Geriatric Burn Research Articles

Understanding Epidemiological Trends in Geriatric Burn Injuries: A National Multicenter Analysis from NEISS 2004-2022.

Burn injuries pose a significant source of patient morbidity/mortality and reconstructive challenges for burn surgeons, especially in vulnerable populations such as geriatric patients. Our study aims to provide new insights into burn epidemiology by analyzing the largest national, multicenter sample of geriatric patients to date. Utilizing the National Electronic Injury and Surveillance System (NEISS) database (2004-2022), individuals with a "Burn" diagnosis were extracted and divided into two comparison age groups of 18-64 and 65+. Variables including sex, race, affected body part, incident location, burn etiology, and clinical outcomes were assessed between the two groups utilizing two proportion z-tests. 60,581 adult patients who sustained burns were identified from the NEISS database with 6,630 of those patients categorized as geriatric (65+). Geriatric patients had a significantly greater frequency of scald burns (36.9% vs. 35.4%; p<0.01), and third degree/full-thickness burns (10.4% vs 5.5%, p<0.01) relative to non-geriatric adult patients with most of these burns occurring at home (75.9% vs 67.4%; p<0.01). The top five burn sites for geriatric patients were the hand, face, foot, lower arm, and lower leg and the top five burn injury sources were hot water, cookware, oven/ranges, home fires, and gasoline. Geriatric patients had over two times greater risk of hospital admission (OR: 2.32, 95% CI: 2.17-2.49, p<0.01) and over five times greater risk of ED mortality (OR: 6.22, 95% CI: 4.00-9.66, p<0.01) after incurring burn injuries. These results highlight the need for stronger awareness of preventative measures for geriatric burn injuries.

Outcomes of Geriatric Burn Patients Presenting to the Trauma Service: How Does Frailty Factor in?

IntroductionFrailty has been known to negatively affect the outcomes of geriatric trauma patients. However, there is a lack of data on the effect of frailty on the outcomes of geriatric trauma patients with concomitant burn injuries. The aim of our study was to compare the outcomes of frail versus nonfrail geriatric trauma patients with concomitant burn injuries. MethodsWe performed a retrospective analysis of American College of Surgeons Trauma Quality Improvement Program (2018). We included geriatric (≥65 y) trauma patients who sustained a concomitant burn injury with ≥10% Total Body Surface Area affected. Patients with body region-specific AIS ≥4 were excluded. Patients were stratified into Frail and Nonfrail, using 5-factor modified Frailty Index. Primary outcomes measured were mortality. Secondary outcomes measured were complications, and hospital and intensive care unit (ICU) length of stay (LOS). Multivariable logistic regression was performed to identify independent predictors of mortality. ResultsA total of 574 patients were identified, of which 172(30%) were Frail. Mean age was 74 ± 7 y and median [interquartile range] ISS was 3[1-10]. Overall, the rate of mortality was 23% and median hospital LOS was 14[3-31]. After controlling for potential confounding factors, frailty was not identified as an independent predictor of mortality (adjusted odds ratio:1.059, P = 0.93) and complications (adjusted odds ratio:1.10, P = 0.73). However, frail patients had longer hospital (β: 5.01, P = 0.002) and ICU LOS (β: 2.12, P < 0.001). ConclusionsAmong geriatric trauma patients with concomitant burn injuries, frailty is associated with longer hospital and ICU LOS, and higher rates of thrombotic complications, but not higher mortality or overall complications. Future research should investigate the impact of early assessment of frailty as well as tailored interventions on outcomes in this population.

Global epidemiology of geriatric burns, capacities of care, and injury outcomes: Perspectives from the World Health Organization global burn registry

