Elderly Burn Patients Research Articles

Epidemiology of elderly burn patients in the United States: Mortality patterns and risk factors revealed by CDC WONDER database

IntroductionBurn-related fatalities pose a significant global public health challenge, with a substantial impact on the elderly population. This study examines two decades of burn-related mortality data in the United States, aiming to understand the trends, disparities, and contributing factors among adults aged 65 and older. ObjectivesThe primary objectives of this study are to (1) analyze the trends in burn-related mortality rates among older adults, (2) investigate disparities based on gender, race and geographic regions, and (3) identify comorbidities and complications associated with burn-related deaths in this demographic. MethodsData were obtained from the Centers for Disease Control and Prevention (CDC) using the National Center for Health Statistics database. The study cohort consists of individuals aged 65 and older who experienced burn-related deaths between 1999 and 2020. Various demographic variables, including age, sex, race/ethnicity, and location of death, were considered. The study also examined urban-rural classifications and regional differences. Mortality rates were calculated and adjusted for age. Joinpoint regression analysis was employed to assess trends in age-adjusted mortality rates over time. Modes of death and common comorbidities and complications were analyzed. ResultsBetween 1999 and 2020, a total of 96,498 older adults succumbed to burn injuries in the United States. Analysis revealed a concerning increase in burn-related mortality rates from 2012 onwards. Demographic disparities were evident, with older men consistently exhibiting higher mortality rates compared to women. Racial disparities were observed, with Black individuals experiencing the highest mortality burden. Geographic analysis indicated elevated mortality rates in Western states and rural areas. Accidents emerged as the leading cause of death, with ischemic heart disease and hypertensive diseases being prevalent comorbidities. Complications, with septicemia being the most common, contribute significantly to mortality. ConclusionOur analysis of 20 years of burn-related mortality data from the CDC reveals alarming trends in the United States. Unlike global trends, mortality rates have stagnated from 1999 to 2020, indicating a persistent public health challenge. Black individuals aged over 65 bear the brunt of burn-related mortality, facing the highest age-adjusted rates among all racial groups. Regional disparities are stark, with states in the top 90 % exhibiting significantly higher age-adjusted mortality rates compared to those in the bottom 10 %. Moreover, rural areas consistently report higher mortality rates than urban areas. Ischemic heart disease, hypertensive diseases, and other heart-related conditions emerge as prevalent comorbidities. To effectively reduce burn-related injuries and fatalities, targeted public health policies are imperative. These interventions must prioritize high-risk populations and adopt culturally sensitive approaches to promote safety. Additionally, enhancing access to healthcare and fire safety education is vital for mitigating the burden of burn-related mortality among the elderly population.

Burns in the Elderly: Causes and Prevention

Burns are frequent accidents but vary greatly in severity depending on the general condition of the victim, the affected surface, and the depth of the injuries. In geriatrics, more than age itself, it is the frequency of associated pathologies and the thinness of the skin that worsen the prognosis. Proper and early management should allow for rapid healing in most cases. Methods: Over a 3-year period (2021-2024), 38 patients over the age of 65 were treated in the Plastic Surgery Department of CHU Mohamed VI in Marrakech. We conducted a retrospective descriptive study, including an epidemiological, clinical, and therapeutic analysis. Results: These patients represented 12% of all those treated at the center. All patients were injured at home, and the most frequent cause was contact burns in the hammam (Moroccan steam bath). In 53% of cases, burns affected less than or equal to 15% of the body surface area. Over one-third (37%) of patients underwent necrosectomy, and 26% received various types of autografts. Pre-existing conditions were present in 60% of patients, with some having more than one. 65% of patients recovered, while 35% died. The most common cause of death was complications from pre-existing diseases and infection. Conclusion: This study highlights the specific challenges in managing elderly burn patients, emphasizing the crucial importance of prevention, early and appropriate management, and a multidisciplinary approach.

