Short-term and long-term increased mortality in elderly patients with burn injury: a national longitudinal cohort study

Abstract

Background The population of elderly patients with burn injuries is growing. Insight into long-term mortality rates of elderly after burn injury and predictors affecting outcome is limited. This study aimed to provide this information. Methods A multicentre observational retrospective cohort study was conducted in all three Dutch burn centres. Patients aged ≥65 years, admitted with burn injuries between 2009 and 2018, were included. Data were retrieved from electronic patient records and the Dutch Burn Repository R3. Mortality rates and standardized mortality ratios (SMRs) were calculated. Multivariable logistic regression was used to assess predictors for in-hospital mortality and mortality after discharge at 1 year and five-year. Survival analysis was used to assess predictors of five-year mortality. Results In total, 682/771 admitted patients were discharged. One-year and five-year mortality rates were 8.1 and 23.4%. The SMRs were 1.9(95%CI 1.5–2.5) and 1.4(95%CI 1.2–1.6), respectively. The SMRs were highest in patients aged 75–80 years at 1 year (SMRs 2.7, 95%CI 1.82–3.87) and five-year in patients aged 65–74 years (SMRs 10.1, 95%CI 7.7–13.0). Independent predictors for mortality at 1 year after discharge were higher age (OR 1.1, 95%CI 1.0–1.1), severe comorbidity, (ASA-score ≥ 3) (OR 4.8, 95%CI 2.3–9.7), and a non-home discharge location (OR 2.0, 95%CI 1.1–3.8). The relative risk of dying up to five-year was increased by age (HR 1.1, 95%CI 1.0–1.1), severe comorbidity (HR 2.3, 95%CI 1.6–3.5), and non-home discharge location (HR 2.1, 95%CI 1.4–3.2). Conclusion Long-term mortality until five-year after burn injury was higher than the age and sex-matched general Dutch population, and predicted by higher age, severe comorbidity, and a non-home discharge destination. Next to pre-injury characteristics, potential long-lasting systemic consequences on biological mechanisms following burn injuries probably play a role in increased mortality. Decreased health status makes patients more prone to burn injuries, leading to early death.

The effectiveness of the psychosocial empowerment program in early adjustment among adult burn survivors

“…In contrast, results diverge from studies that position age as the sole determinant of coping, or those that undermine the importance of degree of burn [ 74 – 77 ]. This discrepancy invites a deeper exploration of coping dynamics, suggesting a more complex interplay of factors than previously understood.…”

The timing of death in burn patients

“…This result is similar to that of previous studies and supports the utility of the PBI and Baux score as prognostic indicators. 8 , 9 , 10 …”

“…However, few paper focused on the chronic death, if any, the cause of death is not analyzed in detail. 8 , 9 , 11 , 12 , 22 , 23 These studies focused primarily on post‐discharge evaluation, not examine the time during hospitalization when so‐called PIICS may begin to occur. We analyzed the period around 6 months, when the systemic immune response is likely to be out of balance, and the result proves our hypothesis that there are many deaths even in the chronic phase of burns.…”

“…According to some research, patients with burns, regardless of their severity, have lower long‐term mortality than the general population, but the timing and cause of death during each burn phase period have not been analyzed in detail. 8 , 9 , 10 , 11 …”

Estudo epidemiológico acerca dos óbitos por queimaduras no estado do Piauí entre 2016 e 2021

“…Quanto aos tipos, dividem-se em: químicas, térmicas, radioativas, biológicas e elétricas. Outra característica é que, em queimados, a gravidade da infecção varia de acordo com as características da lesão, pela etiologia, classificação, manejo e resposta imunológica de cada paciente (Rocha et al, 2020;Cords et al, 2023;Hernández et al, 2022).…”