BackgroundAn increasing aging population alongside a potentially increasing injury risk emphasizes a critical need for evidence-based burn care regarding preventive and therapeutic strategies tailored to the unique needs of older adults. However, we note a critical gap in understanding geriatric burn trends on a global scale and the care capacity across settings. Thus, this study sought to ascertain the global trend of geriatric burns with a focus on patient demographics, injury characteristics, capacities of care, and injury outcomes. MethodsA retrospective design focusing on older adults aged ≥ 60 years with burns recorded in the World Health Organization Global Burn Registry as of 31st May 2023 was employed. Descriptive statistics were employed to analyze the data. ResultsOf the 9277 records obtained from the Global Burn Registry, 849 participants (9.2%) were aged ≥ 60 years with the majority of these reported from the Eastern Mediterranean (EMRO) and Southeast Asia (SEARO) regions. More females than males were involved in burn injuries with the most common aetiological factor being flame. Most burns occurred in the home/ domestic setting with a seasonal variation (more injuries occurred in December and January). In terms of burn care capacity, the data suggest the availability of specialized services in most settings albeit the AFRO and SEARO regions still lacked the resources to offer specialized burn care. While most injured older adults were discharged home with no physical impairment (395, 46.5%), a substantial number died (250, 29.4%) during hospitalization, particularly in the African (AFRO) region and 111 (11.1%) left the facility against medical advice with the majority from the SEARO region (88). ConclusionBurn injuries in older adults remain a public health issue. On the preventive aspect, the results demonstrate a need to intensify safety in the home or domestic setting, and during festive seasons. Therapeutically, the findings underscore a need to consider the inclusion of more specialist geriatric and palliative care services in the burn management process. Additionally, we identified a need to strengthen burn care capacity in the AFRO and SEARO regions.

741 Implementation and Effectiveness Outcomes of Geriatric Burn Bundle at a Regional Burn Center

Abstract Introduction Strong evidence supports geriatric consultation and targeted management in the care of older injured patients. We developed and implemented a geriatric care bundle that includes clinical frailty screening, mini-nutritional assessment and feeding protocol, and reduction in initial prescribed opiate doses for patients ≥65 years. Clinical frailty scores and co-morbidities trigger consultation to geriatric and palliative care services rather than chronological age. We sought to evaluate process adherence, length of stay (LOS) and mortality as measures of bundle implementation and effectiveness. Methods We performed a retrospective medical record review of older burn-injured patients aged ≥65 years hospitalized at a regional burn center over the first two years of implementation (July 2019 to June 2021). We reviewed patient and injury characteristics. Primary outcome was adherence to specific bundle components: clinical frailty scale (CFS-9) and mini-nutritional screening rates, and geriatric and palliative consultation rates, stratified by implementation year. Secondary outcomes included LOS and mortality. Results All 127 older adult patients admitted to the acute burn service were analyzed. Median age was 71 years (IQR67-78), median burn size was 6% TBSA (IQR2-13), median frailty score was 3 (IQR3-4), and median mini nutrition score was 11 (IQR9-14). CFS-9 scoring and mini nutrition completion rates, as well as geriatric service consultations increased over 2 years (Table). In contrast, palliative care consults decreased over 2 years (from 34% to 16%). LOS and mortality decreased each year from 9 to 7 days and 14 to 10%, respectively. Conclusions Implementation of a geriatric burn bundle demonstrated a sustained increase in utilization of geriatric focused interventions, tailored to patients most likely to benefit based on frailty and comorbidities. Electronic medical records system integration during the initial implementation phase of the geriatric burn bundle was effective in obtaining high compliance and completion rates. However, there is still progress to be made toward full compliance with screening. Applicability of Research to Practice Implementation of a targeted bundle should be considered for optimal geriatric burn care.

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.

Challenges in Managing Geriatric Burn Patients

Burns are one of the most common and devastating injuries worldwide. Its effects are more pronounced especially among older adults who undergo physical and functional changes. Furthermore, burn injuries require surgical management increasing metabolic demands which poses challenges in the geriatric population.

Enzymatic Debridement in Geriatric Burn Patients-A Reliable Option for Selective Eschar Removal.

