Gretchen Carrougher

Gretchen Carrougher
University of Washington Seattle | UW · Department of Surgery

MN, RN

About

208
Publications
24,178
Reads
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5,219
Citations
Citations since 2017
82 Research Items
2582 Citations
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20172018201920202021202220230100200300400500
20172018201920202021202220230100200300400500
20172018201920202021202220230100200300400500
Additional affiliations
October 2002 - present
University of Washington Seattle
Position
  • Burn Model Systems research
January 2000 - December 2012
Education
September 1985 - December 1987
University of Washington Seattle
Field of study
  • Burn, Trauma and Emergency Nursing

Publications

Publications (208)
Article
Full-text available
To identify barriers to return to work after burn injury as identified by the patient. A cohort study with telephone interview up to 1 year. Hospital-based burn centers at 3 national sites. Hospitalized patients (N=154) meeting the American Burn Association criteria for major burn injury, employed at least 20 hours a week at the time of injury, and...
Article
Hypertrophic scarring after burns is an unsolved problem and remains as devastating today as it was in the 40s and it may be that the main reason for this is the lack of an accepted, useful animal model. The female, red Duroc pig was described as a model of hypertrophic scarring nearly 30 years ago but then vanished from the literature. This seemed...
Article
The female red Duroc pig has been found to be a promising model of hypertrophic scarring. The female Yorkshire pig has been demonstrated to heal in a very different manner, more resembling human normotrophic scarring. Given these observations, we studied microvessel density, an important aspect of wound healing, in human hypertrophic scars and the...
Article
Knowledge of the pathophysiology of hypertrophic scarring following deep dermal injuries is minimal due to the lack of an animal model. We previously confirmed that thick scars in female, red Duroc pigs (FRDP) are similar to human hypertrophic scar. The purpose of this study was to evaluate TGFbeta1, IGF-1, decorin, and versican expression in FRDP...
Article
Specialty certification for burn nursing will be available in 2023. This review outlines the path taken from specialty recognition by the American Nurses Association to the Certified Burn Registered Nurse (CBRN) certification. Clinical expertise, knowledge, skill, mastery of professional issues, and competence are hallmark features of a nurse speci...
Article
Introduction: Pain is a common and often debilitating sequela of burn injury. Burn pain develops following damage to peripheral sensory nerves and the release of inflammatory mediators from injury. Burn pain is complex and can include background and procedural pain that result from the injury itself, wound care, stretching, and surgery. Clinicians...
Article
Individuals who experience burns are at higher risk of developing post-traumatic stress disorder and chronic pain. A synergistic relationship exists between post-traumatic stress disorder and chronic pain. We sought to examine the role of individual post-traumatic stress disorder symptom clusters as predictors of pain interference. We hypothesized...
Article
Disparities in socioeconomic status and minority status impacts the risk of burn injury and the severity of that injury, thus impacting the subsequent cost of care. We aimed to characterize the demographic details surrounding receipt of financial assistance due to burn injury and its relationship with health-related quality of life scores. Particip...
Article
Introduction Health Related Quality of Life (HRQoL) surveys such as PROMIS-29 may facilitate shared decision-making regarding surgery after burn injury. We aimed to examine whether scar revision and contracture release surgery after index hospitalization was associated with differences in HRQoL. Methods Patient and PROMIS-29 Profile v2.0 data were...
Article
Full-text available
Introduction The loss of income from injury, additional health care expenses, and inability to return work can lead to unsatisfactory outcomes. Community level disadvantage (e.g., low high school completion, low home ownership, low income) are more common among minority groups. We hypothesized community level disadvantage would negatively impact th...
Article
Full-text available
Introduction Current early burn care prognostication models predict in-hospital mortality (e.g., revised Baux Score). However, patients, families and clinicians need more holistic tools in the hours and days after injury to identify specific factors that might affect their quality of life and indicate a need for more intensive services. This projec...
