer missed appointments but worse overall follow-up rates. Patients fail to follow up due to homelessness, substance dependence, and distance to the hospital. These findings are consistent with patients’ self-identified barriers to follow-up in a QI survey.

Understanding factors in burn patient follow-up

2021 ◽  
Author(s):  
Eve A Solomon ◽  
Elizabeth Phelan ◽  
Lilia G Tumbaga ◽  
Irina P Karashchuk ◽  
David G Greenhalgh ◽  
...  
Keyword(s):  
Substance Use ◽  
Drug Users ◽  
Discharge Planning ◽  
Univariate Analysis ◽  
Retrospective Chart Review ◽  
Multivariate Regression Analysis ◽  
Missed Appointments ◽  
Factors Associated ◽  
Injured Patients

Abstract Follow-up rates (FUR) are concerningly low among burn-injured patients. This study investigates the factors associated with low FUR and missed appointments (MA). We hypothesize that patients who are homeless, use illicit substances, and have psychiatric comorbidities will have lower rates of follow-up (FU) and more MAs. Data from a discharge-planning survey of 281 burn-injured patients discharged from September 2019 – July 2020 was analyzed and matched with patients’ EMR records for a retrospective chart review. Data collected included general demographics, burn characteristics, hospitalization details, FU visits, MAs, homeless status, substance use, major psychiatric illness (MPI), and survey responses. Data analysis used Chi-square, Fisher’s exact test, Student t-test, Wilcox Rank Sum test, and Multivariate Regression Analysis (MVR). Overall, 37% of patients had no FU in clinic and 46% had one or more MA. On MVR, homeless patients were more likely to never follow up, OR = 0.227 (95% CI = 0.106-0.489), as were patients who anticipated transportation difficulties, OR = 0.275 (95% CI = 0.151-0.501). Homeless patients were more likely to have MA, OR= 0.231 (95% CI = 0.099-0.539). On univariate analysis, patients with one or more documented MPI had lower FUR, with 50.62% having no FU (p = 0.0020). Among patients who responded to the survey that they were current drug users, 52% had no FU as compared to 28% of patients who responded that they did not use drugs (p = 0.0007). Factors associated with lower FUR and more MAs include homeless status, substance use, MPI, and transportation difficulties.

Demographic factors associated with missed follow-up among solid tumor patients treated at a large multi-site academic institution

2020 ◽  
Vol 16 (32) ◽  
pp. 2635-2643
Author(s):  
Samantha L Freije ◽  
Jordan A Holmes ◽  
Saleh Rachidi ◽  
Susannah G Ellsworth ◽  
Richard C Zellars ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Odds Ratio ◽  
Regression Models ◽  
Tumor Patients ◽  
Logistic Regression Models ◽  
Factors Associated ◽  
Follow Up Care ◽  
Risk Patients ◽  
African American Race

Aim: To identify demographic predictors of patients who miss oncology follow-up, considering that missed follow-up has not been well studies in cancer patients. Methods: Patients with solid tumors diagnosed from 2007 to 2016 were analyzed (n = 16,080). Univariate and multivariable logistic regression models were constructed to examine predictors of missed follow-up. Results: Our study revealed that 21.2% of patients missed ≥1 follow-up appointment. African–American race (odds ratio [OR] 1.33; 95% CI: 1.17–1.51), Medicaid insurance (OR 1.59; 1.36–1.87), no insurance (OR 1.66; 1.32–2.10) and rural residence (OR 1.78; 1.49–2.13) were associated with missed follow-up. Conclusion: Many cancer patients miss follow-up, and inadequate follow-up may influence cancer outcomes. Further research is needed on how to address disparities in follow-up care in high-risk patients.

scholarly journals Early-Life Adversities and Recalcitrant Smoking in Midlife: An Examination of Gender and Life-Course Pathways

2020 ◽  
Vol 54 (11) ◽  
pp. 867-879
Author(s):  
Chioun Lee ◽  
Lexi Harari ◽  
Soojin Park
Keyword(s):  
Life Course ◽  
Low Socioeconomic Status ◽  
Early Life ◽  
Financial Strain ◽  
Low Ses ◽  
Family Instability ◽  
Family Problems ◽  
Low Socioeconomic ◽  
Logistic Regression Models