The treatment of geriatric burn patients represents a major challenge in burn care. The objective of this study was to evaluate the efficacy of enzymatic debridement (ED) in geriatric burn patients. Adult patients who received ED for treatment of mixed pattern and full thickness burns (August 2017-October 2022) were included in this study and grouped in the younger (18-65 years) and geriatric (≥65 years) groups. Primary outcome was a necessity of surgery subsequent to ED. Both groups (patient characteristics, surgical and non-surgical treatment) were compared. Multiple logistic and linear regression models were used to identify the effect of age on the outcomes. A total of 169 patients were included (younger group: 135 patients, geriatric group: 34 patients). The burn size as indicated by %TBSA (24.2 ± 20.4% vs. 26.8 ± 17.1%, p = 0.499) was similar in both groups. The ASA (2.5 ± 1.1 vs. 3.4 ± 1.1, p < 0.001) and ABSI scores (6.1 ± 2.8 vs. 8.6 ± 2.3, p < 0.001) were significantly higher in the geriatric group. The %TBSA treated with ED (5.4 ± 5.0% vs. 4.4 ± 4.3%, p = 0.245) were similar in both groups. The necessity of additional surgical interventions (63.0 % vs. 58.8 %, p = 0.763) and the wound size debrided and grafted (2.9 ± 3.5% vs. 2.2 ± 2.1%; p = 0.301) were similar in both groups. Regression models yielded that age did not have an effect on efficacy of ED. We showed that ED is reliable and safe to use in geriatric patients. Age did not have a significant influence on the surgical outcomes of ED. In both groups, the size of the grafted area was reduced and, in many patients, surgery was avoided completely.

Epidemiological and clinical characteristics of older adults with burns: a 15-year retrospective analysis of 2554 cases in Wuhan Institute of Burns

BackgroundWith the increase of geriatric burns, it’s urgent to summarize its characteristics. The aim of this study was to analyze the epidemiological and clinical characteristics of older adults with burns in a large center, and to provide suggestions for the prevention and treatment of geriatric burns.MethodsThis retrospective study was conducted at Wuhan Institute of Burns which is the largest burn center in central China between 2004 to 2018. Demographic and clinical data of the 60 years or above older burn inpatients were collected from medical records, analyzed and compared among groups.ResultsThis study analyzed 2554 elderly burns, which included 50.9% in young geriatric group (60–69 years old), 32.9% in middle geriatric group (70–79 years old) and 16.2% in the oldest geriatric group (80 years old or above). The most common causes of elderly burns were flames (1081, 42.3%) and scalding (1041, 40.8%). Elderly burns with total body surface area (TBSA) of 0–9% accounted for 60.6% and the larger TBSA, the fewer number of patients. The majority of patients (70.5%) injured at home.The median of time interval from injury to admission was 7 h and the oldest geriatric group (24 h) was highest. One hundred and twenty-one cases (8.5%) were treated by cooling treatment, and 72.7% of these patients were treated less than 10 min. The median number of pre-injury diseases was one. Ninety patients (6.3%) had inhalation injury.The median length of stay (LOS) was 14 days.The median hospital cost was 10,410 CNY or 2137 CNY per % TBSA, which was correlated with TBSA, LOS, surgery, inhalation injury, number of pre-injury diseases and etiology. The mortality rate was 3.0% and correlated with TBSA, inhalation injury, pulmonary disease and Alzheimer’s disease. The lethal area 50% (LA50) for total admitted elderly burns was 78.3% TBSA (95% confidence interval [CI] = 69.8 ~ 89.9% TBSA).ConclusionGeriatric burns was still common and even increasing in central China, with flame burns and scalds the most common causes, majority of whom injured at home and often had problems such as few cooling treatment, improper emergency management and delayed admission. TBSA, etiology, pre-injury diseases and inhalation injury were the risk factors of length of stay, hospital cost and treatment outcomes.

Rehabilitation of Geriatric Burn Patient Post-Meek Micrograft with Bilateral Partial Calcanectomy: A Case Report

Looking along the physiological and physical changes in aging, in the light of a major burn, co-morbidities, surgical intervention and precaution, a geriatric burn patient requires a delicate balance of ideal burn care and rehabilitation to achieve functional independence. A 70-year-old patient, with 30% total body surface area flame burn injury, underwent bilateral partial calcanectomy secondary to calcaneus osteomyelitis, and Meek micrograft technique for burn injury on bilateral lower extremities, is presented in this case report. In order to ensure good graft take, her knees were immobilized causing bilateral soft tissue contractures. Subsequently, upon initiation of ambulation, gait abnormalities observed include absence of heel off and toe off, with heel walking. The patient was admitted for intensive inpatient rehabilitation, where significant improvement in the knee range of motion and ambulation were achieved. The patient was eventually discharged ambulatory with walker. Despite expected complications, rehabilitation management proved to be beneficial in improving function and ambulation in geriatric burn patient.

