Assessing Clinical Outcomes at Discharge with the Modified Rankin Scale (mRS) for Burn Patients
Submitted by K. Coles, S. Daniel, S. Kopf, G. Milligan, & L. Steadman
Tags: burn Burn Patients clinical Modified Rankin Scale outcome
Introduction
Burn injury is a significant health problem that presents various challenges to the patient and healthcare providers. Each year in the United States, an estimated 486,000 burn injuries require medical attention, of which 40,000 require hospitalization (American Burn Association, 2016). Of these 40,000 around 30,000 are admitted to specialized burn centers, specializing in burn care and management. Statistics reveal that the common causes of burns are due to fire/flame at 43%, scalds 34%, contact 9%, electrical 4%, chemical 3%, and other 7%. (American Burn Association, 2016). The most common place of occurrence was in the home at 73%. Burns occur in children and adults, affecting 68% of males and 32% of females. Also reported by the American Burn Association (ABA) was a survival rate for all cases at 96.8% (2016). Furthermore, a reported survival rate of 96.8% for all cases by the ABA (2016), underscores the importance of comprehensive care for burn patients, which begins at the time of injury and extends throughout the rehabilitation process. An optimal outcome is achieved when the patient is reintegrated back into society at a functional preinjury level (Herndon, D. 2017).
Through the efforts of the members of the interdisciplinary Burn Team (IBT), education provided to patients with burns helps to provide the burn survivor with a better understanding of their individual care experience during hospitalization while also promoting patient participation in activities required for their recovery, such as physical and occupational therapy, diet modification, wound care, and pain management. Through the collaboration of the members of the IBT, their clinical expertise, knowledge, and skills help to ensure that patients receive the best care and help to improve their outcomes.
These authors propose that since the Modified Rankin Scale (mRS) is predominantly utilized primarily by physical and occupational therapists who care for burn patients, to evaluate physical and cognitive impairments, nurses might have limited awareness and appreciation of the tool's significance, potentially leading to passive participation within the healthcare team.
Therefore, this article aims to examine the usefulness of the mRS with burn patients and the importance of including mRS education as part of the onboarding process for new burn unit nurses.
Discussion
The Modified Rankin Scale (mRS) is a valuable tool widely used in healthcare settings, particularly in the assessment of patients with stroke and other neurological conditions (Table 1). The mRS was developed by Dr. John Rankin; this scale provides a standardized method for evaluating functional disability and outcomes among patients. Understanding the mRS is essential for healthcare professionals, as it plays a crucial role in guiding treatment decisions, predicting prognosis, and facilitating communication among interdisciplinary teams. (Pożarowszczyk et al. 2023). This scale, ranging from Category 0 to 6, serves as a disability scale wherein Category 0 signifies perfect health, while Category 6 represents death.
The primary function of the mRS is to determine the level of functionality and one's ability to care for themselves on admission and at time of discharge. The mRS serves as a valuable prognostic tool, with higher scores correlating with elevated rates of long-term disability and mortality. Patients with higher mRS scores typically experience reduced functional ability, necessitating greater support, and may struggle to perform basic activities of daily living (Rangaraju, S., Haussen, D., Nogueira, R. G., Nahab, F., & Frankel, M. 2017). The ability to grade the functional status early will help determine discharge needs, thus predicting support requirements early in the hospitalization. This scale is particularly useful in helping healthcare teams tailor interventions and treatment plans based on the severity of impairments.
While the mRS is used and has shown to be a valid interdisciplinary tool for the assessing and evaluating physical and cognitive impairments for post-burn injury (Kumar et al., 2020), this comprehensive tool can be used in address the multifaceted needs of burn patients throughout their recovery journey. The IBT strives to assist the burn survivor in achieving optimal functional outcomes. The quality of care provided to the burn patient by burn team experts significantly affects the burn survivor's survival rate and functional recovery.
An IBT typically consists of medical and nursing personnel, a burn care coordinator, a social worker, a wound care team, physical and occupational therapists (PT/OT), dietitians, pharmacists, and a chaplain. An IBT led by expert leadership facilitating the efforts of multiple disciplines with common goals and values can produce more efficient outcomes for the patient (Herndon, D. 2017). The burn patient will fulfill the basic relatedness need by interacting with team members and building trust. Frequent open communication will potentially reinforce the working relationship of the patient with the healthcare providers, supporting compliance with the therapeutic exercise programs, diet plans, and wound care necessary for recovery.