718 Predictors of Lengthened Admission in Elderly Burn Patients, a Secondary Analysis of 529 Cases

718 Predictors of Lengthened Admission in Elderly Burn Patients, a Secondary Analysis of 529 Cases

711 Analysis of the Risk Factors for Mortality in Elderly Burn Patients

Abstract Introduction The elderly experience higher mortality rates compared to younger burn patients with similar burn injuries. The aim of this retrospective study was to analyze the clinical factors affecting mortality in elderly burn patients admitted to single burn center. Methods Data were collected on all elderly burn patients admitted to Mackay memorial hospital burn center between 2010 to 2020, focused on the population over 60 years old. The demographic data, burn profiles, hospital length of stay, use of mechanical ventilation and inotropic agents, delayed burn-related complication and hospital mortality were studied retrospectively. Both univariate and multivariate analysis were used to identify the risk factors for mortality. Results 61 elderly burn patients were evaluated and flame was the most common cause of burns(57.4%). All of the burns involved more than 20% of total body surface area. Sixteen patients(26.2%) expired during hospitalization. Univariate analysis showed that the mortality among elderly burn patients was associated with age(P< 0.001), burn surface area(P< 0.001), burn grade(P=0.016), use of inotropic agents(P< 0.001), initial endotracheal tube insertion(P< 0.001) and delayed burn-related acute kidney injury(P< 0.001), sepsis(P< 0.001) as well as pulmonary edema(P< 0.001). We stratified the above risk factors into two subgroups: Initial presenting patient profile(Age, TBSA, Burn grade) and delayed burn-related complication(Acute kidney injury, Sepsis, Pulmonary edema). Multivariate logistic regression was used to analyze the two subgroups. We found that in the initial presenting patient profile subgroup, age(P=0.014) and TBSA(P=0.004) were positively correlated to patient mortality. Conversely, among the burn-related complications subgroup, only sepsis(P=0.002) was the only significant independent factor related to patient mortality. Conclusions This study identified key factors that affect mortality among elderly burn patients. Attention should be paid to those elderly burn patients with older age, increased TBSA, or delayed burn-related sepsis due to significantly increased mortality risk. Applicability of Research to Practice Classic determinants of burn mortality are age, burn size, and the presence of inhalation injury (Revised Baux score). Several studies revealed that in-hospital complications was one of the strongest mortality predictors after burns. Understanding that sepsis is a major factor for mortality in elderly burn patient, we may improve our quality of care to decrease the mortality rate.

537 Epidemiology of Elderly Burn Injuries – A Five Decade Single Center Retrospective Review

Abstract Introduction Age has long been known to be an independent risk factor for worse outcomes in burn patients. In comparison to younger patients, geriatric patients have higher morbidity and mortality. As the median age of the US population has increased, we have seen a greater proportion of elderly burn patients at our burn unit over the last five decades. Methods Retrospective chart review was performed for all burn patients admitted to our burn unit between 2000 and 2019. Demographics and outcomes data was collected for geriatric patients (age 65 and older). This was compared to historic data available for our burn unit between 1972 to 2000. Results Between 2000 to 2019, our burn unit admitted a total of 5881 burn patients of all ages. There were 652 (11%) geriatric patients admitted. The proportion of geriatric patients admitted statistically significantly increased over that period. Meanwhile, length of stay and mortality statistically significantly decreased in the 2000-2019 time period compared to the previous period. The main mechanism of burn injury was flame exposure. Compared to data on geriatric burn patients from 1972 to 2000, mortality has decreased substantially. In the 1970s mortality was 77% compared to 21% in the past decade. The mortality rate increased significantly with age, TBSA and inhalation injury over both time periods. Conclusions Though lagging behind younger age groups, overall survival and outcomes are improving in elderly burn patient due to advances in critical care and surgical burn management. Acknowledging the unique characteristics of this group of patients, such as impaired healing and multiple comorbidities, allows for improved outcomes. Applicability of Research to Practice Burn centers should notice and prepare for an increasing trend in elderly burn patient admission.