Geriatrik Hastalarda Yanık Yaralanmalarının Epidemiyolojik İncelenmesi: 10 Yıllık Analiz

Özet Amaç: Yanık epidemiyolojisi, her bölgenin sosyo-ekonomik etkenlere ve kültürel özelliklerine bağlı olarak değişiklik göstermektedir. Bu travmaların önüne geçilmesi veya azaltılması için alınması gereken tedbirler açısından her bölgede yanık travmalarının etiyolojisine yönelik verilere ihtiyaç vardır. Bu çalışmadaki amacımız 2012- 2021 yılları arasında Yanık Merkezimizde tedavi gören yaşlı Türk ve Suriyeli hastaların demografik ve epidemiyolojik olarak incelenmesidir. Materyal ve Metot: Kurum onayı alındıktan sonra Ocak 2012 ile Aralık 2021 tarihleri arasında, 10 yıllık dönemde, hastanemiz yanık merkezinde yatarak tedavi gören toplam 21531 hastanın kayıtları incelendi. Toplamda 155 hastanın (136 Türk, 19 Suriyeli) demografik ve epidemiyolojik verileri kaydedildi. Ayakta tedavi gören, başka bir merkeze sevk edilen veya kronik yanığı olan hastalar çalışma dışı bırakıldı. Çalışmaya alınan hastanın yaşı, cinsiyeti, yanık nedenleri, yanık lokalizasyonları, yanık şiddeti (toplam vücut yüzey alanı (TBSA) yüzdesine göre hafif, orta, şiddetli ve kritik olarak gruplandırıldı), başvuru zamanı, hastaların ikamet ettikleri yer, hastanede takip süresi ve sonuçları kayıt edildi. Yanık nedenleri; haşlanma, alev, elektrik, kimyasal yanık olarak sınıflandırıldı. TBSA dokuzlar kuralına göre hesaplandı. Yanık lokalizasyonları baş-boyun, gövde(ön ve arka), üst ekstremite ve alt ekstremite, kalça ve genital bölge olarak sınıflandırıldı. Hastaların başvuru tarihleri sonbahar, kış, ilkbahar ve yaz olarak sınıflandırıldı. Hastaların yaşadıkları bölge kentsel ve kırsal olmak üzere iki grupta değerlendirildi. Bulgular: Çalışmaya 97’si (%62.7) kadın, 58’i (%37.3) erkek olmak üzere toplam 155 hasta dahil edildi. En sık görülen neden haşlanma yaralanmalarıydı. Bunu alev yanıkları ve elektrik yanıkları takip ediyordu. Hastaların yanık derecelerinin toplam vücut alan yüzeyine göre sınıflandırdığımızda en yüksek oranda orta (%10-30 TBSA) derecede yanık olduğunu gördük. Yine en sık yanan vücut anatomik bölgesi ise kol(%51.6) ve bacak(%50.3) olmak üzere ekstremitelerde olduğu görüldü. Hastaların 136’sı Türk, 19’u Suriyeli olduğu görüldü. Yanık nedenlerinin analizinde ise kimyasal ve elektrik yanıklarının Suriyelilerde hiç görülmediği, alev ve haşlanma yanıklarının ise Türklerde istatistiksel olarak anlamlı şekilde daha fazla olduğu saptandı. Yanık vücut alanları incelendiğinde ise her iki ırkta da en sık ekstremite yanıklarının olduğu tespit edildi. Takiplerde 15 (%9.7) hastanın öldüğü görüldü. Ölümler arasında ise en sık ölümün %80 oranla 65 yaş altında gerçekleştiği saptandı (p=0.027). Sonuç: Yaşlı nüfustaki yanık yaralanmalarını incelediğimiz bu çalışmada bölgesel nüfus, Suriyeli mülteci sayısı, yaşam koşulları gibi etkenler göz önüne alındığında genç hastalara kıyasla bu özel hasta grubunda tıbbi bakım ihtiyacının fazla ve önemli olduğunu söyleyebiliriz. Geriatrik yanık hastalarında gerek komorbid hastalıklar gerekse yaşlanmanın sistemsel etkisi nedeniyle her adımda multidisipliner yaklaşım ile azalan mortalite ve morbiditeyi yakalayabiliriz.

