Functional sequelae and disability assessment

Outcome from thermal injury depends on many factors other than severity of illness. Presently we perform formal impairment ratings only when asked by insurance companies, social security, worker's compensation, or the legal system. With increasing emphasis on quality improvement and outcomes, it is important for burn surgeons to factually document the result of their (and their patients') labors. Impairment ratings may be time-consuming while on the learning curve; however, they are a standardized way to evaluate and compare diverse outcomes of care. This chapter describes how to perform impairment rating for burn survivors. It draws on the diagnosis- and system-based method published by the American Medical Association in the Guides to the Evaluation of Permanent Impairment, now in its 6th edition, applying these concepts to the typical sequelae of burn convalescence. A systematic approach to evaluating outcomes in this manner should be considered in all burn centers.