Gretchen J. Carrougher

University of Washington | UW · Department of Surgery

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...

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...

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...

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...

Background A national database is used to evaluate pediatric burn survivor outcomes, but the generalizability to the United States pediatric burn injury population is unclear, as only 60% of enrollees are U.S. residents. An increased understanding of population similarities and differences between residents of the United States and residents of Mex...

In this study, we aimed to integrate a genetic repository with an existing longitudinal national burn database. We set out two primary objectives, namely (1) to develop standard operating procedures for genetic sample collection and storage, DNA isolation, and data integration into an existing multicenter database; and (2) to demonstrate the feasib...

Burn survivors are involved in burn research, but typically in the role of research subject. We believe that the outcomes and impact of burn research can be improved by engaging survivors as collaborators in the planning, implementation, and dissemination of burn research. The goal of this work was to produce the first burn research agenda generate...

Older adults are at a higher risk of complications after burn injuries since many physical and mental changes are compounded by increasing age. Few studies have targeted the long-term effects of burns on older adults. Therefore, this study will investigate the long-term physical and mental health outcomes in older adults. 3129 participants from the...

Burn injury can have a lasting impact on quality of life beyond the initial injury. The aim of this study was to examine the recovery process through analyzing the relationship between body image, physical function, and return to work. This study uses data from the Burn Model System (BMS) National Longitudinal Database and includes 1,001 participan...

Background Knowledge translation and consumer testing seeks to move clinical research from scientists, peer-reviewed journals, and conferences to the hands of end-users. The National Institute on Disability, Independent Living, and Rehabilitation Researched funded Burn Model System (BMS) and Model System Knowledge Translation Center (MSKTC) have wo...

Some severe burn injuries may warrant amputation; however, the physical and functional adjustments resulting from postburn amputation can have long-term consequences. This study investigates longitudinal functional and psychosocial outcomes among pediatric burn amputees. Pediatric participants enrolled in the Burn Model System national longitudinal...

Daily rehabilitation after burn injury is vital for prevention of function-limiting contractures. However, adherence to prescribed therapy following acute burn hospitalization has historically been low and not well-studied. Studies involving virtual reality technology have demonstrated an association with improved functional outcomes in burn therap...

Introduction Neuropathic pain (NP) is a poorly studied but common complaint of burn survivors and severely limits patients in regard to quality of life and function well after their burn injury. Currently, there is a paucity of data on the association between NP and its sequelae with burn survivors in the literature. As such, the purpose of this st...

Burn nurses care for patients throughout the recovery continuum.

Background Injuries are a leading cause of death and disability for Alaska Native (AN) people. Alaska Native Tribal Health Consortium (ANTHC) is supporting the development of a burn care system that includes a partnership between Alaska Native Medical Center (ANMC) in Anchorage, AK and UW Medicine Regional Burn Center at Harborview Medical Center (...

Objective To address the limited understanding of neuropathic pain (NP) among burn survivors by comprehensively examining its prevalence and related factors on a national scale using the Burn Model System (BMS) National Database. Summary Background Data NP is a common but underexplored complaint among burn survivors, greatly affecting their qualit...

Objective: To identify clinical factors (physical and psychological symptoms and post-traumatic growth) that predict social participation outcome at 24-month after burn injury DESIGN: A prospective cohort study based on Burn Model System National Database SETTING: Burn Model System centers PARTICIPANTS: 181 adult participants less than two years a...

Introduction: Understanding trajectories of recovery in key domains can be used to guide patients, families, and caregivers. The purpose of this study was to describe common trajectories of physical health over time and to examine predictors of these trajectories. Method: Adults with burn injuries completed self-reported assessments of their hea...

Introduction The care required to recover serious burn injuries is costly. In the US, these costs are often borne by patients. Examining the relationship between out-of-pocket (OOP) costs and health-related quality of life (HRQL) is important to support burn survivors. Methods Financial data from a regional burn center were merged with data in the...

Introduction Patients with major burns experience physiologic changes that can impact their recovery for months after hospital discharge. Little is known about sleep quantity and quality in the post-discharge period. Here, we report on actigraphy sleep data for participants enrolled in a prospective trial of home-based virtual rehabilitation. Meth...

Introduction State labor and industry benefits (L&I) include workers’ compensation, wage replacement, vocational rehabilitation (VcR), workplace accommodations, job retraining, and labor protections. These vital services are not available to working adults injured outside their workplaces. We aimed to examine the impact of L&I on quality-adjusted l...

Introduction People with burn injuries experience challenges in multiple domains including wound and scar management, pain/pruritus, psychosocial recovery, return-to-work, and community re-integration. Mobile software platforms can provide clear, concise, and consumable information across different stakeholder groups. These platforms require a user...

Introduction Disparities in pain experience and treatment amongst people of different races and ethnicities have been described for several conditions. However, the relationship between race, ethnicity, socioeconomic status (SES) and pain reported by people with burn injury is not well understood. This study compares pain intensity and interference...

Introduction The incidence of hypothermia and frostbite is increasing given larger numbers of people experiencing homelessness (PEH) across the country. Cold injuries create functional deficits that compound comorbidities of people who already experience disproportionate disability burdens. We collaborated with PEH to identify modifiable cold injur...

Introduction Patient-Reported Outcomes Measure System-10 (PROMIS-10) is a brief survey consisting of 10 items that evaluates patients’ global physical and mental health. PROMIS-10 was introduced into our burn clinic as a screening tool and serial measure of recovery. We aimed to assess the implementation of PROMIS-10 to improve its equitable use in...

Introduction The Burn Model System (BMS) collects longitudinal data on burn survivors. This provides a unique resource for the burn research community, however, as patients are only enrolled in select sites across the United States, it is important to examine how similar the BMS participants’ demographics and burn characteristics are compared to th...

Introduction People with burn injury often experience long-term social participation challenges. A previous study explored demographic and injury variables predicting social participation outcomes after burn injury. This study aims to further examine post-traumatic growth, and physical and psychological symptoms as predictors of social participatio...

Introduction Restoring cardiovascular fitness can be challenging during the first months after hospital discharge for adult burn patients. Furthermore, adherence to prescribed home therapy among people with burn injury has traditionally been low. We conducted a 5-year randomized controlled trial of 12-weeks of gamified virtual home therapy compared...

Introduction A large burn data set is being used to evaluate outcomes of pediatric burn survivors, but questions remain whether this data set is generalizable to the typical population of US burn centers as only 62% of enrollees are from the US. A better understanding of similarities and differences within this data set will help in the applicabili...

The care required to recover serious burn injuries is costly. In the US, these costs are often borne by patients. Examining the relationship between out-of-pocket (OOP) costs and health-related quality of life (HRQL) is important to support burn survivors. Financial data from a regional burn center were merged with data in the Burn Model System (BM...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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....

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...

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...

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...

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...

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...

Dear Editor, In 2020, the American Burn Association Nursing Professional Certification Committee (ABA-NPCC) sought specialty recognition for burn nursing from the American Nurses Association (ANA). With the submission of Burn Nursing: Scope and Standards of Practice,¹ the ANA asked the committee to outline 14 characteristics² for our specialty. Rec...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

Introduction The incidence of unintentional burn injuries provides a natural condition that induces guilt and other emotions, such as blame, in the parents of the inflicted child. Empirical evidence generated has suggested that the consequences of guilt include both prosocial behaviors and antisocial behaviors. Therefore, the effects of guilt on pa...

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...

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)...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...