Geriatric Burn Injuries Presenting to the Emergency Department of a Major Burn Center: Clinical Characteristics and Outcomes

BackgroundBurn injuries in geriatric patients are common and may have significant associated morbidity and mortality. Most research has focused on the care of hospitalized patients after admission to burn units. Little is known about the clinical characteristics of geriatric burn victims who present to the emergency department (ED) and their ED assessment and management. ObjectiveOur aim was to describe the clinical characteristics and outcomes of geriatric patients presenting to the ED with burn injuries. MethodsWe performed a comprehensive retrospective chart review on all patients 60 years and older with a burn injury presenting from January 2011 through September 2015 to a large, urban, academic ED in a hospital with a 20-bed burn center. ResultsA total of 459 patients 60 years and older were treated for burn injuries during the study period. Median age of burn patients was 71 years, 23.7% were 80 years and older, and 56.6% were female. The most common burn types were hot water scalds (43.6%) and flame burns (23.1%). Median burn size was 3% total body surface area (TBSA), 17.1% had burns > 10% TBSA, and 7.8% of patients had inhalation injuries. After initial evaluation, 46.4% of patients were discharged from the ED. Among patients discharged from the ED, only 1.9% were re-admitted for any reason within 30 days. Of the patients intubated in the ED, 7.1% were extubated during the first 2 days of admission, and 64.3% contracted ventilator-associated pneumonia. ConclusionsBetter understanding of ED care for geriatric burn injuries may identify areas in which to improve emergency care for these vulnerable patients.

14 Prognostic Factors for In-hospital Mortality of Geriatric Burns from the US National Inpatient Sample 2016-2018

IntroductionOlder adults experience a disproportionately higher rate of hospitalization and mortality due to burns. However, national estimates of in-hospital mortality in geriatric patients with acute burns outside of the recognized burn centers are lacking. The purpose of this study is to characterize such national estimates and identify the prognostic factors associated with in-hospital mortality in elderly patients with acute burn injuries.MethodsPatients ≥50 years with an acute burn diagnosis in the United States National Inpatient Sample from 2016 to 2018 were identified by using International Classification of Diseases, Tenth Revision, Clinical Modification codes (T20.0-T31; initial encounters only). Trend weights were used from the Agency for Healthcare Research and Quality to generate national estimates. Factors associated with in-hospital mortality were evaluated by multivariable logistic regression.ResultsA total of 60,515 weighted discharges met inclusion criteria. For age groups 50-64 (reference category), 65-74, 75-84, and ≥85, the numbers of discharges were 33,100, 15,295, 7,880, and 4,240, respectively; the in-hospital mortality rates were 3.3%, 5.3%, 6.6%, and 9.9%, respectively. The full list of significant variables of the multivariable regression can be seen in Table 1. Specifically, variables associated with increased in-hospital mortality include age 75-84 (odds ratio [OR], 3.91; p< 0.001), age ≥85 years (OR, 11.94; p< 0.001), total body surface area (%TBSA) 10-19% (OR, 2.93; p=0.017), and %TBSA ≥20% (OR, 27.78; p< 0.001). Intentional burns were associated with an increased risk of mortality (OR, 7.86; p=0.005), whereas hot liquids and vapor burns were associated with a decreased risk of mortality (OR, 0.33; p=0.043). Respiratory distress/failure (OR, 5.78; p< 0.001), aspiration pneumonia/pneumonitis (OR, 5.01; p=0.004), shock (OR, 4.58; p=0.004), and acute renal failure (OR, 2.85; p=0.005) were associated with an increased risk of mortality. One or more surgical excisions were associated with a reduced risk of mortality (OR, 0.26; p< 0.001).ConclusionsAge ≥75 years, %TBSA ≥10%, intentional burn as the mechanism of injury, and certain comorbidities and complications were significant risk factors for in-hospital mortality in geriatric burn patients.

