Geriatric Burn Research Articles

284 Outcomes in Geriatric Burn Patients

284 Outcomes in Geriatric Burn Patients

Outcomes of Geriatric Burns Treated as Outpatients.

Most literature about geriatric burns has focused on inpatient management; therefore, our study investigated the effects of burn characteristics and preexisting medical comorbidities on treatment outcomes for geriatric burn patients treated as outpatients. A retrospective review was conducted for 391 patients over 65 years of age seen in the emergency department of Fukui Prefectural Hospital over a 10-year period. Charts were reviewed for age, sex, burn characteristics, burn mechanisms, preexisting medical comorbidities, and treatment outcomes. Multivariate regression analysis was used to examine the relationship between outcomes of outpatients and comorbidities, which were calculated by the Charlson comorbidity index. Seventy-three patients aged 65 years and older were treated as outpatients at Fukui Prefectural Hospital. The majority (80%) of these patients had burns on less than 5% of their total body surface area. Scald burns accounted for 63% of burn mechanisms, with burns to the lower extremities being the most frequent. The mean percentage of total burn surface area was 4% in the outpatient group and 28% for the inpatient group. The mean time to healing was 24.3 days in outpatients. Of the 73 outpatients, 17 (23%) showed delayed healing. Of these 17 patients, 3 patients experienced wound infection and 2 patients had documented hypertrophic scarring. Four patients ultimately underwent excision and grafting. The common preexisting medical comorbidities in the outpatient group were congestive heart failure and diabetic mellitus. There were no significant differences for medical comorbidities between outpatients and inpatients. The Charlson comorbidity index for outpatients with delayed healing was higher than that for those without delayed healing. The Charlson comorbidity index was associated with delayed healing of outpatients, but age or total burn surface area were not. The characteristics of geriatric burn outpatients were distinct from those of inpatients. The weighted sum of preexisting medical comorbidities may affect wound healing among geriatric burn outpatients.

Current situation and reflection on the prevention and treatment of burns in the elderly

With ageing of the population, it is estimated that the percentage of old people aged above 65 years old will be approached to 30% in China by 2035. This presents a considerable challenge to geriatric burn treatment, as elderly burn patients have more serious injuries, longer hospital lengths of stay, and higher rates of complications and mortality. In this article, we analyze the current status of burns in the elderly in China and the factors contributing to the outcome of the elderly, and put forward therapeutic strategies so as to improve the level of prevention and treatment of burns in the elderly.

Characterizing End-of-Life Care after Geriatric Burns at a Verified Level I Burn Center.

End-of-life (EoL) care after geriatric burns (geri-burns) is understudied. To examine the practices of burn surgeons for initiating EoL discussions and the impact of decisions made on the courses of geri-burn patients who died after injury. This retrospective cohort study examined all subjects ≥65 years who died on our Level I burn service from April 1, 2009, to December 31, 2014. Measurements obtained were timing of first EoL discussion (EARLY <24 hours post-admission; LATE ≥24 hours post-admission), decisions made, age, total body surface area burned, and calculated probability of death at admission. The cohort consisted of 57 subjects, of whom 54 had at least one documented EoL care discussion between a burn physician and the patient/surrogate. No differences were seen between groups for the likelihood of an immediate decision for comfort care after the first discussion (p = 0.73) or the mean number of total discussions (p = 0.07). EARLY group subjects (n = 38) had significantly greater magnitudes of injury (p = 0.002), calculated probabilities of death at admission (p ≤ 0.001), shorter times to death (p ≤ 0.001), and fewer trips to the operating theater for burn excision and skin grafting (p ≤ 0.001) than LATE subjects (n = 16). LATE subjects' first discussion occurred at a mean of 9.3 ± 10.0 days. The vast majority of geri-burn deaths on our burn service occur after a discussion about EoL care. The timing of these discussions is driven by magnitude of injury, and it does not lead to higher proportions of an immediate decision for comfort care. The presence and timing of EoL discussions bears further study as a quality metric for geri-burn EoL care.

