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Oehlers J, Blayney C, Tate J, Cheng A, Tucker A, Reed MJ, Stewart BT, Arbabi S, O'Connell K, Powelson E, Pham TN. Implementation of a geriatric care bundle for older adults with acute burns. Burns 2024; 50:841-849. [PMID: 38472006 PMCID: PMC11055663 DOI: 10.1016/j.burns.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/28/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Frailty and comorbidities are important outcome determinants in older patients (age ≥65) with burns. A Geriatric Burn Bundle (Geri-B) was implemented in 2019 at a regional burn center to standardize care for older adults. Components included frailty screening and protocolized geriatric co-management, malnutrition screening with nutritional support, and geriatric-centered pain regimens. METHODS This study aimed to qualitatively evaluate the implementation of Geri-B using the Proctor Framework. From June-August 2022, older burn-injured patients, burn nurses, and medical staff providers (attending physicians and advanced practice providers) were surveyed and interviewed. Transcribed interviews were coded and thematically analyzed. From May 2022 to August 2023, the number of inpatient visits aged 65 + with a documented frailty screening was monitored. RESULTS The study included 23 participants (10 providers, 13 patients). Participants highly rated Geri-B in all implementation domains. Most providers rated geriatric care effectiveness as 'good' or 'excellent' after Geri-B implementation. Providers viewed it as a reminder to tailor geriatric care and a safeguard against substandard geriatric care. Staffing shortages, insufficient protocol training, and learning resources were reported as implementation barriers. Many providers advocated for better bundle integration into the hospital electronic health record (EHR) (e.g., frailty screening tool, automatic admission order sets). Most patients felt comfortable being asked about their functional status with strong patient support for therapy services. The average frailty screening completion rate from May 2022 to August 2023 was 86%. CONCLUSIONS Geri-B was perceived as valuable for the care of older burn patients and may serve as a framework for other burn centers.
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Affiliation(s)
- Julia Oehlers
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA.
| | | | - Jo Tate
- UW Medicine Regional Burn Center, Seattle, WA, USA
| | | | | | - May J Reed
- UW Department of Medicine, Seattle, WA, USA
| | - Barclay T Stewart
- UW Medicine Regional Burn Center, Seattle, WA, USA; UW Department of Surgery, Seattle, WA, USA
| | - Saman Arbabi
- UW Medicine Regional Burn Center, Seattle, WA, USA; UW Department of Surgery, Seattle, WA, USA
| | | | | | - Tam N Pham
- UW Medicine Regional Burn Center, Seattle, WA, USA; UW Department of Surgery, Seattle, WA, USA
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Bayuo J, Agbeko AE, Wong AKC, Wong FKY, Baafi EO, Baffour PK, Naw HE, Agbenorku P. Global epidemiology of geriatric burns, capacities of care, and injury outcomes: Perspectives from the World Health Organization global burn registry. Burns 2023; 49:1796-1807. [PMID: 37945508 DOI: 10.1016/j.burns.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/30/2023] [Accepted: 09/27/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND An 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. METHODS A 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. RESULTS Of 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). CONCLUSION Burn 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.
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Affiliation(s)
- Jonathan Bayuo
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong; Department of Nursing, Presbyterian University, Ghana.
| | | | | | | | | | | | - Hser Eh Naw
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
| | - Pius Agbenorku
- Directorate of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana; School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Ghana
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Muro I, Qualman AC, Kovacs EJ, Idrovo JP. Burn-Induced Apoptosis in the Livers of Aged Mice Is Associated With Caspase Cleavage of Bcl-xL. J Surg Res 2023; 290:147-155. [PMID: 37267704 PMCID: PMC10330893 DOI: 10.1016/j.jss.2023.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 04/05/2023] [Accepted: 04/29/2023] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Older adult burn victims have poorer outcomes than younger burn victims. The liver is critical for the recovery of patients with burns. Postburn hepatic apoptosis in young individuals compromises liver integrity; however, this pathway has not yet been studied in older individuals. Because aged animals with burns suffer significant liver damage, we hypothesized that apoptosis is altered in these animals and may affect liver function. Understanding postburn hepatic apoptosis and its effects on liver function in aged animals may help improve outcomes in older patients. METHODS We compared the protein and gene expression levels in young and aged mice after a 15% total-body-surface-area burn. Liver and serum samples were collected at different time points after injury. RESULTS Caspase-9 expression in liver tissue was downregulated by 47% in young animals and upregulated by 62% in aged animals 9 h postburn (P < 0.05). The livers of aged mice showed a Bcl-extra-large (Bcl-xL) transcription increase only after 6 h; however, the livers of young mice exhibited 4.3-fold, 14.4-fold, and 7.8-fold Bcl-xL transcription increases at 3, 6, and 9 h postburn, respectively (P < 0.05). The livers of young mice showed no changes in Caspase-9, Caspase-3, or Bcl-xL protein levels during the early postburn period. In contrast, the livers of aged mice contained cleaved caspase-9, reduced full-length caspase-3, and an accumulation of ΔN-Bcl-x at 6 and 9 h postburn (P < 0.05). p21 expression decreased in aged mice; however, it was significantly increased in the liver tissue of young mice postburn (P < 0.05). Serum amyloid A1 and serum amyloid A2 serum protein levels were 5.2- and 3.1-fold higher in young mice than in aged mice, respectively, at 6 and 9 h postburn (P < 0.05). CONCLUSIONS Livers of aged mice exhibited different apoptotic processes compared to those of young mice early after burn injury. Collectively, burn-induced liver apoptosis in aged mice compromises hepatic serum protein production.