Geriatric Burn Injuries: Prevalence, Management and Clinical Outcome

Burns are a significant public health issue that result in more than 180 000 fatalities annually. For specialized burn care, the geriatric burn population is a sensitive and usually challenging group. Despite the fact that all age groups have shown advances in burn care, geriatrics still have worse survival rates. Burn severity, treatment, and outcomes are impacted in geriatrics because of the physiological differences between them and younger adult burn patients. The atrophic skin of the elderly results in deeper burns, or a higher ratio of full-thickness total body surface area compared to younger patients, but it also hinders the healing of both donor sites and burns. The purpose of this research is to review the available information about geriatric burn injuries: prevalence, management and clinical outcome. Elderly people are more susceptible to complications such pneumonia, congestive heart failure, and pulmonary edema. The morbidity and mortality seen in geriatric burn patients are also attributed to altered immunological and inflammatory response driven by age leading to increased hospital stays and more severe complications. Management of geriatric burn patients involves two concepts. the revolutionary theory of eschar excision and wound closure within the first week of hospitalization, and the conventional strategy of reducing physiologic stress by delaying surgery in the early post-burn stage while the development of effective fluid resuscitation protocols, which has most significantly boosted patient survival, is one of the pillars of modern burn care. The epidemiology of burn injuries in geriatrics is quite variable and demands further research.

Pain Management in Geriatric Burn Patients: A Scoping Review of Strategies and Key Issues

The effect of poorly treated pain is well documented in the literature. To offer support for the development of geriatric-specific pain management protocols, this review sought to scope the literature to identify what has been accomplished in geriatric burn pain management and offer suggestions. Arksey and O’Malley’s scoping review methodology was employed with extensive database and grey literature searches. A narrative synthesis was employed to analyse the evidence. The PRISMA extension guidelines for scoping reviews were followed in reporting this review. Sixteen evidence types comprising eleven reviews, two retrospective studies, two book chapters, and one practice guideline were retained in the review. The two retrospective studies emerged from the United States. The review findings suggest that though a plethora of generic pain assessment tools exist, they are yet to be validated in the older adult burn population. Pain management strategies involved the use of pharmacological agents (mainly opioids), but no outcome regarding pain relief was reported. Key issues identified include cautious use of opioids, oversedation concerns, and varied complexities associated with pain management. Though the literature remains largely unexplored, the complexities associated with geriatric burn pain management suggest a need for a multidisciplinary approach. More prospective studies are also needed to evaluate both pharmacological and non-pharmacological interventions in the geriatric burn population.

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.

Early Enteral Nutrition in Geriatric Burn Patients: Is There a Benefit?

Nutrition is a critical component of acute burn care and wound healing. There is no consensus over the appropriate timing of initiating enteral nutrition in geriatric burn patients. This study aimed to assess the impact of early enteral nutrition on outcomes in this patient population. We performed a 1-year (2017) analysis of the American College of Surgeons Trauma Quality Improvement Program and included all older adult (age ≥65 years) isolated thermal burn patients who were admitted for more than 24 hr and received enteral nutrition. Patients were stratified into two groups based on the timing of initiation of feeding: early (≤24 hr) vs late (>24 hr). Multivariate logistic regression was performed to control for potential confounding factors. Outcome measures were hospital and intensive care unit lengths of stay, in-hospital complications, and mortality. A total of 1,004,440 trauma patients were analyzed, of which 324 patients were included (early: 90 vs late: 234). The mean age was 73.9 years and mean TBSA burnt was 31%. Patients in the early enteral nutrition group had significantly lower rates of in-hospital complications and mortality (15.6% vs 26.1%; P = 0.044), and a shorter hospital length of stay (17 [11,23] days vs 20 [14,24] days; P = 0.042) and intensive care unit length of stay (13 [8,15] days vs 17 [9,21] days; P = 0.042). In our regression model of geriatric burn patients, early enteral nutrition was associated with improved outcomes. The cumulative benefits observed may warrant incorporating early enteral nutrition as part of intensive care protocols.