The epidemiology of geriatric burns in Iran: A national burn registry-based study

Defining the epidemiology and outcome of geriatric burn patients is critical for specialized burn centers, health-care workers, and governments. Better resource use and effective guidelines are some of the advantages of studies focusing on this aspect. The outcome of these patients serves as an objective criterion for quality control, research, and preventive programs.We used data from the burn registry program in our country. For 2 years, >28,700 burn patients were recorded, 1721 of whom were admitted. Among them, 187 patients were ≥55 years old. Sixty-nine percent of patients were male and 31% female, with a male to female ratio of 2.22:1. The mean±standard deviation (SD) of age was 63.4±8.1. The cause of burns was flame (58.2%) and scalds (20.3%). Most of the burns were sustained at home. The mean duration of hospital stay was 19.5 days (range 3–59 days). The mean (SD) of the total body surface area (TBSA) was 20.3% (8.4%). The median hospital stay (length of stay (LOS)) was 11 days (SD=14). The increase in TBSA was related to a longer LOS (p<0.02).Burn wound infection developed in 44.3% of patients. The presence of inhalation injury was significantly related to mortality (p<0.001). Among the patients, 9% recovered completely, 74.9% recovered partially (requiring further treatment), 1% underwent amputation, and 12.8% died. The lack of insurance coverage did not affect the survival of our geriatric burn patients. However, being alone or single, ignition of clothing, cause of burn, comorbid illnesses, complications following the burn, TBSA, age, and sepsis were positively correlated with mortality. The mean cost of treatment for each patient was about $7450.

Creation of a decision aid for goal setting after geriatric burns: a study from the prognostic assessment of life and limitations after trauma in the elderly [PALLIATE] consortium.

We hypothesized that a decision-support aid to predict index admission mortality and discharge disposition for geriatric burns could be constructed using the well-accepted Baux score (age +total body surface area burned) in a geriatric-specific cohort. National Burn Repository version 8.0 (2002-2011) was queried for all subjects aged 65 years or older. Baux scores were calculated and patients grouped into deciles. Three discharge outcomes (death,home, discharge to nonhome setting) were measured per decile. A receiver operating characteristic analysis was used to determine optimal Baux score cutpoints based on the Youden Index. The odds of mortality at various Baux score cutoffs were estimated using logistic regression. The sample was composed of 8,001 subjects. Withdrawal of care was documented in 264 deaths; median time to withdrawal was three days. As Baux score increased, three peaks in disposition were seen. Less than 50% of patients with a Baux score of 80 or greater were discharged home. Patients with a moderate Baux score (80-130) had an increased likelihood of discharge to a nonhome setting. Baux scores of 130 or greater were nearly uniformly fatal (mortality, 94-100%). Baux score of 86.15 or less was predictive of discharge home (area under the curve, 0.698; sensitivity, 75.28%; specificity, 54.64%), and a score greater than 93.3 was predictive of mortality (area under the curve, 0.779; sensitivity, 57.46%; specificity, 87.08%). For geriatric patients whose Baux scores exceed 86, return-to-home rates drop drastically; mortality increases at a score greater than 93, and mortality is nearly universal at a score ≥130 or greater. We are piloting a display of these findings as a decision-making aid when setting goals of care with stakeholders after geriatric burns. Epidemiologic/prognostic study, level III; therapeutic/care management, level IV.

Baux Cutoff Points Predict Geriatric Burn Outcomes

Baux Cutoff Points Predict Geriatric Burn Outcomes

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

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

Epidemiologic investigation of geriatric burns in Southwest China

Objective To study the epidemiologic characteristics of burns in the elderly patients to reduce risks. Methods Features, including causes, seasonality, co-morbidities and mortality among 280 burned patients over 60 years old, admitted to Burn Unit, Southwest Hospital from 1999 to 2006, were analyzed retrospectively. Results The incidence of burns in the elderly has been decreasing gradually from 4.35% in 1999 to 3.81% in 2006. The geriatric burns could happen any time during a year, but most frequently in summer and winter. Seventy percent of the geriatric burns were related to activities of daily life. The co-morbid conditions in the elderly, which comprised 83.9% of the victims, contributed to the burn outcomes. No difference in morbidity was found between rural and urban patients. However, mortality was significantly higher in the rural patients with 30% over TBSA burns. Conclusion The incidence of geriatric burns has been decreasing associated with social and individual living levels in China. However, the disparity in the mortality rates between rural and urban suggests investment in rural China is needed to reduce health inequalities.

An epidemiologic study of elderly burn patients in Ain Shams University Burn Unit, Cairo, Egypt

Recent statistics from Egypt indicate that elderly persons comprise 5.8% of the general population. Elderly patients remain a high-risk group in all burn units. This prospective study investigated geriatric burn patients (defined as 60 years and older) who were present at our center between May 1995 and October 2001. Of the 4220 patients who were present during this period, 97 (2.3%) were elderly, and 63 (7.1%) of the 880 total admitted were geriatrics. Of the 97 elderly burn patients who were present during the study period, 31 died (mortality rate 31.9%). Other epidemiological data, including duration of hospitalization, seasonal and day/hour variation in burn incidence and burn causes and accident site are presented. Ideas for management and prevention are also presented.

