Influence of Comorbidities and Age on Outcome Following Burn Injury in Older Adults

Abstract

Despite advances in medical and surgical techniques, older adults tend to be at high risk for adverse outcomes following burn injury. The purpose of this study was to examine the relative impacts of age and medical comorbidities on outcome following injury in a cohort of older adults. This was a retrospective study of all patients age 55 and over admitted to the University of Washington Burn Center from 1999 to 2003. To examine the effect of baseline medical comorbidities on outcome, a Charlson Comorbidity Index score was calculated for each patient. Multivariate regression analyses were used to examine the impact of age and comorbidities on mortality and other complications. Patient records were also matched with the National Death Index to determine the effects of age and comorbidities on mortality within 1 year following hospital discharge. A total of 325 patients who were of 55 years and older were admitted to the burn center during the 5-year study period. The overall mortality rate was 18.5%. Mortality was independently associated with age, inhalation injury, and burn size. One-year mortality was significantly associated with those older than age 75 and the Charlson score. Longer length of stay was significantly associated with burn size, inhalation injury, and total number of in-hospital complications. This study demonstrates that patient age—independent of baseline medical comorbidities—and TBSA burn are the most significant factors impacting in-hospital mortality risk following burn injury. Higher number of medical comorbidities was associated with increased mortality risk within 1 year following discharge.

Inclusion of coexisting morbidity in a TBSA% and age based model for the prediction of mortality after burns does not increase its predictive power

“…More precisely, inclusion of pre-existing medical conditions increased the predictive power of the model minimally, but not significantly. We confirmed what had already been verified by older samples [15]: that age alone, independent of coexisting conditions, increases the risk of mortality in hospital. However, age is one of the factors used in Galeiras's equation and, as is evident from our tables, coexisting morbidities are already adjusted for in the original model by age.…”

“…Clinical observations have suggested that the patient's coexisting diseases may play an important part in the likelihood of survival after a burn, but their impact on the risk of death is controversial [15,19,20,[24][25][26] and deserves further examination. However, we think that a limitation in many models is the lack of proper data about coexisting diseases, and we hypothesised that adding the information to a model with otherwise good predictive ability [10] could further improve the model.…”

“…Since then several models have been developed and many different variables have been introduced. Mortality increases with age and the size of the burn, and inhalation injury often worsens the prognosis [5,9,10,15,16]. The role of sex, however, is conflicting [5,[17][18][19][20][21][22][23].…”

Measured Effect Magnitude of Comorbidities on Burn Injury Mortality

“…It has undergone several modifications and has been utilized and validated in other surgical patient cohort. [23][24][25][26][27][28][29] …”

Outcome of burn care : the mortality perspective

“…54,55 Patients with burns are injured, not ill; they are younger than most of those in a general intensive care unit, and their pre-existing medical conditions differ. 51,56 These factors may all carry a survival advantage, which made us hypothesise that the long-term prognosis would be better for patients with burns than for those in the general intensive care unit.…”