An Anatomical Approach To Risk Factors Associated With Developing Chronic Nerve Pain After Burn Injury: A Retrospective Review Of 1862 Burn Patients
Kevin M. Klifto, PharmD, Pooja S. Yesantharao, MS, Scott D. Lifchez, MD, A. Lee Dellon, MD, PhD, C. Scott Hultman, MD, MBA.
Johns Hopkins University School of Medicine, Baltimore, MD, USA.
PURPOSE: Chronic, neuropathic pain(CNP) after burn injury is relatively common but not well-described in the literature. This study characterizes patients with burns to different anatomical locations of the body to determine anatomic-specific variables independently-associated with developing burn-related CNP.
METHODS: Patients ≥15 years admitted to the Burn Unit were included from 2014-2019. CNP was defined as self-described pain for ≥6 months after burn injury, unrelated to pre-existing illness/medications. Comparisons were made between 1)CNP and 2)non-CNP patients with burns involving the hands, forearms, upper-arms, chest/abdomen, posterior torso, buttock/genitals, thighs, lower legs, feet, face/head, and neck.
RESULTS: Of 1880 consecutive burn patients, 1862 had anatomical data. The following factors were independently-associated with increased odds of burn-related CNP. Hand burns: substance use[OR:10.1,p=0.008], tobacco use[OR:31.0,p<0.001], mechanical ventilation[OR:7.5,p=0.02], hospital length-of-stay(LOS)[OR:1.1,p=0.01], and surgical treatment[OR:4.3,p=0.04]. Forearm burns: older age[OR:1.1,p=0.03], substance use[OR:9.9,p=0.02], tobacco use[OR:16.6,p<0.001], mechanical ventilation[OR:7.2,p=0.02], percent total body surface area burned (%TBSA)[OR:1.1,p=0.03], and surgical treatment[OR:7.6,p=0.002]. Upper-arm burns: substance use[OR:6.2,p=0.02], tobacco use[OR:8.7,p<0.001], mechanical ventilation[OR:4.7,p=0.02], and surgical treatment[OR:5.7,p=0.002]. Thigh burns: substance[OR:8.2,p=0.04] and tobacco use[OR:19.4,p<0.001]. Foot burns: hospital LOS[OR:1.2,p=0.02] and tobacco use[OR:35.5,p=0.01]. Neck burns: older age[OR:1.4,p=0.03] and substance use[OR:10.4,p=0.04].
CONCLUSIONS: This study identified factors independently-associated with developing CNP after burn injury to optimize anatomic risk-stratification and better tailor preventative efforts.
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