Factors Impacting Delayed Return to School Among Children Living with Burn Injury: A Burn Model System Study

Return to school is a key indicator of rehabilitation effectiveness for school-age children with burn injuries. Previous studies reported on the timing of return to school but have not delineated how individual and injury characteristics impact RTS due to single-center analyses and limited sample sizes. Our goal is to provide factors to consider when providing guidance and benchmarking days to RTS and allocating rehabilitation resources after burn injury. We analyzed data from a multicenter, longitudinal cohort study of US school-age children between the ages 5 and 17 years who required operation for wound closure and their parents/guardians. Days from index hospital discharge to return to school by self- or parent/guardian-report were recorded via surveys. The associations between days to return to school and age, sex, burn size, body region of injury, inhalation injury, number of operations, and month of discharge were examined using multivariable mixed-effects Poisson regression analyses with robust standard error estimates. Data from 266 participants were analyzed. The median days to return to school after hospital discharge were 43 (IQR 21.5-81 days). Days to return to school after discharge in school-age children with burn injuries were significantly longer among 12-14-year-olds, boys, and children whose fire/flame injury had had ≥5% TBSA, inhalation injury, head/neck injury, more operations, and were discharged during the school year months. Future research should explore children's experiences with barriers in school settings and develop mitigation strategies addressing both clinical and non-clinical aspects of burn aftercare to enhance care for children with burn injuries.