Article
Full-text available
Introduction Access to healthcare and insurance coverage are associated with quality of life, morbidity, and mortality outcomes. However, most studies have only focused on same-admission and short-term outcomes due to the lack of national longitudinal data and there is limited data on this topic in the burn literature. Our aim was to determine the...
Article
Full-text available
Introduction Financial toxicity negatively impacts recovery after injury. Financial assistance (FA; e.g., disability income, food stamps, low-income housing voucher) may mitigate the impacts of financial toxicity. We aimed to describe FA after burn injury and its association with health-related quality of life (HRQL) and return to work. Methods Da...
Article
Full-text available
Introduction MDROs colonize wounds and cause infections for hospitalized burn patients, which may lead to increased infection risk, wound complications, longer (LOS) and more cost. Little is known about the long-term impacts of MDRO colonization and infection on burn survivors. We aimed to describe the impacts of colonization on long-term health-re...
Article
Full-text available
Introduction Reintegration into the workforce after burn injury is an important issue for survivors. In a 2012 systematic review, 28% of burn survivors never returned to any form of employment. Although pre-burn employment status is strongly associated with post-burn employment, there are little data on the role of pre-injury occupation type on wor...
Article
Full-text available
Introduction Individuals who experience burns are at higher risk of developing post-traumatic stress disorder (PTSD) and chronic pain. There exists a synergistic relationship between PTSD and chronic pain in burn survivors. Theories exist about how aspects of each condition may perpetuate one another, or share underlying mechanisms. Both of these c...
Article
Background: People living with burn injury often face long-term physical and psychological sequelae associated with their injuries. Few studies have examined the impacts of burn injuries on long-term health and function, life satisfaction, and community integration beyond five years post-injury. The purpose of this study was to examine these outco...
Article
Research supports that people of color in the U.S. have poorer outcomes after burn injury compared to White individuals. The current study sought to explore burn health disparities by testing the relationship between racial and ethnic minority status, a proxy for systemic discrimination due to race and ethnicity, with two key constructs linked to f...
Article
Objective: The Burn Specific Health Scale-Brief (BSHS-B) is a commonly used burn specific health outcome measure that includes 40 items across nine subscales. The objective of this study was to use both classical and modern psychometric methods to evaluate psychometric properties of the BSHS-B. Methods: Data were collected post burn injury by a...
Article
Introduction The costs required to provide acute care for patients with serious burn injuries are significant. In the US, these costs are often shared by patients. However, the impacts of pre-injury finances on health-related quality of life (HRQL) have been poorly characterized. We hypothesized that lower income and public payers would be associat...
Article
Introduction Burn survivors experience barriers to returning to work. For those who do return to work, little is known regarding whether they achieve pre-injury productivity (i.e., equivalent or gain in income compared to pre-injury income). Identifying patients at risk of not achieving pre-injury productivity is important for targeting services th...
Article
Background People living with burn injury often report temperature sensitivity. However, its epidemiology and associations with health-related quality of life (HRQOL) are unknown. We aimed to characterize temperature sensitivity and determine its impact on HRQOL to inform patient education after recovery from burn injury. Methods We used the multi...
Article
Introduction Representativeness of research populations impacts the ability to extrapolate findings. The Burn Model System (BMS) National Database is one of the largest prospective, longitudinal, multi-center research repositories collecting patient-reported outcomes after burn injury. Objective To assess if the BMS Database is representative of t...
Article
Introduction Burn injuries can be life-altering events that involve intensive healthcare, changes in body image, psychological stress and financial toxicity. Burn survivors frequently experience numerous and varied barriers to returning to work. For those who return to work, little is known regarding whether they achieve pre-injury productivity (i....
Article
Introduction The critical care, surgery, and rehabilitation required to recover patients with serious burn injuries are associated with high financial costs. In the US, these costs are often borne by patients. However, the relationship between pre-injury finances (personal income and payer) and health-related quality of life (HRQL) of burn survivor...
Article
Introduction Pain is a common and often debilitating sequelae of a significant burn injury. Clinicians and researchers need clinically valid, reliable pain measures to guide treatment decisions and to provide evidence for study protocol development. Pain rating scores that represent mild, moderate, and severe pain in the burn survivor population ha...