Research advances on the prevention and treatment of burn infection in the elderly

Infection is a common complication after burns and the major cause of death in patients suffering severe burn injury. The infection of the elderly after burns is more serious due to their decreased immune function that is complicated with factors such as multiple chronic diseases and dysfunction of various organs. In addition, the burn infection in the elderly lacks the specific symptoms and signs, which brings great challenges to its diagnosis and treatment. To effectively prevent and control infection is very important for the treatment of elderly burn patients. Combined the clinical characteristics of burn infection in the elderly, this paper summarized the research advances of prevention and treatment for burn infection in the elderly from fluid resuscitation, wound treatment, antibiotic using, organ protection, nutritional support, and infection prevention, aiming to provide reference for clinical practice.

Haemoglobin changes before and after packed red blood cells transfusion in burn patients: A retrospective cross-sectional study.

The present study aimed to investigate haemoglobin (Hb) changes before and after packed red blood cell (RBC) transfusion in burn patients. This study was a retrospective cross-sectional study that was conducted on burn patients in Velayat hospital in Rasht, Iran. The sampling method of this study was consecutive sampling. Data were collected using patient records, including age, gender, body mass index (BMI), total body surface area (TBSA) percentage, length of hospitalisation, Frequency of receiving packed RBCs, and Hb level before each packed RBC transfusion and 4 to 6hours after transfusion. Paired t tests and analysis of variance (ANOVA) were used to compare the study variables. Pearson's correlation coefficient was used to investigate the relationship between Hb changes after the transfusion of packed RBCs and the study variables. A total of 110 burn patients participated in this study. The average Hb before and after transfusion was 8.07 (SD=0.97) and 9.16 (SD=1.01), respectively, which were significantly different (P= .0001). The results showed that there was a significant negative relationship between the variables of age (r= -0.188, P= .0001), BMI (r= -0.110, P= .035), and TBSA percentage (r= -0.122, P= .019) with changes in Hb after transfusion. Also, the duration of hospitalisation had a significant positive relationship with Hb changes after transfusion (r= 0.124, P= .017). In sum, Hb level compensation through packed RBC transfusion in elderly burn patients has more challenges. The number of changes in Hb level after receiving packed RBCs decreased with increasing TBSA, BMI, and age. Also, there was a positive correlation between the duration of hospitalisation and changes in Hb levels.

Epidemiological and Clinical Characteristics of 471 Elderly Burn Patients in China: A Burn Center-based Study.

Burns are characterized by difficult treatment, poor prognosis, and high mortality especially in elderly patients. The aim of this paper is to study the epidemiological and clinical characteristics of elderly burn patients admitted to a major burn center from 2016 to 2020. The data of 471 elderly burn patients admitted to our burn center from January 2016 to December 2020 were retrospectively analyzed. Demographic and clinical variables of different age groups were statistically analyzed, and variables related to length of stay (LOS) and hospitalization costs were analyzed through linear regression models. The mean age of included patients was 69.03 years. Scald injuries accounted for 42.7% of all burns with the extremities being the most commonly affected anatomic site (46.5%). Approximately 67.5% and 5.9% of all patients suffered from full-thickness burns and inhalation injuries, respectively. These patients required more surgical procedures, longer operation durations, and higher costs compared with other burn patients. The mean LOS was 17 days with a mortality rate of 2.1%. There were statistically significant differences in the etiological characteristics and clinical manifestations of burn patients in different age groups. Individualized targeted prevention and treatment strategies should be performed according to the clinical characteristics and relevant risk factors of each patient.

Elderly burns; Our clinical experiences

Background: Though mortality rates have decreased with better understanding of burns’ pathophysiology and advanced monitoring, elderly burn patients are still a challenging health problem. The elderly population is increasing worldwide. The aim of this study is to investigate the outcomes of burns for elderly patients and increase medical, public and governmental awareness of the issue. Elderly people should be trained in preventive measures to diminish the number of burn accidents.Methods: Hospitalized patients between 2011 and 2019 were retrospectively studied. Age, gender, burned total body surface area (TBSA), burn agent, comorbidities, location of the burn injury, whether a house fire accompanied, and mortality rates were compared between adult patients (18 to 64 years old) and those who were elderly (65 years or older).Results: Of the 2258 patients, 285 (12.6%) were aged 65 or older. The burned TBSAs of the adult patients were larger than those of the elderly patients (p=0.019). Scalding and contact burns were more frequent among the elderly than the adults (p=0.001). The elderly had greater co-morbidities, were mostly burned at home and more house fires accompanied their injuries than those of the adults (p<0.001). Despite having lesser burned TBSAs, mortality rates were significantly higher in the elderly (p<0.001).Conclusions: As the elderly population increases worldwide, burn treatment facilities should be prepared for their increase in numbers and co-morbidities. To enforce preventive measures, awareness of the growing issue should be raised and public authorities should be alerted to their need to act.

