# From Injury to Independence: Investigating the Impact of Hand Burn Severity on Functional Outcomes in Children and Adolescents Followed for 24 Months After Injury—A Prospective Cohort Study

## TL;DR

Higher hand burn severity in children is linked to worse hand function, especially early on, suggesting the need for early rehabilitation planning.

## Contribution

This study shows that the Hand Burn Severity Score (HABS) can predict functional outcomes in children with hand burns over 24 months.

## Key findings

- Higher HABS scores correlate with worse upper extremity function in children 2–6 months post-burn.
- Higher HABS scores are independently linked to poorer patient-reported outcomes across 24 months.
- HABS may help identify children needing targeted rehabilitation and monitoring.

## Abstract

What are the main findings?
Higher Hand Burn Severity Scores (HABS) at the time of injury were significantly associated with worse upper extremity functional outcome in children, particularly in the early post-burn period (2–6 months).Higher HABS was independently associated with poorer patient-reported function on PROMIS-UE8 across the full 24-month follow-up period.

Higher Hand Burn Severity Scores (HABS) at the time of injury were significantly associated with worse upper extremity functional outcome in children, particularly in the early post-burn period (2–6 months).

Higher HABS was independently associated with poorer patient-reported function on PROMIS-UE8 across the full 24-month follow-up period.

What are the implications of the main findings?
HABS may serve as a useful early risk stratification tool to identify pediatric patients at higher risk for functional impairment, enabling targeted monitoring and intervention.Early rehabilitation planning and resource allocation may be particularly important for children with higher HABS scores to optimize long-tern upper extremity outcomes.

HABS may serve as a useful early risk stratification tool to identify pediatric patients at higher risk for functional impairment, enabling targeted monitoring and intervention.

Early rehabilitation planning and resource allocation may be particularly important for children with higher HABS scores to optimize long-tern upper extremity outcomes.

Background: Hand burns are common in children and can result in long-term functional impairment. The Hand Burn Severity (HABS) score is an anatomy-specific measure of hand burn severity, but its relationship to functional outcomes in pediatric patients has not been well defined. The purpose of this study was to determine whether HABS, measured at the time of injury, is associated with longitudinal upper extremity functional outcomes in children. Methods: We conducted a 24-month prospective longitudinal study of children aged 2–18 years with hand burns. Burn severity was determined using HABS at enrollment, and outcomes were measured using the Burn Outcomes Questionnaire (BOQ) and the eight-item Patient-Reported Outcomes Measurement Information System-Upper Extremity (PROMIS-UE8). Repeated-measures linear regression models evaluated associations between HABS and outcomes over time, adjusting for age, dominant- and bilateral-hand involvement, and surgery. Results: A total of 119 children with 165 hand burns were enrolled. Higher HABS scores, indicating more severe injury, were significantly associated with lower BOQ upper extremity function domain scores, indicating poorer health, at 2- and 6-months post burn, but not at later time points. Higher HABS scores were independently associated with lower patient-reported PROMIS-UE8 scores, indicating poorer health, across the 2-year follow-up period. Conclusions: These findings indicate that higher HABS scores at the time of injury are associated with poorer upper extremity outcomes, particularly in the early post-burn period, suggesting that HABS may help identify children who could benefit from closer monitoring or early rehabilitation planning.