Elderly Burn Research Articles

The Impact of Caregiver Support on Mortality Following Burn Injury in the Elderly

Advances in burn care have decreased mortality in the past 20 years, but affecting elderly mortality rates (>65 years) remain challenging. This study evaluates the impact of home caregiver support on elderly burn patients' mortality. The authors retrospectively reviewed patients aged 65 and older admitted to their burn center from July 1995 to October 2004. Patient demographics, Injury Severity Score, TBSA, and patients' primary caregiver were collected. The outcomes were mortality, disposition, and length of stay and these were evaluated using univariate and subsequently multivariate regression. Significance was calculated at P ≤ .05. A total of 112 patients were included in the analysis. The mean age was 76±8. Male patients constituted 47%, whereas 53% were female patients, and mean TBSA was 21±16%. Thirty patients' primary caregiver was a spouse, for 38 it was a child, and 44 had no caregiver. Fifty-eight patients survived (51.7%), and 54 patients died (48.3%). Only 21% of the survivors had a child as their primary caregiver; however, 48% of the nonsurvivors had a child as the primary caregiver (P ≤ 0.05). On multivariate analysis, age, TBSA, and child as primary caregiver were all independent predictors of mortality. Having a child as a caregiver provided the largest impact, with an odds ratio of 4.4 (95% confidence interval, 1.2-15.62; P = .02).

Predicting resource utilization of elderly burn patients in the baby boomer era

BackgroundCensus predictions for Florida suggest a 3-fold increase in the 65 and older population within 20 years. We predict resource utilization for burn patients in this age group. MethodsUsing the Florida Agency for Healthcare Administration admission dataset, we evaluated the effect of age on length of stay, hospital charges, and discharge disposition while adjusting for clinical and demographic factors. Using US Census Bureau data and burn incidence rates from this dataset, we estimated future resource use. ResultsElderly patients were discharged to home less often and were discharged to short-term general hospitals, intermediate-care facilities, and skilled nursing facilities more often than the other age groups (P < .05). They also required home health care and intravenous medications significantly more often (P < .05). Their length of stay was longer, and total hospital charges were greater (P < .05) after adjusting for sex, race, Charleson comorbidity index, payer, total body surface area burned, and burn center treatment. ConclusionsOur data show an age-dependent increase in the use of posthospitalization resources, the length of stay, and the total charges for elderly burn patients.

A new algorithm to allow early prediction of mortality in elderly burn patients

IntroductionThe elderly are the fastest growing population segment, and particularly susceptible to burns. Predicting outcomes for these patients remains difficult. Our objective was to identify early predictors of mortality in elderly burn patients. MethodsOur Burn Center's prospective database was reviewed for burn patients 60+ treated in the past 10 years. Predictor variables were identified by correlative analysis and subsequently entered into a multivariate logistic regression analysis examining survival to discharge. Results203 patients of 1343 (15%) were eligible for analysis. The average age was 72±10 (range 60–102) and the average total body surface area (TBSA) burned was 23±18% (range 1–95). Age, TBSA, base deficit, pO2, respiratory rate, Glasgow Coma Score (GCS), and Revised Trauma Score (RTS, based on systolic blood pressure, respiratory rate, and GCS) all correlated with mortality (p≤0.05). Using multiple logistic regression analysis, a model with age, TBSA and RTS was calculated, demonstrating:increased risk of mortality=β0+1.12 (age)+1.094 (TBSA)+0.718 (RTS)In this model, β0 is a constant that equals −8.32. ConclusionsPredicting outcomes in elderly burn patients is difficult. A model using age, TBSA, and RTS can, immediately upon patient arrival, help identify patients with decreased chances of survival, further guiding end-of-life decisions.