Article
Introduction Among the many challenges burn survivors face, community integration is often difficult and might affect overall satisfaction with life long-term. The purpose of this study is to examine quality of life, based on life satisfaction and community integration, at long-term follow-ups in the burn population. Methods Data from the Burn Mod...
Article
Introduction Temperature sensitivity is a common problem after burn injury. However, the impact of temperature sensitivity on health-related quality of life (QoL) is unknown. We aimed to describe characteristics associated with temperature sensitivity and determine its association with patient reported QoL. We hypothesized that temperature sensitiv...
Article
Introduction Burn survivors often face many long-term physical and psychological symptoms associated with their injury. To date, however, few studies have examined the impact of burn injuries on quality of life beyond 2 years post-injury. The purpose of this study is to examine the physical and mental well-being of burn survivors up to 20 years aft...
Article
Introduction Burns are painful injuries associated with a long recovery. Patients may not be receiving sufficient pain management education to optimize their experience and recovery after burn injury. Therefore, we aimed to obtain patients’ perspectives about the effectiveness of current burn pain education to inform future efforts. Methods We use...
Article
Background We aimed to analyze the impact of the Affordable Care Act’s Medicaid Expansion on clinical outcomes and patient disposition after burn injury. We hypothesized that increased insurance coverage results in improved outcomes and higher rates of discharge to inpatient rehabilitation. Methods We reviewed the University of Washington Regional...
Article
Objective Despite improved mortality rates after burn injury, many patients face significant long-term physical and psychosocial disabilities. We aimed to determine whether commonly used mortality prognostication scores predict long-term, health-related quality of life after burn injury. By doing so, we might add evidence to support goals of care d...
Article
Introduction Previous reports suggest that many factors impact recovery from burn injury. To improve our understanding of these factors, we queried adult burn survivors using a mixed method design during the first year after injury. Methods An anonymous, 2-page survey was developed and administered to adult burn survivors during routine outpatient...
Article
Introduction: The Burn Model System (BMS) program of research has been funded since 1993 by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). The overarching aim of this program is to improve outcomes and quality of life for people with burns in the areas of health and function; employment; community...
Article
Full-text available
Introduction Inhalation injuries carry significant acute care burden including prolonged ventilator days and length of stay. However, few studies have examined post-acute outcomes of inhalation injury survivors. This study compares the long-term outcomes of burn survivors with and without inhalation injury. Methods Data collected by the Burn Model...
Article
Background: Pain is a common problem after traumatic injury. We describe pain intensity and interference at baseline and one-year post injury in burn, traumatic brain (TBI) and spinal cord injury (SCI) survivors and compare them to the general population (GP). We tested a custom PROMIS® pain interference short form developed for use in trauma popu...
Article
Introduction Pre-burn comorbidities increase the risk of death in the acute phase, and negatively impact quality of life among survivors. Investigations to date have only evaluated comorbidities as indices, limiting the ability to target conditions and develop strategies for risk reduction. Therefore, we aimed to evaluate the differential effects o...
Article
Background: Health-related quality of life is decreased in burn survivors, with scars implicated as a cause. The authors aim to characterize the use of reconstructive surgery following hospitalization and determine whether patient-reported outcomes change over time. The authors hypothesized improvement in health-related quality of life following r...
Article
Introduction As one of the largest prospective, longitudinal, multi-center research data repositories for burn survivors, the Burn Model System (BMS) National Database is in a unique position to explore the characteristics of burn survivors who choose not to participate in long-term research. Given recent shifts in research priorities to include un...
Article
Introduction The Burn Model System (BMS) program of research has been funded since 1994. The overarching aim of this program is to improve outcomes and quality of life for people with disabilities in the areas of: 1) health and function, 2) employment, and 3) community living and participation. This review reports BMS contributions that have positi...
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Introduction Previous data suggest that disparities exist in access to inpatient rehabilitation following burn injury. We aimed to characterize the association between patient race/ethnicity and discharge disposition across multiple centers. Methods Data were derived from the prospectively maintained Burn Model Systems national database. All parti...