48 Metformin Rescues the Aging-induced Failure of Post-burn White Adipose Browning

IntroductionSevere burns are responsible for an estimated 300,000 deaths per year worldwide. While modern burn care has markedly improved survival for pediatric and adult patients, this is sadly not the case for one population: the elderly. Despite being the fastest-growing demographic in North America, burn patients over the age of 60 years have the highest mortality and morbidity rates. Recent evidence suggests that progressive aging induces several structural and functional alterations which impair the capacity of older trauma patients to adequately respond to stress. Indeed, it was discovered that reduced survival in elderly burn patients is associated with the failure to initiate the browning of white adipose tissue (WAT) —a hallmark of the systemic response to injury commonly observed in adults. Interestingly, the widely used hypoglycemic drug metformin has been found to protect against aging-induced metabolic decline in various pathological conditions. Thus, we investigated the anti-aging effects of metformin on the metabolic deterioration of post-burn WAT responses in elderly patients and mice after injury.MethodsHuman WAT was obtained from elderly patients admitted to our burn center. Elderly (75-week) mice received a full-thickness scald burn and/or daily intraperitoneal injections of metformin (100 mg/kg) for 7 days. The inguinal WAT was harvested for histological analyses. Mitochondrial respiration was measured via Seahorse XF96. Gene and protein expression was assessed via RT-PCR and western blot, respectively.ResultsPost-burn metformin treatment restores the thermogenic activation of WAT in elderly patients and mice, reflected by the increased expression of key browning markers, UCP-1 and PGC-1α (p< 0.05). This was accompanied by higher mitochondrial respiration, improved lipolysis (p< 0.05) and increased fat wasting (p< 0.01) relative to control counterparts. The anti-aging effects of metformin appeared to be mediated by AMPK, which consequently increased [NAD+] (p< 0.01), thereby promoting activation of the longevity-specific enzyme Sirt-1 (p< 0.05).ConclusionsHere, we show that post-burn metformin treatment effectively rejuvenates adaptive metabolic responses in elderly WAT by targeting key longevity pathways which rescue the age-dependent loss of being back to youthful levels. Our findings support the potential of anti-aging modalities to improve care and outcomes in elderly burned patients.

509 Why do elderly burn patients die? Analysis of early versus delayed ICU deaths, from 2014-2021

IntroductionDespite continued improvements in critical care, nutrition, and surgical technique, elderly patients with burn injury remain a vulnerable population, with increased mortality. The purpose of this study was to compare early versus late deaths in elderly burn patients admitted to the intensive care unit, to identify potential interventions that might improve survival.MethodsWe conducted a retrospective review of elderly patients (age >=60 years), who were admitted to an urban burn center ICU, with thermal and/or inhalation injury, over an 8-year period. Data were extracted from a prospectively maintained registry and verified through our electronic medical record. Patients who died less than 1 week after admission were compared with those who died after the first week. Univariate analysis was performed by 2-tailed Student’s T test and chi-square, with statistical significance assigned to p values < 0.05.ResultsFrom 2014-2021, we admitted 1322 patients to the burn ICU for thermal and/or inhalation injury. Mortality was 9.4% for patients >= 60 years of age, compared to 2.0% for patients < 60 (p< 0.001). The elderly patients who succumbed to their injury had a mean age of 75.3 years, TBSA 27.7%, modified Baux score of 111.3, and survival of 13.8 days. We observed a bimodal distribution of deaths, peaking on the first day after injury, and in the third week after admission, the most common cause of which, for both groups, was multisystem organ failure. Compared to the delayed deaths (n=21), patients who died within the first week (n=16) had an increased incidence of inhalation injury, a higher modified Baux score but similar age and TBSA, and lower baseline comorbidities and complications (TABLE). ConclusionsPresence of inhalation injury and high modified Baux score, not necessarily age or %TBSA, was associated with early mortality in the elderly, after burn injury. Older patients who survive their initial resuscitation often succumb to complications related to baseline comorbidities. Improved management of these comorbidities, via the active involvement of geriatric medicine and palliative care, represents an opportunity to increase survival.