668 Early Enteral Nutrition in Geriatric Burn Patients: Is There a Benefit?

Abstract Introduction Nutrition is a critical component of acute burn care and wound healing. There is no consensus over the appropriate timing of initiating enteral nutrition (EN) in geriatric burn patients. The aim of our study was to assess the impact of early EN on outcomes in geriatric burn patients. We hypothesized that early EN is associated with improved outcomes. Methods We performed a 2-year (2015–2016) analysis of the ACS-TQIP and included all older adult (age ≥65years) burn patients who received EN. Patients were stratified into two groups based on timing of initiation of EN: Early-EN (&amp;lt; 24 hrs) vs. Late-EN (≥ 24 hrs). We performed propensity score matching (1:2 ratio) to control for possible confounding variables including demographics, comorbidities, injury parameters, height and body weight. Outcome measures were in-hospital; complications, hospital and ICU length of stay, and mortality. Results A total of 593,818 trauma patients were analyzed, of which 447 patients were matched (Early-EN: 159 vs Late-EN: 318). Mean age was 44±22, 75% were males, and median ISS was 29 [26–36] and mean total body burn surface area (TBSA) was 15±5%. There was no significant difference between the two groups in terms of age (p=0.99), gender (p=0.60), race (p=0.91), ISS (p=0.43), GCS (p=0.85), TBSA (p=0.51), height (p=0.71), and weight (p=0.61). Overall, the complications rate was 40%, median hospital LOS was 25 [15–36] days, median ICU LOS was 15 [8–26] days and mortality rate was 16%. Patients in the early ED group had significantly lower rate of complications and mortality Table 1. At the same time, patients in the early group had lower hospital length of stay (23[12–36] vs. 26[16–38], p=0.013) and ICU length of stay (12[8–24] vs. 16[8–26], p=0.025). Conclusions In our propensity matched cohort of geriatric burn patients, early EN was associated with improvement in outcomes. The cumulative benefits observed may warrant incorporating early EN as part of intensive care protocols. Applicability of Research to Practice Geriatric patients are a special subset of the population that require additional considerations. Our research highlights the impact of early enteral nutrition on different in hospital outcomes. This is an area of constant debate, our study shows that early enteral nutrition in geriatric burn patients is associated with improved outcome. We found this applicable in most of our patients and thus it might warrant further incorporation in ICU burn protocols.

525 Autologous Skin Cell Suspension May Enhance Healing of Burn Wounds and Skin Graft Donor Sites in Elderly Burn Patients

Abstract Introduction An autologous skin cell suspension (ASCS) spray containing keratinocytes, fibroblasts, and melanocytes can be processed from a small split thickness skin sample for use at the point-of-care in the operating room. ASCS have been shown to facilitate epidermal regeneration in large TBSA partial thickness burns with minimal donor site morbidity. We hypothesized that ASCS in conjunction with a 3:1 split thickness skin graft applied to burn wounds and ASCS alone applied to the donor site would facilitate healing in a 95 year-old burn patient with 12% TBSA deep partial and full thickness scald burns to the abdomen and bilateral thighs. To our knowledge, she is the oldest patient to undergo epidermal autografting with ASCS. Methods All burn wounds were tangentially excised in the standard fashion to healthy tissue. Split thickness (12/1000 inch) skin graft was harvested from the right lateral thigh, meshed 3:1, and applied to all wound beds. ASCS were prepared and sprayed on grafted sites and the donor site. All areas were dressed with Telfa clear and Xeroform with bacitracin. Dressings were initially changed every 2 days, and wounds were photographed on day 2, 4, 6, 8, 10, and 20. Results All burn wounds were deep partial thickness or full thickness. The right thigh donor site was completely healed by POD 10. 90% of the burn wounds had healed by POD 10. The area of deepest burn, an approximately 20 cm2area on the left medial thigh, was healed by POD 20. Conclusions We believe that ASCS enhanced the rate of re-epithelialization of burn wounds in a 95 year-old patient compared to our experience with skin grafting alone in this population. ASCS also promoted complete healing of the donor site by POD 10. This technology may have a role in decreasing healing time in the geriatric burn population. These findings are important for this population as longer lengths of stay are associated with delirium, hospital acquired infections, and deconditioning. This patient’s improved donor site healing also has broader implications as split thickness skin grafts are used widely for wound coverage in plastic surgery. Applicability of Research to Practice Demonstrates efficacy of ASCS in very elderly patients with moderate-sized deep burns and with skin graft donor sites.

Epidemiological and clinical characteristics of burns in the older person: a seven-year retrospective analysis of 693 cases at a burn center in south-west China.