The use of a frailty scoring system for burns in the elderly

IntroductionBurn in the elderly has a high mortality. Scoring systems incorporating age, and/or co-morbidities have been developed to assist in predicting outcomes in this high risk group. Life expectancy has increased in the general population and within the elderly age group medical co morbidity, physiological response to injury and socioeconomic factors give rise to the concept of biological versus chronological age. For a given age, baseline pre morbid state can vary. It is more valid to consider biological rather than chronological age when calculating risk. The Canadian Study of Health and Aging (CSHA) clinical frailty scale, incorporating fitness, co-morbidities and level of dependence was used to analyse our elderly burn patients admitted to Burns ITU, their surgical management and one-year survival. MethodData from patients with burns greater than 10% and aged over 65years managed on the Burns ITU between 2005 and 2009 were obtained. A frailty score (1–7) was assigned to each patient based on the records of their admission assessment.42 patients met the study criteria for analysis. 18 (42.9%) patients, with mean age 74.9years (range 65–95years) survived (S) their ITU stay and of these, 83.3% survived at 1year. 24 (57.2%) patients, mean age 78.4years (range 66–95years) died (D) whilst on ITU. There was no significant difference between the two groups with regard to age, percentage burn (30% TBSA range 10–85%) (P>0.05 using T Test) or inhalational injury (p>0.05 using Z test).Using Mann–Whitney U test analysis, the frailty score between the two groups showed a significant difference at p=0.0001 (Mann–Whitney U test=78), median=3 (S) and median=5 (D). This suggests patients with better pre-morbid capacity, as evaluated by the frailty scoring system, were more likely to survive their burn insult and treatment. Significantly, more patients in the group that survived underwent surgical debridement (Mann–Whitney U test=111, p=0.02). ConclusionFrailty scoring system appears to be a useful adjunct in predicting outcome in burns requiring admission to HDU/ITU in the senior population. The frailty score may predict which patients will benefit from surgery which also continues to be an important determinant of outcome in these patients.

Long-Term Functional Outcomes in the Elderly After Burn Injury

Although the elderly represent a substantial proportion of the population, limited information exists on postdischarge long-term outcomes of elderly burn survivors. The purpose of this study was to assess elderly burn patient outcomes 2 to 10 years after discharge. This study was a prospective cross-sectional survey assessment of quality of life and retrospective trauma registry for the American College of Surgeons review of patients ≥ 60 years of age discharged alive after acute burn from 1997 to 2007. In-hospital treatment and burn demographic information were obtained from database and chart review. Surviving patients or their families were contacted, and the Short-Form-12 and Functional Independence Measure (FIM) administered. Of the 344 patients discharged, 232 participated. Mean age was 72.3 (60-85.8) years, TBSA burn was 7.8% (1-79), and length of stay was 11.2 ± 0.9 days (1-51). Most patients were discharged home (71%) or to a skilled nursing facility (SNF; 20%). Mean interval between discharge and survey administration was 46.1 months. In all, 24% of patients sent home died after discharge and prior to interview compared with 58% of patients sent to an SNF. On multivariate analysis, mortality increased with age (confidence interval [CI] 1.04-1.09), and government insurance (CI 0.34-0.94), but decreased with discharge to home (CI 1.68-4.47). There were no differences in FIM or Short-Form-12 scores between groups. Long-term mortality after discharge in elderly burn survivors is substantial. Patients sent to an SNF or with government insurance had increased mortality postdischarge. These data suggest that issues that may influence disposition status of elderly burn patients should be optimized prior to discharge to mitigate adverse outcomes associated with SNF placement.

Thermal Burns and Scalds: Clinical Complications in the Elderly

Burns are categorized as superficial, superficial partial thickness, deep partial thickness, and full thickness. Superficial burns heal spontaneously; more serious burns require treatment. Elders are disproportionately affected, and advanced age is associated with poorer outcomes, partially because of thin skin and preexisting conditions. Clinical complications are common in elderly burn victims. Treatment's two stages, acute care and follow-up care, are discussed. Severe burns can result in significant scarring and painful contractures, and victims are at increased risk for depression and related psychiatric problems. The majority of elders suffering from severe burns are transferred to long-term care and rehabilitation facilities for follow-up care. Most burns are preventable, and burns occurring in long-term care facilities require investigation.