Conversely, patients with fewer burns and a lower mRS score are more likely to be candidates for early discharge, given decreased support. Utilizing tools such as the mRS to identify functional needs at discharge will only serve as a positive patient care initiative and help identify needed resources during hospitalization and discharge. The mRS is an outcome measurement tool to determine treatment effects, show clinical improvement, and classify patient outcomes.
Understanding a burn patient's mRS score can help to identify rehabilitation plans and assist in setting realistic goals for recovery. Overall, the mRS serves as an essential measure in assessing the impact of burn injuries on patients' functional outcomes and guiding their journey toward recovery.
Conclusion and Impact
A thorough understanding of the mRS is essential for healthcare burn teams involved in caring for patients with physical and cognitive deficits. Incorporating education on the mRS into professional development programs, healthcare institutions can enhance interdisciplinary collaboration, improve patient outcomes, and ensure the delivery of high-quality care across the continuum of treatment and rehabilitation.
The mRS is proven to be valid and reliable for assessing the physical and cognitive needs of patients with neurological deficits. (Rangaraju, S., Haussen, D., Nogueira, R. G., Nahab, F., & Frankel, M. 2017). Patients requiring hospitalization for burn injuries often require extensive assessment of their physical and cognitive status at the time of admission and during the extent of their hospital stay. Nursing care begins at the time of admission. It continues throughout a patient’s hospital stay, placing nurses in the ideal position to assess the patient utilizing the mRS and updating the IBT regarding the patient’s functional status. The application of the mRS by nursing staff can provide information regarding physical and cognitive deficits to assist all members of the IBT in prioritizing care needs. Consistent application of the mRS can provide real-time data regarding a patient’s readiness for discharge by providing information to the IBT regarding a patient’s willingness and ability to transition from acute care to inpatient rehabilitation or outpatient therapy. Ideally, the application of the mRS can potentially maximize inpatient treatment by identifying functional deficits early and focusing care to overcome those deficits. This will help to minimize the patient’s time in acute care while facilitating the transition from the acute care setting into the rehabilitation setting.
References
- American Burn Association. (2016). Burn Incidence and Treatment in the United States: 2016 Fact Sheet. Retrieved March 14, 2024, from the American Burn Association Web site: http://www.ameriburn.org/resources_factsheet.php?PHPSESSID=a2285ea8680d8964619c
- Herndon, D. (2017). Total Burn Care (5th ed.). Philadelphia, PA: Elsevier.
- Kumar, A., Iyer, P., & Allareddy, V. (2020). Modified Rankin Scale. In StatPearls [Internet]. StatPearls Publishing.
- Pożarowszczyk N, Kurkowska-Jastrzębska I, Sarzyńska-Długosz I, Nowak M, Karliński M. Reliability of the modified Rankin Scale in clinical practice of stroke units and rehabilitation wards. Frontiers in Neurology 2023 Mar 3;14:1064642. doi: 10.3389/fneur.2023.1064642. PMID: 36937517; PMCID: PMC10020493.
- Rangaraju, S., Haussen, D., Nogueira, R. G., Nahab, F., & Frankel, M. (2017). Comparison of 3-month stroke disability and quality of life across modified Rankin Scale categories. Interventional Neurology, 6(1-2), 36-41. doi/10.1161/STROKEAHA.117.017866
Table1 Modified Rankin Scale used to measure physical and cognitive outcomes and identify disabilities
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MODIFIED RANKIN SCALE |
||||
|
|
Disability |
ACTIVITIES |
Supervision |
|
|
PERFORMS WITHOUT ASSISTANCE |
PERFORMANCE MAY REQUIRE ASSISTANCE |
|||
|
Rankin 0 |
None |
*All usual tasks |
*None |
*None |
|
Rankin 1 |
None significant |
*Dressing, toileting, eating, cooking, walking *Previous work *Social & leisure activities |
*None |
*None |
|
Rankin 2 |
Slight |
*Dressing, toileting, eating, cooking, walking *Personal & financial affairs |
*Driving, reading, working, dancing
|
*Weekly visits
|
|
Rankin 3 |
Moderate |
Dressing, toileting, eating |
*Walking with walking aid *Shopping, cooking, cleaning *Financial affairs |
*More often than weekly visits |
|
Rankin 4 |
Moderately severe |
|
*Walking, dressing, toileting, eating *Financial affairs |
*Daily visits |
|
Rankin 5 |
Severe |
|
*All personal, and financial affairs (Bedridden, incontinent) |
*Constant care |
|
Rankin 6 |
Death |
|
|
|