BackgroundBurns are one of the major traumas that may affect older individuals. The purpose of this study was to investigate the epidemiological and clinical characteristics of geriatric burns at a major center in south-west China.MethodsThis retrospective study was conducted at the Institute of Burn Research, Southwest Hospital of Army Medical University between 2010 and 2016, and the data collected from medical records included admission date, age, gender, premorbid disease, burn etiology, injured anatomical location, burn area and depth, inhalation injury, number of surgeries, length of stay (LOS), clinical outcome, and medical cost.ResultsOf the 693 older burn patients included, 60.75% were male and 56.85% were aged 60–69 years. Burns peaked in December–March and June. Flame was the most common cause of burns, making up 51.95% of all cases, and also dominated in the burn patients aged 60–69 years. Limbs were the most common anatomical sites of burns (69.41%), and the median total body surface area (TBSA) was 5% (interquartile range [IQR]: 2%–15%). The percentage of the patients who underwent surgeries and number of surgeries significantly increased in the cases of contact burns, younger age and full-thickness burns. Six deaths resulted in a mortality of 0.9%. The median LOS was 16 days (IQR: 8–29 days), and the main risk factors were more surgeries, better outcomes, and full-thickness burns. The median cost was 20,228 CNY (IQR: 10,457– 46,581.5 CNY), and major risk factors included longer LOS, larger TBSA, and more surgeries. Furthermore, compared to the earlier data from our center, the proportion of older adults among all burns (7.50% vs. 4.15%), proportion of flame burns (51.95% vs. 33.90%), and mean age (69.05 years vs. 65.10 years) were significantly higher, while the proportion of premorbidities (16.9% vs. 83.9%), mortality (0.9% vs. 7.5%) and median TBSA (5% vs. 21%) were significantly lower.ConclusionsThis study suggested that closer attention should be paid to prevent burn injuries in older people aged 60–69 years, especially males, regarding incidents in the summer and winter, and flame burns. Moreover, tailored intervention strategies based on related risk factors should be under special consideration.

209 Attitudes Among Burn Surgeons and Palliative Care Physicians Regarding Goals of Care for Geriatric Burn Patients

The significance of delineating goals of care (GoC) for geriatric patients has been well known to the palliative care community but is a relatively new concept to burn surgeons. We surveyed palliative care specialists (PCS) and burn surgeons (BS) to elicit their attitudes regarding: 1) the importance of goal setting for burned seniors; 2) each specialty’s confidence in their own ability to conduct GoC conversations; and 3) their confidence in the ability of the other specialty to do so. A 13-item survey was developed by the steering committee of a multi-center consortium dedicated to palliative care in the burned geriatric patient. The instrument draft was sent to burn and palliative care providers unaffiliated with the consortium for beta-testing. The finalized instrument was electronically circulated to all active physician members of the American Burn Association (ABA) and the American Academy for Hospice and Palliative Medicine (AAHPM). Surveys underwent review and approval by the research committees of each organization. Responses were received from 45 subjects categorized as BS (7.3%) and 244 PCS (5.7%). PCS rated being more familiar with GoC, were more comfortable having a GoC discussion with laypeople, were more likely to have reported high quality training in performing GoC conversations, believed more palliative care physicians were needed in ICUs, and had more interest in conducting GoC conversations relative to BS. Interestingly, both sets of physicians believed themselves to perform GoC discussions better than their peers perceived them to do so. In regard to perceptions of the best model for conducting GoC discussions, BS favored leading team discussions, where PCS endorsed both PCS and BS led discussions. Both also generally agreed that GoC discussions should occur with 72 hours of admission. PCS were more likely to have reported training in determining GoC in fellowship and on-the-job training, have fewer years of experience in their specialty, and less frequently deliver care to burned seniors relative to BS. Regarding work setting, BS reported working predominantly in academic private centers and academic safety net hospitals, and PCS representing a wider array of contexts. Both BS and PCS believe themselves to conduct GoC discussions for burned seniors better than the other specialty perceived them to do so, which led to disparate views on perceptions on the optimal leadership of these discussions. A dichotomy of views regarding the roles and responsibilities of BS and PCS in the conduct of GoC discussions for burned seniors highlights the need for future work to inform best practices.