Influence of race and neighborhood on the risk for and outcomes of burns in the elderly in North Carolina

Risk factors for mortality and length of hospital stay in elderly burn patients are well established, but the influence of race and socioeconomic status has not been evaluated. This study evaluates the effect of neighborhood level socioeconomic indicators on burns risk, and determines whether race and neighborhood influence burn injury outcomes in the elderly. Data from the North Carolina Jaycee Burn Center was linked to United States Census Bureau block group socioeconomic data. The odds of death and increased length of hospital stay for European–Americans and Minorities were determined using logistic regression. Rates of burn were determined using Poisson regression, and multilevel modeling was used to evaluate the influence of neighborhood on outcomes. No significant differences in mortality were observed between European–American and Minority patients in individual (Minority OR 0.71; p = 0.3200) and multilevel (0.72; p = 0.4020) models. Minorities had significantly higher odds of increased length of hospital stay in individual (2.05; p = 0.0020) and multilevel (2.55; 0.037) models. High proportions of rural households (RR = 1.39; p = 0.0010) and poverty (1.26; p < 0.0001) were significantly associated with increased risk of burn. Additional investigation using larger databases will allow further elucidation of the contextual effects of socioeconomic status on burn in the elderly.

Effect of Preinjury Statin Use on Mortality and Septic Shock in Elderly Burn Patients

Effect of Preinjury Statin Use on Mortality and Septic Shock in Elderly Burn Patients

Effect of Preinjury Statin Use on Mortality and Septic Shock in Elderly Burn Patients

Premorbid statin use has been associated with decreased mortality in septic and trauma patients. This has been ascribed to the pleiotropic, anti-inflammatory effects of HMG-CoA reductase inhibitors. This association has not been investigated in burn victims. A retrospective review of 223 consecutive patients, aged 55 years and older admitted to Vanderbilt University Regional Burn Center from January 2006 to December 2008, was performed. Multivariate regression analysis determined odds ratios of death and sepsis by statin use, adjusting for cardiovascular comorbidities. Of 223 patients, 70 (31.4%) were taking statins before admission. Mean age and mean total body surface area burn were not significantly different by statin use. The odds ratio of inhospital death was 0.17 (95% confidence interval 0.05-0.57; p = 0.004) if on statins. The odds ratio of mortality when stratified by cardiovascular comorbidities did not change. Sepsis developed in 30 patients (13.5%), with an odds ratio in statin users of 0.50 (95% confidence interval 0.20-1.30; p = 0.155). Preinjury statin use was associated with an 83% reduction in the odds of death after thermal injury. The odds of sepsis decreased by 50%, although not statistically significant. Further study is warranted to investigate the potential benefits of statin therapy in the management of burn victims.

The characteristics of elderly burns in Shanghai

Objective This study aims to analyse the epidemiologic characteristics of severe burn in the elderly in Shanghai and to discusses a possible prevention programme for this population. Methods A retrospective review of all medical records of elderly patients (aged 60 and older) admitted with acute burns to the Burn Center of the RuiJin Hospital between January 1996 and December 2004 was carried out. Patient demographics, etiology of burn, mechanism of injury, burn extent, anatomical areas burned, number of operations, and outcomes were reviewed. Results A total of 201 (5.8% of hospitalised patients) elderly patients (mean age (±SD) of 69.3 ± 7.1 years (range 60–90 years)) were admitted. Majority of the patients were men (62.2%) and the most common etiologies were flames (52.7%) and scalds (39.8%). The majority of burns occurred at home (73.6%), followed by burns at workplace (15.9%) and public areas (10.5%). The median total body area burned was 11.7% (range 0–84%), and the majority of burns were classified as mild (60.2%) and moderate (32.8%). Predominant anatomical areas involved were the legs (76.1%), arms (67.2%), head and neck (49.8%) and hands (49.3%). The most common pre-injury conditions were cardiovascular diseases (25.9%), diabetes (8.5%) and neurological diseases (6%). Eighty-seven patients (43.3%) required surgical treatment. The most common complications were multiple organ failure (2%), pneumonia (1%) and wound infection (1%). Sixteen patients (8%) died: half of them in hospital, and the rest at home. There was a significant correlation between post-injury complications and death ( r = 0.69, p < 0.001). The mean total hospitalisation cost was ¥22993.09 (US$ 3381.34). Conclusions Domestic and workplace burns with devastating consequences are very common in the elderly population in Shanghai. Burn prevention education and implementation of safety measures at home and at workplace would help reduce such incidences.