Article
Introduction Burns are often painful injuries, associated with a long recovery. Little is known about patients’ pain experience or understanding of burn pain. Patients may also not be receiving sufficient pain education to optimize their pain experience. The aim of this project was to obtain patients’ perspectives to inform future burn pain educati...
Article
Introduction Feeling a part of community and participating in social life are important aspects of overall quality of life. Burn survivors consider community reintegration one of the most important issues affecting their recovery. Integration, including social integration, has been studied in this population, but longitudinal analyses to examine fa...
Article
Introduction Understanding contributors to patient length of stay is critical for burn center resource management and efficiency. In this study, we analyzed how distance from patient homes to a burn center impacts hospital length of stay. Methods Under IRB approval, we reviewed our trauma registry for burn patients admitted to a regional burn cent...
Article
Introduction With changes in insurance coverage after the implementation of the Affordable Care Act (ACA) in 2014, we aim to analyze the impact of Medicaid expansion on clinical outcomes and patient disposition after burn injury. We hypothesize that with increased insurance coverage, more patients are discharged to a skilled nursing facility (SNF)...
Article
Introduction Perception of mental and physical function in adult burn survivors is decreased following injury. Individuals who undergo post-hospitalization reconstructive surgery may have lower Health Related Quality of Life (HRQoL) that is influenced by the severity of their burns. We sought to characterize self-reported health perceptions in burn...
Article
Introduction Pre-existing comorbidities in burn survivors increase the risk of death and negatively impact quality of life. Investigations to date have only evaluated comorbidities as cumulative indices, which prevents identification of specific conditions for risk reduction after injury. Therefore, we aimed to evaluate the differential effects of...
Article
Introduction The effects of inhalation injury on mortality are well established. However, little is known about the long-term impacts of inhalation injuries on survivors. This study aims to describe the inhalation injury population and examine differences in long-term physical, mental, employment, and satisfaction with life outcomes between adult b...
Article
Introduction: Despite many advances in burn care, the development of extremity contracture remains a common and vexing problem. Extremity contractures have been documented in up to one third of severely burned patients at discharge. However, little is known about the long-term impact of these contractures. The purpose of this study was to examine...
Article
Introduction: Patients who sustain burn injuries are frequently transferred to regional burn centers. Severely injured patients, unlikely to survive, may be transported far from home and family to die shortly after arrival. An examination of early deaths, those that happen within a week of transfer, may offer an opportunity to revise the way we th...
Article
Burn survivors who misuse alcohol and/other substances have been associated with poorer long-term outcomes and clinical complications following injury. The self-reported CAGE questionnaire (Cut down, Annoyed, Guilty, and Eye-opener) is an outcomes assessment tool used to screen for potential substance misuse. Understanding the persistence and emerg...
Article
Participant attrition in longitudinal studies can lead to substantial bias in study results, especially when attrition is non-random. A previous study of the Burn Model System (BMS) database prior to 2002 identified participant and study related factors related to attrition. The purpose of the current study was to examine changes in attrition rates...
Article
Competence in healthcare is a recognized expectation by consumers. In 2018 following an extensive review and consensus-building process, burn nursing practice competencies were published. Clinical nurse leaders were called upon to use these published competencies in practice as a basis for the requisite knowledge and skills needed in the care of th...
Article
Objective: To investigate the impact of patient and injury characteristics on employment for working-age, adult burn survivors using the multicenter Burn Model System national database. Design: Longitudinal survey; Setting: Multicenter regional burn centers PARTICIPANTS: Adult burn survivors (n=967) age > 18 years with known employment status pr...
Article
Introduction: Electrical injuries exhibit significant acute and long-term sequelae. Amputation and neurological deficits are common in electrical injury survivors. There is a paucity of information on the long-term outcomes of this population. Therefore, this study examines the long-term outcomes of electrical injuries by comparing them to fire/fl...
