Longitudinal Trajectories of Health-Related Quality of Life and Life Satisfaction After Major Burn Injury: A Multicenter Cohort Study

Abstract Advances in burn care have markedly improved survival after major injuries. However, survivors often experience significant physical and psychosocial sequelae. We aimed to characterize long-term health-related quality of life (HRQoL) among burn survivors to inform expected trajectories, rehabilitation needs, and common impairments. Adult burn survivors from a multicenter, longitudinal cohort study were stratified into 20–49.9%, 50–69.9%, and ≥70% total body surface area burn size groups. Patient-reported physical and mental HRQoL and life satisfaction were assessed using validated outcome measures at discharge (pre-injury recall), 6, 12, 24 months, and 5 years post-injury. Standardized summary scores were derived using validated bridges. Mixed-effects linear regression models evaluated longitudinal changes and between-group differences. A total of 1,113 participants were analyzed. All outcomes declined early after injury but improved progressively thereafter. Notably, by 24 months, mental health and life satisfaction approached pre-injury levels across all burn size groups. Physical health deficits were greater with increasing burn size, with significant net differences relative to the 20-49.9% reference group (p.0001). Mental health and life satisfaction outcomes showed minimal between-group differences overall, though individuals with the largest burns exhibited significantly better relative mental health at 24 months (p.05). Although outcomes improve over time following major burn injury, persistent physical deficits support the classification of major burns as a chronic condition. These findings characterize burn size–specific recovery trajectories and demonstrate that, despite persistent physical deficits, mental health and life satisfaction can return to near pre-injury levels even after the most extensive injuries.