An analysis of 11,196 burn admissions and evaluation of conservative management techniques

We present an 8-year analysis (1993–2000) of 11,196 burn admissions with an average of 116.6 patients per month. Patients were largely treated by conservative techniques. The mean burn percentage was 50.35. Almost 80% of admissions were in the 16–55 years age group. Paediatric and geriatric burns were 17.1 and 3.1%, respectively. Flame burns accounted for 82.15% of admissions and of these 77.5% were sustained in the kitchen. A total of 35.32% of flame accidents were due to malfunctioning kerosene pressure stove. The overall mortality was 51.80%. These figures need further qualification because 46.8% of patients had more than 50% BSA burns and 50.72% patients reported to the hospital more than 6 h after sustaining burns. Patients with <60% BSA burns, and who were received within 6 h of injury had a mortality of 23% only. Significantly, 1078/1952 deaths (55.23%) of patients <60% BSA burns took place in first 6 days of admission when 3639 patients with <60% BSA injury were received more than 6 h after burn injury. This reflects that even if economic constraints preclude one from having the best infrastructure reasonable mortality rates are still achievable with conservative line of management, even in face of a heavy work load. This also makes one question the cost effectiveness of high cost technology in burn management.

Reducing the burn risk to elderly persons living in residential care

A 45-month retrospective analysis of 70 geriatric burn admissions to the Welsh Regional Burns and Plastics Unit highlighted 13 (18.6 per cent) injuries that occurred whilst the patient was in residential care (six residential care homes, seven nursing homes). The mean age overall was 83 years. The residential care patients had a TBSA of 12.5 per cent with a mortality of 46 per cent, whilst the group living in the community had a TBSA of 8.63 per cent with a mortality of 14 per cent. These results were not statistically comparable due to the unequal population grouping. The cause of injury in the residential group included five hot water scalds, six radiator contact burns, one flame burn and one flash burn. All 13 patients were found to have such severe dementia that they were unable to give a reliable history. In the majority of patients a lack of supervision was in part responsible. Some basic measures are presented that could reduce the incidence of accidental burn injury in this vulnerable group of the population.

The Acultural Dimensions of Chronic Pain: Flawed Reality Construction and the Problem of Meaning

Pain folklore is inadequate to make sense of chronic pain. As a result, chronic pain sufferers feel frustrated and socially isolated. They encounter further difficulties in social settings, where problems regarding the management of pain remain unsolved. They cannot find refuge in retreating to certain knowledge of their private inner states, for their troubles are located not in pain but in language and culture. The problems of chronic pain sufferers suggest a form of suffering which transcends physical pain. Chronic pain is increasingly becoming a topic of interest for researchers. Some have linked chronic pain to disruptions in pain physiology (Beers and Basset, 1979; Bishop, 1973; Emmers, 1981; Livingston, 1976; Melzack, 1973); others have looked at the psychology of chronic pain (Sternbach, 1968, 1978), psychological profiles of chronic pain patients (Sternbach, 1974), and proposed methods of measuring pain (Harcus et al., 1978). Physiological and psychological studies often trade on one another's insights, generating proposed treatments for chronic pain (Beks, 1979; Bond, 1979; Davidson, 1976; Fordyce, 1976; Hart, 1974; Hendler and Fenton, 1979; Lipton, 1980; Mark, 1981). Some of this work is written as self-help guides for chronic pain patients (Epstein, 1981; Olshan, 1981; Shealy, 1976). Sociologists generally focus on pain as a social phenomenon; they locate pain in society and culture. Appropriately, they study pain in social settings where it is an ongoing concern. Fagerhaugh and Strauss (1977) examined how the staff, patients, and families on hospital geriatric wards and burn units recognized, defined and managed pain. Zborowski (1969) found that ideas and folklore about pain, which is to say pain's location in culture, affected how hospital patients of different ethnic backgrounds perceived their pain, its meaning, and its intensity. Despite cultural variations, nearly all folklore about pain includes the background belief that -with the exception of certain identifiable maladies - pain will eventually dissipate or can be treated. When pain persists despite treatment, sufferers must summon resources extrinsic to basic pain folklore to organize their experiences, that is, to tell them what they are suffering with,