Article
Introduction: Opioid overuse is a growing patient safety issue but continue to be integral to burn pain management. This study aims to characterize opioid use in discharged patients and factors for predictive of long term use. Methods: Participants with burns admitted to a single center from 2006 to 2015 were included. Total outpatient morphine...
Article
Introduction: Appropriate graft healing after split-thickness skin graft and early recognition of complications (graft loss) are critical to burn patient management. Larger mesh ratio expansions and Meek micrografting may pose a greater challenge in estimating the percentage of wound healing. This study looks at the reliability of photograph asses...
Article
The number of delirium days in hospitalized patients directly correlates with mortality and long-term cognitive dysfunction. Burn patients are at greater risk for delirium due to prolonged mechanical ventilation, high sedative and analgesic medication requirements, and the common need for multiple operations. Limited research exists on nurses’ unde...
Article
Gabapentin has analgesic efficacy for neuropathic pain and is increasingly used in burn care. This study investigated the effect of a neuropathic pain control protocol, as well as early gabapentin initiation (< 72 hours from injury) on total inpatient opioid use, chronic pain, and itch. This is a single-institution retrospective cohort study of pat...
Article
Introduction Contact burns are a common type of burn injury seen frequently in the inpatient setting. They are responsible for up to 9% of all burns in the American Burn Association National Burn Repository, making them the third leading etiology for hospital burn admissions. This study aims to explore risk factors and possible prevention strategie...
Article
Introduction Burn survivors report that pruritus (also categorized as neuropathic pain) is common for years after injury and can affect all aspects of quality of life. Pharmacological interventions have not consistently shown to be effective and often have side effects. Hypnosis has been successfully used to treat burn pain and nonburn-related prur...
Article
Introduction Burn survivors have surgical needs after their incident hospitalization. Little is understood regarding what predicts these operations and their effect on patient reported outcomes (PROs). We aim to characterize the use of burn-related operations post-hospitalization and determine whether PROs change during this time. We hypothesized i...
Article
Introduction Despite many advances in burn care, the development of extremity contracture remains a common and vexing problem. Extremity contractures have been documented in up to one third of severely burned patients at discharge. However, little is known about the long-term impact of these contractures. The purpose of this study was to examine ra...
Article
Introduction The self-reported CAGE substance use tool (Cut down, Annoyed, Guilty, and Eye-opener) screens for potential problems with alcohol or drug use. This study aims to examine the prevalence of substance use in the Burn Model System (BMS) National Database adult population by reviewing CAGE substance use scores and trajectories over time fol...
Article
Introduction Successful burn care should facilitate comprehensive, functional recovery after an injury. But we have a poor understanding of which risk factors influence long-term outcomes after burn injury. Studies have correlated hospital-acquired complications (HACs) with poor long-term outcomes in some populations. The purpose of this study was...
Article
Amputations following a burn injury, although infrequent, may impact community re-integration and create a barrier to returning to work. The objective of this study was to compare patient and injury characteristics, quality of life, and employment status for those with and without amputation using a national longitudinal database of people with bur...
Article
Background The Burn Specific Health Scale-Brief (BSHS-B) evaluates 9 aspects of health and has been validated globally. Existing reports typically focus on outcomes shortly after injury. The purpose of this study is to determine whether quality of life remains a concern for burn survivors ten years after-injury. Methods Cross sectional data of sur...
Article
Introduction Little is understood about the inpatient experience from the burn patients’ perspectives. Rather, hospitals emphasize quantitative feedback as part of the ongoing process improvement. Comments returned with the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) administrative survey may provide important patient...
Article
Introduction: The advent of consoles that deliver both interactive games and therapy may augment rehabilitation options in burn patients. The Jintronix software combines therapy-specific software and interactive gaming as a form of coaching and records patient performance on the Kinect® platform. Our objective was to determine the feasibility of a...
Article
Introduction Burn care outreach education is essential to improving regional care and is required for verification by the American Burn Association. Our center has developed a 2-day course targeting remote and rural providers in our region. The curriculum is tailored to providers who have requested burn education extending beyond the first 24 hours...
