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

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.

An age-associated increase in pulmonary inflammation after burn injury is abrogated by CXCR2 inhibition

Burn patients over the age of 60 are at a greater risk for developing pulmonary complications than younger patients. The mechanisms for this, however, have yet to be elucidated. The objective of this study was to determine whether increased chemoattraction plays a role in the age-related differences in pulmonary inflammation after burn injury. At 6 or 24 h after receiving sham or 15% total body surface area scald injury, lungs from young and aged mice were analyzed for leukocyte content by histological examination and immunostaining. Lungs were then homogenized, and levels of neutrophil chemokines, MIP-2 and KC, were measured. At 6 h after burn, the number of neutrophils was four times higher in the lungs of both burn groups compared with aged-matched controls (P<0.05), but no age difference was evident. At 24 h, in contrast, neutrophils returned to sham levels in the lungs of young, burn-injured mice (P<0.05) but did not change in the lungs of aged, burn-injured mice. Pulmonary levels of the neutrophil chemokine KC but not MIP-2 were consistently three times higher in aged, burn-injured mice compared with young, burn-injured mice at both time-points analyzed. Administration with anti-CXCR2 antibody completely abrogated the excessive pulmonary neutrophil content by 24 h (P<0.05), while not affecting the inflammatory response of the wounds. These studies show that CXCR2-mediated chemoattraction is involved in the pulmonary inflammatory response after burn and suggest that aged individuals sustaining a burn injury may benefit from treatment strategies that target neutrophil chemokines.

A three-decade review of thermal injuries among the elderly at a regional burn centre

AIM

To review trends in incidence and treatment of thermal injuries among the elderly.

METHOD

A 3-year retrospective review of medical records of people aged 65 years and older admitted to our burn centre over July 2003-June 2006.

RESULTS

Elderly people with burns continued to have significant comorbidities. They were often burned because they were inappropriately trying to live alone. Thus discharge was often complicated.

CONCLUSIONS

At our burn centre, survival among elderly people with burns has increased, probably as a result of more sophisticated medical, surgical and nursing care, as well as more extensive rehabilitation.

Acute physiology, age, and chronic health evaluation (APACHE) III score is an alternative efficient predictor of mortality in burn patients

The present study was performed to evaluate the prognostic value of the acute physiology, age, chronic health evaluation (APACHE) III score in burn patients. We hypothesised that APACHE III score efficiently predicts mortality of burn patients as it reflects the physiological changes in the acute phase and the severity of the underlying illness. Data such as age, gender, inhalation injury, total burn surface area (TBSA), burn index (BI), prognostic burn index (PBI), APACHE III score and outcome of 105 hospitalised patients were analysed retrospectively. TBSA, BI, PBI, and APACHE III score in the mortality group were significantly higher than those of surviving group. The mean scores of surviving versus mortality groups were as follows: TBSA, 19.2+/-17.8% versus 69.1+/-28.4%, p<0.0001; BI, 12.8+/-13.1% versus 66.8+/-28.6%, p<0.0001; PBI, 68.8+/-26.0% versus 124.4+/-33.6%, p<0.0001; APACHE III score, 28.4+/-22.2% versus 71.3+/-32.1%, p<0.0001. PBI and APACHE III score showed marked associations between higher scores and higher mortality. APACHE III score showed a significant correlation with PBI (p<0.0001). The present study suggested that APACHE III score could be used as an alternative efficient predictor of mortality in burn patients.

Burn wound infections

Burns are one of the most common and devastating forms of trauma. Patients with serious thermal injury require immediate specialized care in order to minimize morbidity and mortality. Significant thermal injuries induce a state of immunosuppression that predisposes burn patients to infectious complications. A current summary of the classifications of burn wound infections, including their diagnosis, treatment, and prevention, is given. Early excision of the eschar has substantially decreased the incidence of invasive burn wound infection and secondary sepsis, but most deaths in severely burn-injured patients are still due to burn wound sepsis or complications due to inhalation injury. Burn patients are also at risk for developing sepsis secondary to pneumonia, catheter-related infections, and suppurative thrombophlebitis. The introduction of silver-impregnated devices (e.g., central lines and Foley urinary catheters) may reduce the incidence of nosocomial infections due to prolonged placement of these devices. Improved outcomes for severely burned patients have been attributed to medical advances in fluid resuscitation, nutritional support, pulmonary and burn wound care, and infection control practices.

Burn wound infections

Burns are one of the most common and devastating forms of trauma. Patients with serious thermal injury require immediate specialized care in order to minimize morbidity and mortality. Significant thermal injuries induce a state of immunosuppression that predisposes burn patients to infectious complications. A current summary of the classifications of burn wound infections, including their diagnosis, treatment, and prevention, is given. Early excision of the eschar has substantially decreased the incidence of invasive burn wound infection and secondary sepsis, but most deaths in severely burn-injured patients are still due to burn wound sepsis or complications due to inhalation injury. Burn patients are also at risk for developing sepsis secondary to pneumonia, catheter-related infections, and suppurative thrombophlebitis. The introduction of silver-impregnated devices (e.g., central lines and Foley urinary catheters) may reduce the incidence of nosocomial infections due to prolonged placement of these devices. Improved outcomes for severely burned patients have been attributed to medical advances in fluid resuscitation, nutritional support, pulmonary and burn wound care, and infection control practices.