Elderly burns: Clinical frailty scale and functional ambulation classification in predicting prognosis.

The study was to investigate the role of mobility and frailty in predicting the prognosis of elderly burns along with the burn severity. In this retrospective study, 67 patients aged 65 and over who were hospitalized between October 1, 2017, and Septem-ber 30, 2020 in our burn center are included in the study. The demographic data, etiological data, clinical variables, the percentage of burned total body surface area (TBSA), Abbreviated Burn Severity Index (ABSI), Functional ambulation classification (FAC) scores, and Clinical frailty scale (CFS) scores are evaluated. Mean age of the study population was 71.58±7.4 years and most of the patients were female (65.7%). The percentage of TBSA was 11.34±12.2. The flame burns were the most common etiology (87.5%) of deaths (n=8), whereas 52.5% of the survivors were scalds. Most of the survived patients were functional ambulatory (93.2%). On the other hand, only 25% of patients who died were functional ambulatory (p<0.001). Also, 83% of the survivors were normal according to CFS scoring, whereas 25% of the patients who did not survive were vulnerable and 75% was frail (p<0.001). The percentage of elderly burns is low, yet the mortality is high in these patients which emphasize the importance of elderly burns. The ABSI is of great help, but ambulation status and comorbid diseases should be taken into consideration in terms of elderly burns. The current study demonstrated that FAC and CFS will be helpful to better predict the outcomes of elderly burn patients along with ABSI.

Effect of the Mini-Nutritional Assessment-Short Form in Elderly Burn Patients.

Nutritional assessment can early identify patients who are malnourished and at risk of malnutrition. To examine the effect of nutritional status on wound healing in elderly burn patients, we used the Mini-Nutritional Assessment-Short Form (MNA-SF) to measure the nutritional status of elderly patients. This study aimed to examine the role of MNA-SF in elderly burn patients through the correlation analysis of wound healing indicators and MNA-SF score. This was a prospective observational and cross-sectional study. This study used the MNA-SF to investigate the elderly burn patients at the department of burn. According to the score, the patients fell into three groups: good nutritional status (more than 12 points), malnutrition risk (8-11 points), and malnutrition (0-7 points). At the same time, we measured and compared the wound healing indicators among the three groups of patients, and detected the correlation. The results showed gender had a slight influence on the score of nutritional status, while age was negatively correlated with the MNA-SF score and nutrition-related indicators. There was a low positive linear correlation between the wound healing percent area change or wound healing rate of patients and the score of the MNA-SF. This study finds malnutrition is common among hospitalized elderly burn patients. The application of the MNA-SF in elderly burn patients is efficient and accurate to identify malnutrition early and prevent further obstruction of the normal wound healing, which can provide reference points for early nutrition intervention programs.

Long-term survival among elderly after burns compared with national mean remaining life expectancy

