Analysis on the characteristics of elderly severe burn in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine during 2005-2016

Abstract

Objective To explore characteristics of elderly severe burn patients and to provide evidence for the development of elderly severe burn treatment strategy. Methods A retrospective study about elderly severe burn with patients′ age over 60 years (including 60 years) and burn area over 30% total body surface area (TBSA) admitted to Department of Burns and Plastic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine was conducted between 1st January 2005 and 31st December 2016, by reviewed dates, age, gender, burn extent, etiology of burn, mechanism of injury, pre-injury conditions, complications following burn, inhalation injury, length of intensive care unit (ICU) stay of survived patients and the outcomes. Data were processed with analysis of variance of repeated measurement, one-way ANOVA, t test, rank-sum test, chi-square test, Fisher exact probability test and binomial test. Correlation was analyzed between data of age, gender, burn area, full thickness burn area, etiology of burn, mechanism of injury, pre-injury conditions, complications following burn, inhalation injury, length of ICU stay of survived patients and outcomes of patients using the univariate and multivariate Cox regression analysis. Results Seventy-three elderly severe burn patients were enrolled in this study, the morbidity was increasing significantly with 2.7% in 2005 to 17.8% in 2016 , the difference was statistically significant(χ2=45.18, P<0.05). Male patients (65.8%) were more than female patients (34.2%), and the difference was statistically significant (P=0.01). The median age was 66 years (range 61-86 years), there was no statistically significant difference between the age of male and female(Z=-0.22, P=0.83). The average burn area was (53.9±20.9)%TBSA, median full thickness burn area was 0. There were no statistically significant differences in gender ratio, age, etiologies in patients of different severity of burn (with P values above 0.05). Critical burn patients were more likely with inhalation injury, longer length of ICU stay, higher case fatality rate (with P values below 0.05) and were easily happened at workplace. The most common etiology was flame(79.5%). The majority of injuries occurred at home(57.5%) while patients injuried at workplace accounted for 31.5%. The most common pre-injury conditions were cardiovascular diseases (43.8%), neurological diseases(9.6%), diabetes (6.8%), respiratory diseases(6.8%). The most common complications were wound infection(42.5%), multiple organ failure(11.0%), pneumonia infection(11.0%). Patients accompanying inhalation injury was 11(15.1%). Median ICU stay of survived patients was 12 days. The case fatality rate was 32.9%. Total burn area and full thickness burn area were risk factor for death of elderly severe burn patients, only full thickness burn area was independent risk factor (HR=1.024, and 95%CI 1.006-1.041, P=0.008). Conclusions With the development of aging society, the morbidity of elderly severe burn patients was increasing, elderly severe burn are more likely to happen at home. Burn prevention strategy to decrease the morbidity, burn extent and to improve the recovery rate is pressing issue. At the same time, building an efficient rehabilitation system to improve life quality of recovered patients is in urgent need. Key words: Burns; Aged; Characteristics; Analysis