Abstract Background Little is known about life-course factors that explain why some individuals continue smoking despite having smoking-related diseases. Purpose We examined (a) the extent to which early-life adversities are associated with the risk of recalcitrant smoking, (b) psychosocial factors that mediate the association, and (c) gender differences in the associations. Methods Data were from 4,932 respondents (53% women) who participated in the first and follow-up waves of the Midlife Development in the U.S. National Survey. Early-life adversities include low socioeconomic status (SES), abuse, and family instability. Potential mediators include education, financial strain, purpose in life, mood disorder, family problems/support, and marital status. We used sequential logistic regression models to estimate the effect of early-life adversities on the risk of each of the three stages on the path to recalcitrant smoking (ever-smoking, smoking-related illness, and recalcitrant smoking). Results For women, low SES (odds ratio [OR] = 1.29; 1.06–1.55) and family instability (OR = 1.73; 1.14–2.62) are associated with an elevated risk of recalcitrant smoking. Education significantly reduces the effect of childhood SES, yet the effect of family instability remains significant even after accounting for life-course mediators. For men, the effect of low SES on recalcitrant smoking is robust (OR = 1.48; 1.10–2.00) even after controlling for potential mediators. There are noteworthy life-course factors that independently affect recalcitrant smoking: for both genders, not living with a partner; for women, education; and for men, family problems. Conclusions The findings can help shape intervention programs that address the underlying factors of recalcitrant smoking.

scholarly journals The Patient-Centered Medical Home for Refugee Children in Rhode Island

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Tecla Mtui Temu ◽  
Lisa Ratanaprasatporn ◽  
Linda Ratanaprasatporn ◽  
Delma-Jean Watts ◽  
Carol Lewis
Keyword(s):  
Rhode Island ◽  
Medical Home ◽  
Laboratory Data ◽  
Retrospective Chart Review ◽  
Refugee Children ◽  
Background Information ◽  
Missed Appointments ◽  
Patient Centered ◽  
Medical Interpreters

Purpose. To describe a “medical home” for pediatric refugees and its ability to provide culturally competent care, to partner with and train medical interpreters, and to improve health screening and follow-up adherence rates of pediatric refugees immigrating to Rhode Island. Methods. A retrospective chart review of refugees was performed. Background information, initial laboratory data, whether patients completed the recommended follow-ups scheduled at 1, 3, 6, and 12 months, and completion of tuberculosis treatment were recorded. Results. Since its initiation, 104 refugee children have attended the clinic ranging in age from 5 months to 18 years. Since the initiation of the medical home for refugee children in 2007, initial screening rates have gone up to 99-100% compared to a low of 41% in 2003–2006 prior to the establishment of the medical home. There was a 43% reduction in missed appointments in 15-month follow-up. Conclusion. The refugee “medical home” allows refugees to benefit from a comprehensive system for disease detection and ongoing primary health care.

scholarly journals Factors Associated with Low Socioeconomic Status Predict Poor Postoperative Follow-up after Meningioma Resection

2015 ◽  
Vol 77 (03) ◽  
pp. 226-230 ◽  
Author(s):  
Philip Brinson ◽  
Kyle Weaver ◽  
Reid Thompson ◽  
Lola Chambless ◽  
Arash Nayeri
Keyword(s):  
Socioeconomic Status ◽  
Low Socioeconomic Status ◽  
Low Socioeconomic ◽  
Factors Associated

Predictive Clinical and Surgical Factors Associated with Recurrent Apoplexy in Pituitary Adenomas

2021 ◽  
Author(s):  
Alan Siu ◽  
Sanjeet Rangarajan ◽  
Michael Karsy ◽  
Christopher J. Farrell ◽  
Gurston Nyquist ◽  
...  
Keyword(s):  
Pituitary Apoplexy ◽  
Radiation Treatment ◽  
Univariate Analysis ◽  
Rare Event ◽  
Retrospective Chart Review ◽  
Subtotal Resection ◽  
Cavernous Sinus Invasion ◽  
Factors Associated ◽  
Increased Risk

Abstract Introduction Pituitary apoplexy is an uncommon clinical condition that can require urgent surgical intervention, but the factors resulting in recurrent apoplexy remain unclear. The purpose of this study is to determine the risks of a recurrent apoplexy and better understand the goals of surgical treatment. Methods A retrospective chart review was performed for all consecutive patients diagnosed and surgically treated for pituitary apoplexy from 2004 to 2021. Univariate analysis was performed to identify risk factors associated with recurrent apoplexy. Results A total of 115 patients were diagnosed with pituitary apoplexy with 11 patients showing recurrent apoplexy. This occurred at a rate of 2.2 cases per 100 patient-years of follow-up. There were no major differences in demographic factors, such as hypertension or anticoagulation use. There were no differences in tumor locations, cavernous sinus invasion, or tumor volumes (6.84 ± 4.61 vs. 9.15 ± 8.45 cm, p = 0.5). Patients with recurrent apoplexy were less likely to present with headache (27.3%) or ophthalmoplegia (9.1%). Recurrent apoplexy was associated with prior radiation (0.0 vs. 27.3%, p = 0.0001) and prior subtotal resection (10.6 vs. 90.9%, p = 0.0001) compared with first time apoplexy. The mean time to recurrent apoplexy was 48.3 ± 76.9 months and no differences in overall follow-up were seen in this group. Conclusion Recurrent pituitary apoplexy represents a rare event with limited understanding of pathophysiology. Prior STR and radiation treatment are associated with an increased risk. The relatively long time from the first apoplectic event to a recurrence suggests long-term patient follow-up is necessary.

