PreMorbid Mobility Impairments Increase Likelihood of Shelter Discharge After Burn Hospitalization: A Burn Model System Database Study

Burn injuries are functionally limiting, and premorbid mobility impairments may further complicate recovery. Premorbid mobility impairments are associated with worse outcomes in other populations; however, their role in burn recovery remains unclear. This retrospective cohort study included adult burn survivors injured from 2014 to 2025, from the Burn Model System National Burn Database. Premorbid mobility impairment was defined as self-reported pre-burn physical problems or impairments affecting mobility (difficulty moving your arms, legs, or body). Outcomes included length of stay, discharge disposition, and PROMIS Global Mental Health scores at 6- and 12-month follow-up post injury. All regression models were adjusted for age, total body surface area (TBSA), and inhalation injury. The model for Global Mental Health scores additionally adjusted for discharge location, Global Physical Health, pre-injury Global Mental Health, and follow-up time. A total of 1,372 adult burn survivors were included, with a mean age of 46.2. Premorbid mobility impairments was associated with longer hospital stay (IRR 1.15, 95% CI [1.04 - 1.27], P = 0.006,) and discharge to shelter (OR 1.75, 95% CI [1.41- 2.19], P < 0.001). There was also a trend toward lower PROMIS Mental Health scores among survivors with premorbid mobility impairments (β = -1.92, P = 0.091). Premorbid mobility impairment is associated with poorer burn outcomes, including longer hospital stay and discharge to unstable settings such as shelters, and may also be linked to poorer mental health outcomes. It remains unclear whether shelter discharge reflects premorbid housing instability or a new post-burn disposition.