IntroductionAs compared to younger adults, older people have a greater risk of domestic accidents, such as burns, and their prognosis is worsened by a diminished physiological ability to face a thermal trauma. The in-hospital mortality is adversely affected by old age and burn size, whereas less is known about the long-term-survival in elderly patients who survive a burn injury. The aim of this study was to investigate if elderly burn patients after discharge from a Swedish National Burn Centre have a shorter remaining life compared to the national population, by using calculated remaining Life Expectancy (rLE). MethodsIn this retrospective study we included all patients who were admitted for burns to the Linköping Burn Centre during 1993–2016 and who were 60 years or older and alive, at the time of discharge. The control group was extracted from Statistics Sweden, the national statistics database, and consisted of all individuals from the Swedish population matched for each patient in the study group, by sex and age at the year of discharge. The proportion who died before reaching the rLE was compared between the study population and the control group by calculating risk ratio. ResultsThe study group consisted of 111 former patients and 77 of them (69%) died before reaching the rLE, with mean 4.7 years of life lost (YLL), which was 33% more than that (52%) of the control group (RR 1.33, 95% CI 1.18–1.51). Burn related factors, such as TBSA % or FTB % were not found to account for this effect. ConclusionWe found that the long-time survival of elderly patients after burns is shorter than that of a national control, the magnitude of which is quantitatively important. The current study does not support that burn related factors account for this effect and the reason should therefore be sought in other factors, such as e.g., co-morbidity or psychosocial issues.

Exploring the Background, Context, and Stressors of Caregiving to Elderly Burned Patients: A Qualitative Inquiry.

Elderly persons are at risk of experiencing burns and require support from both formal and informal caregivers. Informal caregiving in this situation has been minimally explored. Guided by the Stress Process Model, this study aimed at exploring the background, context, and stressors of informal caregivers of elderly burned persons during hospitalization. A qualitative descriptive design was utilized. Purposive sampling approach was used to recruit fourteen (14) informal caregivers who rendered care to elderly burned persons during hospitalization. Interviews were conducted and transcribed verbatim following which directed content analysis was undertaken deductively. Three categories and six subcategories emerged which characterize the background, context, and stressors of informal caregiving to elderly burn patients. All the injuries occurred in the home setting and its sudden nature led to varied postburn emotional responses which characterized the context of burns caregiving. Primary stressors that emerged were related to the injury, actual caregiving demand, and concerns regarding increasing frailty levels. Secondary stressors identified were financial concerns and lifestyle changes. The findings suggest that the occurrence of burn injury served as a precursor to postburn stress response among informal caregivers. Increasing frailty levels, adequacy of household safety measures, and financial issues were key concerns which emphasize the need for psychosocial/transitional support, innovative healthcare financing measures, and continuing education on burns prevention in the home setting.

No Difference in Morbidity or Mortality Between Octogenarians and Other Geriatric Burn Trauma Patients.

Geriatric burn trauma patients (age ≥65years) have a 5-fold higher mortality rate than younger adults. With the population of the US aging, the number of elderly burn and trauma patients is expected to increase. A past study using the National Burn Repository revealed a linear increase in mortality for those >65years old. We hypothesized that octogenarians with burn and trauma injuries would have a higher rate of in-hospital complications and mortality, than patients aged 65-79years old. The Trauma Quality Improvement Program (2010-2016) was queried for burn trauma patients. To detect mortality risk a multivariable logistic regression model was used. From 282 patients, there were 73 (25.9%) octogenarians and 209 (74.1%) aged 65-79years old. The two cohorts had similar median injury severity scores (16 vs. 15 in octogenarians, P = .81), total body surface area burned (P = .30), and comorbidities apart from an increased smoking (12.9% vs. 4.1%, P = .04) and decreased hypertension (52.2% vs. 65.8%, P = .04) in the younger cohort. Octogenarians had similar complications, including acute respiratory distress syndrome, pulmonary embolism, deep vein thrombosis (P > .05), and mortality (15.1% vs. 10.5%, P = .30), compared to the younger cohort. Octogenarians were not associated with an increased mortality risk (odds ratio 1.51, confidence interval 0.24-9.56, P = .67). Among burn trauma patients ≥65years, age should not be a sole predictor for mortality risk. Continued research is necessary in order to determine more accurate approaches to prognosticate mortality in geriatric burn trauma patients, such as the validation and refinement of a burn-trauma-related frailty index.