scholarly journals Challenging Dogma: Optimal Treatment of the “Fight Bite”

Hand ◽  
2019 ◽  
Vol 15 (5) ◽  
pp. 647-650
Author(s):  
Carl M. Harper ◽  
Arriyan Samandar Dowlatshahi ◽  
Tamara D. Rozental
Keyword(s):  
Complication Rate ◽  
Wound Care ◽  
Retrospective Chart Review ◽  
Optimal Treatment ◽  
Fisher Exact Test ◽  
Oral Antibiotics ◽  
Exact Test ◽  
Logistic Regression Models ◽  
Human Bites

Background: The optimal treatment of human bites to the dorsal metacarpophalangeal region (ie, “fight bite”) in the absence of gross purulence is controversial. Few studies have compared the outcomes of operative debridement with expectant wound care and oral antibiotics. Methods: We performed a retrospective chart review of all patients evaluated at a Level 1 trauma center over a 10-year period. We compared demographic and clinical characteristics of patients across treatment and outcome groups using the Fisher exact test. Logistic regression models were used to describe the relationships between the outcome and treatment variables. Results: We identified 115 patients with a mean age of 29 years. The mean follow-up was 51.8 days. Seventy-two (63%) patients were treated with antibiotics only. Thirty-two (28%) patients were treated with irrigation in the emergency department (ED) and expectant wound care. Eleven (9%) patients were treated with irrigation and debridement in the operating room. No demographic variables were found to correlate with the treatment selected. A 12% complication rate (major and minor) was observed. After adjusting for duration of follow-up and days to presentation, neither the treatment rendered nor the antibiotics selected influenced the rate of complications. Time to presentation >24 hours was the only variable associated with higher complication rate ( P = .003). Conclusions: Not all fight bites require operative intervention. Irrigation in the ED with expectant wound care and oral antibiotics can be sufficient for patients presenting within 24 hours of injury in the absence of gross purulence.

Factors Associated with Mortality Following Burns Complicated by Necrotizing Skin and Soft Tissue Infections: A Systematic Review and Meta-analysis of Individual Participant Data

2021 ◽  
Author(s):  
Kevin M Klifto ◽  
Caresse F Gurno ◽  
Stella M Seal ◽  
C Scott Hultman
Keyword(s):  
Soft Tissue ◽  
Graft Survival ◽  
Burn Injury ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Individual Participant Data ◽  
Soft Tissue Infections ◽  
Factors Associated ◽  
Burn Center ◽  
Individual Participant

Abstract We reviewed studies with individual participant data of patients who sustained burn injury and subsequently developed necrotizing skin and soft tissue infections (NSTI). Characteristics and managements were compared between patients who lived and patients who died to determine factors associated with mortality. Six databases (PubMed, EMBASE, Cochrane Library, Web of Science, Scopus and CINAHL) were searched. PRISMA-IPD guidelines were followed throughout the review. Eligible patients sustained a burn injury, treated in any setting, and diagnosed with a NSTI following burn injury. Comparisons were made between burned patients who lived “non-mortality” and burned patients who died “mortality” following NSTI using non-parametric univariate analyses. Fifty-eight studies with 78 patients were published from 1970 through 2019. Non-mortality resulted in 58 patients and mortality resulted in 20 patients. Patients with mortality had significantly greater median %TBSA burned (45%[IQR:44-64%] versus 35%[IQR:11-59%],p=0.033), more intubations (79% versus 43%,p=0.013), less debridements (83% versus 98%,p=0.039), less skin excisions (83% versus 98%,p=0.039), more complications (100% versus 50%,p<0.001), management at a burn center (100% versus 71%,p=0.008), underwent less flap surgeries (5% versus 35%,p=0.014), less graft survival (25% versus 86%,p<0.001), and less healed wounds (5% versus 95%,p<0.001), compared to patients with non-mortality, respectively. Non-mortality patients had more debridements, skin excised, systemic antimicrobials, skin graft survival, flaps, improvement following surgery and healed wounds compared to mortality patients. Mortality patients had greater %TBSA burned, intubations, management at a burn center and complications compared to non-mortality patients.

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