Mortality estimates in the elderly burn patients: The Northern Ireland experience

There is a relative paucity of mortality data in the medical literature from UK burn units. The objective of this study was to audit our mortality in the elderly during a 10-year period and compare it with the most robust data available in the UK from Birmingham. Data were collected on all patients 65 years of age and older between 1st January 1996 and 31st December 2005. Data included age, burn size, cause of thermal injury, outcome (survival/death) and the expected mortality derived from the revised Bull mortality grid. Notes on 143 patients were available for review. The mean age was 76.7 years and the maximum burn size treated was 65%. Ten patients were diagnosed with smoke inhalation. All but 22 patients had a pre-morbid condition, predominantly cardiovascular disease. Surgical procedures were performed on 113 patients. We performed excision and grafting of burned tissue, in 50% of patients, within 72 h of sustaining thermal injury. There were 18 deaths in the group while the expected number of deaths was estimated to be 33. This difference was found to be statistically significant ( x 2 = 8.92, d.f. = 1, p < 0.005). In conclusion, our experience has shown better survival in the elderly than was expected. This we mainly attribute to an aggressive therapy approach including admission to the intensive care unit and early surgery.

Clinical factors affecting mortality in elderly burn patients admitted to a burns service

Introduction The purpose of this retrospective study was to provide basic probabilistic predictors of mortality to assist in determining appropriate therapeutic aggression in elderly burns population. Method Eighty patients over the age of 70 years were admitted to the Victorian Adult Burns Service in Melbourne, Australia, over a period of 4 years. Retrospective data was analysed, taking into account patient demographics, type, site, depth and area of burn, presence of inhalation injury, number of co-morbidities, survival time and the number of operations performed, withdrawal of care and implementation of comfort measures only. Results Comparing survivors and non-survivors, significant differences were found between age, percentage total burn surface area (TBSA%), percentage full thickness surface area (FTSA%), presence of inhalation injury, site of burn and number of operations. The number of co-morbidities and gender were not significant to outcome. FTSA%, presence of inhalation injury, site of burn, age and number of operations were all significantly related to survival time. When patients who obtained comfort care were excluded from analysis, age and the number of operations were not considered to be significantly related to mortality. Conclusion This study indicates that TBSA%, FTSA%, inhalation injury and age are significant predictors of death in the elderly burns population, although only the first three remain significant when patients who receive comfort care measures only are excluded.

Elderly burn prevention: A novel epidemiological approach

Objective To develop burn prevention strategies for the elderly population in Hong Kong using a novel epidemiological approach. Methods Medical records of all patients aged 60 or above who were admitted to our hospital in a 6-year period were reviewed and demographic data, injury characteristics, details of management and outcome were obtained. Selected interviews were undertaken to determine the exact mechanisms of injury and further details of the medical and social background. Results Fifty-nine elderly patients were identified from the medical records with under half (42%) aged 75 and above. Male to female ratio was 1:1.68. Three-quarters of the injuries occurred at home, principally in the kitchen and bathroom. Two-thirds of the burns were scalds. Forty-eight percent of the admitted patients had surgery. Thirty-seven patients (or next of kin) were interviewed further. Of the subgroup only 12% had received appropriate first aid and 27% had treatment delayed for over 24 h before seeking medical help. The majority of patients had little or no formal education and one quarter were living alone. Conclusion We identified common scenarios of elderly burns which could be used to focus prevention strategies.

Utility of Acellular Allograft Dermis in the Care of Elderly Burn Patients

Utility of Acellular Allograft Dermis in the Care of Elderly Burn Patients

Early Predictors of Mortality in Elderly Burn Patients

Early Predictors of Mortality in Elderly Burn Patients

The Incidence and Impact of Pre-Existing Protein Energy Malnutrition on Outcome in the Elderly Burn Patient Population

The Incidence and Impact of Pre-Existing Protein Energy Malnutrition on Outcome in the Elderly Burn Patient Population