65 Pain Management Practices in the Elderly Patient with Burn Injury

Abstract Introduction Opioids are key to pain management in burns but have increased side effects like falls and delirium in the elderly. However, comorbidities prevalent in this population (e.g., chronic kidney disease) limit use of non-opioid adjuncts, making pain control for these patients a difficult balance. Little data exists regarding pain control practices in elderly burn patients. We aim to retrospectively characterize pain management strategies (including opioids and non-opioid adjuncts) in this patient population. Methods This is a retrospective cohort of patients age &amp;gt;65 with burns &amp;lt; 20% total body surface area (TBSA) admitted to the burn stepdown unit from 2014 to 2019. The primary outcome was to quantify opioid use inpatient and at discharge in morphine milligram equivalents (MME). Secondary outcomes included percent of patients receiving opioids and adjunct analgesics at these timepoints. Mean MME inpatient vs. at discharge were compared using paired t-test. Percent of patients receiving opioids and non-opioid adjuncts were compared using McNemar’s test. Results One hundred elderly patients (mean age 73.9, SD 6.7) with mean TBSA of 5.6% (SD 4.5) were included. Fifty-two percent required autografting; the remainder received porcine or non-operative therapy. Mean daily inpatient MME was 18.0 (SD 20.8) and mean discharge MME was 28.0 (SD 20.5) (p=.001), equivalent to 12mg and 18.5mg of oral oxycodone. Inpatient, 72% of patients received opioids vs. 83% at discharge (p=.041). Acetaminophen was the most commonly prescribed non-opioid adjunct inpatient and at discharge; other adjuncts like non-steroidal anti-inflammatories (NSAIDs) and gabanoids were infrequently used. Conclusions Elderly burn patients are discharged with more opioids than utilized while inpatient. Aside from acetaminophen, non-opioid adjuncts used commonly in younger patients such as NSAIDs and gabanoid medications are under-utilized, presumably due to concern for comorbidities.

53 Frailty is Not Only a Phenomenon of Elderly Burn Patients

Abstract Introduction Recent evidence indicates that increased frailty is associated with increased mortality in patients with burn injuries over the age of 50 years old. This work found that 35.7% of burn patients over 65 years old were frail at the time of their burn admission while 19.2% of burn patients 50 to 64 years old were frail. While frailty is associated with increased age the two are separate entities suggesting that frailty may be present in much younger patients who present with burn injuries. We hypothesize that frailty exists in all age groups of patients presenting with burn injury and the prevalence increases with age. Methods Following IRB approval, a 5-year (2014–2019) retrospective chart review was conducted of all burn patients admitted to the burn center. Data collected includes age, gender, and burn size (% TBSA). Frailty was determined using the Modified Frailty Index 11 (MFI 11) from co-morbidities included in the burn registry. Patients were considered frail if they have an MFI ³ 2 and pre-frail for an MFI³1 and &amp;lt; 2. Patients were assessed by decades for age. Statistical analysis included descriptive statistics, chi-square, and t-tests. Results A total of 2173 patients (mean age 46.1±17.3 years, 1584 males (72.8%), mean % TBSA 12.5±16.3%) were analyzed. All age groups included patients who were pre-frail (Table 1). In the under 20-year-old group, 8.5% were pre-frail. This increases with each age group to the 71-80-year-old group in which 41.7% of patients are pre-frail. The over 80-year-old group had slightly fewer pre-frail patients (35.9%). There were no frail patients in the under 20-year-old group. In the 21–30 there were 3 patients (0.7%) that had an MFI of 2 or more placing them in the frail group. Frailty was significantly different across the age groups (p&amp;lt; 0.001). As patients age, the proportion of female patients increases (from 17.6% to 37.5%. p&amp;lt; 0.0001). Frailty was also associated with gender with women having a higher percentage of frailty (p=0.0006). With respect to burn size, age category was not associated with burn size (p=0.12), but frail patients had smaller burns than non-frail or pre-frail patients (9.5% vs. 13.3% vs. 12.2%, p=0.0002). Conclusions Pre-frail patients were identified in all age groups. Frailty was present in all age groups except for those who are under 20 years of age. Frailty was associated with female sex and smaller burns. By not specifically looking for frailty in all burn patients admitted to the hospital we are potentially missing frail patients who may benefit from interventions to improve their outcomes.

