Burns in the elderly: a nationwide study on management and clinical outcomes

Abstract

Background In modern-day burn care, advanced age remains an important predictor for mortality among burn victims. In this study, we compared the complete treatment trajectory (including pre-hospital and surgical treatment) and the outcomes between an elderly burn population and a younger adult burn population. Methods In this nationwide study, data from the Dutch Burn Repository were used. This is a uniform national registration for Dutch specialized burn care. All adult patients that were admitted to one of the three Dutch burn centres from the period 2009 to 2015 were included in the analysis. Burn patients were considered as elderly when ≥65 years of age, and were then further subdivided into three age categories: 65–74, 75–85 and 85+ years. Younger adults in the age category 18–64 years were used as the reference group. Surgical management was studied comprehensively and included timing of surgery, the number of procedures and details on the surgical technique, especially the technique used for debridement and the grafting technique that was applied. For the comparison of clinical outcome, the following parameters were included: mortality, wound infections, length of stay/TBSA (total body surface area) burned, discharge disposition and secondary reconstructions. Results During the study period, 3155 adult patients were included (elderly, n = 505). Burn severity, reflected by the median TBSA, varied between 3.2–4.0% and was comparable, but aetiology and pre-hospital care were different between elderly and the younger adult reference group. Surgical treatment was initiated significantly faster in elderly burn patients (p < 0.001). Less selective techniques for surgical debridement were used in the elderly burns patients (hydrosurgery, 42.0% vs 23.5–22.6%), and on the other hand more avulsion (5.3% vs 7.3–17.6%) and primary wound closure (6.7% vs 24.5%). The most frequently used grafting technique was meshed skin grafts (79.2–88.6%); this was not related to age. Mortality increased rapidly with a higher age and showed a high peak in the 85+ category (23.8%). Furthermore, considerable differences were found in hospital discharge disposition between the elderly and the reference group. Conclusions In conclusion, elderly burn patients who require specialized burn care are vulnerable and medically challenging. Differences in aetiology, comorbidity, physiology and the management prior to admission possibly affect the initial surgical management and result in significantly worse outcomes in elderly. Elderly patients need optimal, timely and specialized burn care to enhance survival after burn injuries.

Epidemiological and clinical characteristics of elderly burns：A 15-year retrospective analysis of 2554 cases in Wuhan Institute of Burns

“…At present, the reported proportion of elderly burns in China has increased from 3.4% [ 9 ] (patients admitted from 1999 to 2004) or 3.8% [ 7 ] (patients admitted from 2003 to 2009) in the early stage, to 7.5% [5] (patients admitted from 2010 to 2016) in the recent stage. This study showed that the proportion of elderly burns has increased from 5.7% in 2004 to 8.6% in 2018, which was generally consistent with previous reports, but lower than that in developed countries such as the Netherlands [ 10 ] (10.0%, patients admitted from 2009 to 2015), the United States [ 11 ] (10.1%, patients discharged from 1997 to 2010). This may be related to the lack of medical resources and ability to pay for medical expenses in China, leading to more elderly burns being treated in outpatient clinics or even at home.…”

“…The treatment of elderly burns involves many problems such as medical aid system and social ethics [6,10]. In this study, 34 patients (1.3%) gave up treatment by themselves or their families.…”

Colistin Therapy, Survival and Renal Replacement Therapy in Burn Patients: A 10-Year Single-Center Cohort Study

“… 7 , 28–30 Our data showed that in colistin-treated patients the overall mortality rate of 37.6% (50/133 patients) was related to older age, a higher percentage of third-degree burn areas, and severity of AKI, all well-known risk factors for death in the general burn population. 31 , 32 In the same way, by comparing colistin- and other antibiotic-treated groups, we found that a higher mortality rate and the severity of the burn were more frequently associated with MDRGN strains such as Acinetobacter baumannii , Pseudomonas aeruginosa and Klebsiella pneumoniae maintaining colistin as a unique sensitivity to antibiotics. In effect, the patients of the control group presented different types of MDRGN strains, and they were also treated with the new antibiotics specifically active against MDRGN when appropriate.…”

Comparing Auditory and Visual Distractions for Reducing Pain Severity and Pain Anxiety in Older Outpatients with Burn: A Randomized Controlled Trial

“…Older people are at high risk of burn injuries and related adverse outcomes due to cognitive impairment, low immunity, slow wound healing, and decreased mobility [ 4 , 5 ]. Moreover, painful diseases including osteoarthritis, diabetic neuropathy and lower back pain make older people more vulnerable to the negative consequences of burn injuries compared with younger adults [ 6 , 7 ].…”