A three decade analysis of factors affecting burn mortality in the elderly

This study's objective was to identify variables that affect the mortality of elderly burn patients and to assess their changes over time. A retrospective review was conducted on all patients 75 or older ( n = 201) admitted to a university-based burn center between 1972 and 2000. Variables examined were age, sex, TBSA, ABSI, inhalation injury, timing from burn to operative intervention, the number of surgical procedures, the number of pre-morbid conditions, and mortality. There were 95 fatalities. TBSA strongly correlated with mortality ( p < 0.0001). Adjusting for TBSA and inhalation injury, mortality significantly decreased ( p = 0.04, odds ratio = 0.58). Mortality significantly increased with inhalation injury ( p < 0.01). Fatality risk increased by 400% with inhalation injury. Absence of inhalation injury was not significant with respect to mortality in the 1970s, however there was a significant decrease ( p = 0.02) in mortality without an inhalation injury in the 1980s and 1990s. ABSI was strongly predictive of mortality ( p < 0.0001). On average there was a 200% increase in mortality per unit increase of ABSI. The elderly are 58% less likely to die from burns now as compared to the 1970s. Although mortality rose with increasing TBSA equally in each decade, the absolute risk of mortality decreased over time. This data suggests major strides have been made in burn care, however similar success has not been achieved with inhalation injuries.

Utility of Acellular Allograft Dermis in the Care of Elderly Burn Patients

Because skin thins with advancing age, traditional thickness skin grafts cannot always be obtained in very elderly burn patients without creating a new full-thickness wound at the skin graft donor site. In an attempt to circumvent this problem, acellular allograft dermis (Alloderm, Life Cell Corp., The Woodlands, TX) and thin autograft (depth 0.005 inches) was used in skin grafting 10 elderly burn patients (age 78 year +/- 2, TBSA burn 17% +/- 2; mean +/- SEM) over a 1-year period. The outcome of patients receiving Alloderm was compared retrospectively to a similar group of 18 elderly patients admitted over the prior year, eight of whom underwent operative wound excision and autografting (depth 0.014 inches) without Alloderm. Length of hospital stay was significantly reduced in patients treated with Alloderm compared to the total group of elderly in whom selective use of operative debridement and skin grafting was used. Functional outcome was improved in those patients who underwent skin grafting regardless of operative technique. Donor site healing time was significantly reduced with Alloderm (12 days +/- 1 versus 18 days +/- 2), while graft take was similar to conventional autografting. Unfortunately, 3-month mortality remained poor regardless of operative skin grafting or technique used. This initial experience suggests that use of Alloderm may allow more elderly burn patients to undergo operative wound closure, thus improving functional outcome and reducing hospitalization. Unfortunately, long-term survival for very elderly burn patients remains poor.

The Incidence and Impact of Pre-Existing Protein Energy Malnutrition on Outcome in the Elderly Burn Patient Population

Protein energy malnutrition (PEM) and involuntary weight loss is a common problem in the elderly population. Our purpose was to determine the incidence and the effect on outcome of PEM in the elderly burn patient population. A chart review and review of the burn data registry was undertaken to determine the incidence and effect of PEM in patients older than 65 years of age with major burns from 1% to 30% TBSA. PEM was diagnosed using standard physiological and biochemical markers. Data were compared with those from a well-nourished elderly burn group to assess the impact. Of the 123 patients studied, we found that PEM was present in 61%. There was a significant increase in infection rate, decrease in the rate of healing of a standard skin graft donor site, and an increase in length of stay in the PEM group compared with the nourished elderly burn group. Mortality with PEM was 17% compared with 9% without PEM, a significant increase. We conclude that PEM is a common comorbid factor in the elderly burn population that increases morbidity and mortality.

Gender influences on burn outcomes in the elderly

Background: Women, aged 65 and older, now comprise a larger number of injuries requiring hospitalization than do young men. The purpose of this study was to evaluate gender differences in outcome and disposition of elderly (>65 years) burn patients. Methods: We compared demographic, etiologic, and outcome differences between male and female patients 65 years of age and older admitted for acute burn treatment during a five-year period. Results: Elderly patients comprised 8.5% of burn admissions. Women, who accounted for 33% of burns occurring in this group, tended to have smaller (12.0% versus 17.2% total body surface area (TBSA); p = 0.20) and less severe (3.6% versus 9.7% 3rd TBSA; p < 0.05) injuries, but mortality did not differ from men. Although not significant, elderly women, who were less likely to be married, tended to stay in the hospital longer and were significantly less likely to be discharged home than men (41.7% versus 66.7%; p < 0.05). Conclusions: Elderly burn patients, particularly women, utilize more resources than younger patients. Further research on the social and economic resources available to the elderly burn population, particularly women, is warranted in order to provide cost effective quality care during acute hospitalization and upon discharge.