The prognostic nutritional index on postoperative day one is associated with one-year mortality after burn surgery in elderly patients.

BackgroundBurn injury in elderly patients can result in poor outcomes. Prognostic nutritional index (PNI) can predict the perioperative nutritional status and postoperative outcomes. We aim to evaluate the risk factors, including PNI, for one-year mortality after burn surgery in elderly patients.MethodsBurn patients aged ≥65 years were retrospectively included. PNI was calculated using the following equation: 10 × serum albumin level (g/dL) + 0.005 × total lymphocyte count (per mm3). Cox regression, receiver operating characteristic curve and Kaplan–Meier survival analyses were performed to evaluate the risk factors for postoperative one-year mortality.ResultsPostoperative one-year mortality occurred in 71 (37.6%) of the 189 elderly burn patients. Risk factors for one-year mortality were PNI on postoperative day one (hazard ratio (HR) = 0.872; 95% CI = 0.812–0.936; p < 0.001), Sequential Organ Failure Assessment score (HR = 1.112; 95% CI = 1.005–1.230; p = 0.040), American Society of Anesthesiologists physical status (HR = 2.064; 95% CI = 1.211–3.517; p = 0.008), total body surface area burned (HR = 1.017; 95% CI = 1.003–1.032; p = 0.015) and preoperative serum creatinine level (HR = 1.386; 95% CI = 1.058–1.816; p = 0.018). The area under the curve of PNI for predicting one-year mortality after burn surgery was 0.774 (optimal cut-off value = 25.5). Patients with PNI ≤25.5 had a significantly lower one-year survival rate than those with PNI >25.5 (32.1% vs 75.9%, p < 0.001).ConclusionsPNI on postoperative day one was associated with postoperative one-year mortality in elderly burn patients. The postoperative one-year survival rate was lower in patients with PNI ≤25.5 than in those with PNI >25.5. These findings indicate the importance of identifying elderly burn patients with low PNI, thereby reducing the mortality after burn surgery.

Advanced age heightens hepatic damage in a murine model of scald burn injury.

Elderly burn patients exhibit a lower survival rate compared with younger counterparts. The liver is susceptible to damage after burn injury, which predisposes to poor outcomes. Lipid homeostasis and the antioxidant glutathione system play fundamental roles in preserving liver integrity. Herein, we explored changes in these major pathways associated with liver damage in the aging animals after burn injury. We compared liver enzymes, histology, lipid-peroxidation, and glutathione-metabolism profiles from young and aged female mice after a 15% total body surface area burn. Mice were euthanized at 24 hours after injury, and livers and serum were collected. Aged burn animals exhibited elevated (p < 0.05) aspartate aminotransferase and alanine aminotransferase levels and increased inflammatory cell infiltration, edema, and necrosis compared with their younger counterparts. The percentage of adipophilin-stained area in livers from young sham, young burn, aged sham, and aged burn groups was 10%, 44%, 16%, and 78% (p < 0.05), respectively. Liver malondialdehyde levels were 1.4 ± 0.5 nmol/mg, 2.06 ± 0.2 nmol/mg, 1.81 ± 0.12 nmol/mg, and 3.45 ± 0.2 nmol/mg (p < 0.05) in young sham, young burn, aged sham, and aged burn mice, respectively. Oxidized glutathione (GSSG) content increased 50% in the young burn, and 88% in aged burn animals compared with the young sham group (p < 0.05). The reduced glutathione GSH/GSSG ratio was significantly reduced by 54% in aged burn mice compared with young sham animals (p < 0.05). Furthermore, glutathione peroxidase gene expression showed a 96% decrease in the aged burn group compared with young sham mice (p < 0.05). Aged burn animals exhibit severe liver damage from heightened lipid peroxidation and inadequate antioxidative response. The increased peroxidation is associated with abundant lipid deposits in hepatic tissue postburn and a weak antioxidative response due to hepatic glutathione peroxidase downregulation. Further studies will focus on the functional significance of these findings concerning hepatic homeostasis.