Article
Introduction Although the general research on body image has shown that there are associations between ethnicity and perceptions of body image, to our knowledge, no studies have examined the relation between satisfaction with appearance and ethnicity after a burn injury. The purpose of the study was to determine the impact that ethnicity has on sat...
Article
Introduction Past research has demonstrated that a burn injury negatively affects quality of life, especially in patients with more serious injuries. Clinicians and researchers often use need for surgery to achieve wound closure as a surrogate for severity of burn injury. This study assessed quality of life based on the 10-item Global Health Scale...
Article
Introduction Returning to work following a traumatic injury is an important milestone. Data from multiple, single-center studies suggest that most adult burn survivors return to work, but that multiple factors delay or prevent return to work (RTW) for some. The objective of this study was to compare patient and injury characteristics and employment...
Article
Introduction Health literacy represents the degree to which individuals have the capacity to obtain, process and understand basic health information to make appropriate decisions. Limited health literacy affects people of all ages, races, educational and socioeconomic levels. Nearly 90% of adults have been reported to have difficulty using health i...
Article
Introduction Patients who sustain burn injuries are frequently transferred to regional burn centers. Severely injured patients may be transported far from home and family to die shortly after arrival. An examination of early deaths within a week of transfer may offer an opportunity to revise the way we think about critical burns and the best way to...
Article
Introduction Effective pain management is essential after burn injury. We describe pain intensity and interference at discharge from hospital and at 1-year post injury in burn survivors, and compare them to the general population (GP) and people with traumatic brain injury (TBI) and spinal cord injury (SCI). Methods PROMIS pain intensity (average...
Article
Introduction Electrical burns are severe injuries that often result in a different set of complications than other types of burns. The objective of this study is to examine long-term physical, mental health, and employment outcomes of burn survivors with electrical injuries and compare them to those of survivors with fire/flame injuries. Methods D...
Article
Introduction Appropriate graft healing after split-thickness skin graft and early recognition of complications (infection, graft loss, shearing) are critical to burn patient management. Whereas prior retrospective studies have indicated good accuracy of providers’ bedside and photo assessments for graft ratios up to 1.5:1, it remains unclear whethe...
Article
Introduction Opioid overuse is a growing patient safety issue in the United States. Despite this, the use of these medications continues to be integral to pain management for burn patients. This study aims to characterize opioid use in discharged patients and factors predictive of long term use. Methods With IRB approval, we reviewed participants...
Article
Introduction Burns are the fifth most common cause of non-fatal childhood injuries with approximately 6,000 children cared for every year in US burn centers. Although providers routinely educate patients about their injury and wound care needs, children and families still experience significant anxiety. Few standardized resources exist to explain w...
Article
Introduction Burn survivors report physical and mental health concerns long after their burn wounds have healed. Many issues impact recovery, but specific predictive characteristics are limited. As part of our outpatient screening process to evaluate recovery, adult outpatients complete the PROMIS-10® Global Health Scale (GHS). Summary scores from...
Article
Successful acquisition of survey data in any longitudinal study is key to reducing bias and determining reliable, generalizable findings. As part of a multicenter longitudinal study of patient-reported outcomes, a minimum benchmark for follow-up was set at 80%. In review of our center’s participation, we found this benchmark was not consistently me...
Article
Objective: To identify important sources of distress among burn survivors at discharge and at 6, 12 and 24 months post injury, and to examine if the distress related to these sources changed over time. Design: Exploratory. Setting: Outpatient burn clinics in 4 sites across the country. Participants: A total of 1009 participants who met pre-s...
Article
Competency standards for nurses who specialize in the care of burn-injured patients are lacking. Currently, there are no nationally agreed on standards that define safe and competent burn nursing practice. In 2014, nurse members of the American Burn Association proposed the Burn Nurse Competency Initiative (BNCI) with the intent of establishing a c...
Article
This report from a single center describes 15 patients with injuries caused by explosions of e-cigarettes that occurred over a period of less than a year. Patients had a combination of flame burns, chemical burns, and blast injuries.