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Affiliation(s)
- Israel Muro
- Division of G.I., Trauma, and Endocrine Surgery, Department of Surgery, University of Colorado, Aurora, Colorado
| | - Andrea C Qualman
- Division of G.I., Trauma, and Endocrine Surgery, Department of Surgery, University of Colorado, Aurora, Colorado
| | - Elizabeth J Kovacs
- Division of G.I., Trauma, and Endocrine Surgery, Department of Surgery, University of Colorado, Aurora, Colorado; Division of Burn Research, Division of Alcohol Research, Department of Immunology and Microbiology, University of Colorado, Aurora, Colorado
| | - Juan-Pablo Idrovo
- Division of G.I., Trauma, and Endocrine Surgery, Department of Surgery, University of Colorado, Aurora, Colorado.
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Mulatu D, Zewdie A, Zemede B, Terefe B, Liyew B. Outcome of burn injury and associated factor among patient visited at Addis Ababa burn, emergency and trauma hospital: a two years hospital-based cross-sectional study. BMC Emerg Med 2022; 22:199. [PMID: 36494642 PMCID: PMC9733383 DOI: 10.1186/s12873-022-00758-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Burn is one of the critical health problems worldwide. Developing countries with sub-Saharan and Asian populations are affected more. Its mortality and non-fatal complications depend on several factors including age, sex, residency, cause, the extent of the burn, and time and level of care given. OBJECTIVE The purpose of this study was to assess the outcome of burn injury and its associated factor among patients who visited Addis Ababa burn emergency and trauma hospital. METHODS The institutional-based, retrospective cross-sectional study design was conducted from April 1, 2019, to March 30, 2021. After checking the data for its consistency the data were entered and analyzed by using SPSS version 25. A total of 241 patients who had visited Addis Ababa burn, emergency and trauma Hospitals after sustained burn injury were recruited through convenience sampling method for final analysis. Model goodness-of-fit was checked by Hosmer and Lemeshow test (0.272). After checking multi-collinearity both the bi-variable and multivariable logistic regression model was fitted and variables having a p-value less than or equal to 0.05 at 95% CI in the multivariable analysis were considered statistically significant. RESULT Adults (age 15 to 60 years) are the most affected groups accounting for 55.2% followed by pediatric age groups (age <15 years) (43.6%) and the elderly (age > 60 years) (1.2%). Scald burn was the major cause accounting for 39 % followed by Flame burn (33.6%), Electrical burn (26.6%), and chemical burn (0.8%). The mean TBSA% was 15.49%, ranging from1% to 64%. Adult males are more affected by electrical burns while adult females and the elderly encounter flame burn. 78.4% of patients were discharged without complications, 14.9% were discharged with complications and 6.6% died. The commonest long-term complication is the amputation of the extremity (19, 7.9%). Age greater than 60 years and TBSA% greater than 30% is a strong predictors of mortality with odds of 2.2 at 95% CI of [1.32, 3.69] and 8.7 at 95% CI of [1.33, 57.32] respectively. CONCLUSION AND RECOMMENDATION The mortality rate show decrement from previous studies. Overall scald burn is common in all age groups but electrical burns and flame burns affected more adult and elderly age groups. Extremities were by far, the commonest affected body parts. The extent of burn injury and the age of the patient independently predict mortality. Early intervention will reduce mortality and complications.
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Affiliation(s)
- Damena Mulatu
- grid.59547.3a0000 0000 8539 4635Department of internal medicine, School of medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ayalew Zewdie
- grid.460724.30000 0004 5373 1026Department of Emergency Medicine and Critical Care, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Biruktawit Zemede
- grid.460724.30000 0004 5373 1026Department of Emergency Medicine and Critical Care, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Bewuketu Terefe
- grid.59547.3a0000 0000 8539 4635Department of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bikis Liyew
- grid.59547.3a0000 0000 8539 4635Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, P.O.BOX 196, Gondar, Ethiopia
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Lachs DK, Stern ME, Elman A, Gogia K, Clark S, Mulcare MR, Greenway A, Golden D, Sharma R, Bessey PQ, Rosen T. Geriatric Burn Injuries Presenting to the Emergency Department of a Major Burn Center: Clinical Characteristics and Outcomes. J Emerg Med 2022; 63:143-158. [PMID: 35637048 PMCID: PMC9489596 DOI: 10.1016/j.jemermed.2022.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 01/05/2022] [Accepted: 01/25/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Burn 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. OBJECTIVE Our aim was to describe the clinical characteristics and outcomes of geriatric patients presenting to the ED with burn injuries. METHODS We 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. RESULTS A 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. CONCLUSIONS Better understanding of ED care for geriatric burn injuries may identify areas in which to improve emergency care for these vulnerable patients.
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Affiliation(s)
- David K Lachs
- Department of Emergency Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Michael E Stern
- Department of Emergency Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Kriti Gogia
- Department of Emergency Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Sunday Clark
- Boston Trauma Institute, Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Mary R Mulcare
- Department of Emergency Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Andrew Greenway
- Division of Trauma, Burns, Acute and Critical Care, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Daniel Golden
- Department of Emergency Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Rahul Sharma
- Department of Emergency Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Palmer Q Bessey
- Division of Trauma, Burns, Acute and Critical Care, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York.
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Wong L, Rajandram R, Allorto N. Systematic review of excision and grafting in burns: Comparing outcomes of early and late surgery in low and high-income countries. Burns 2021; 47:1705-1713. [PMID: 34303572 DOI: 10.1016/j.burns.2021.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 04/08/2021] [Accepted: 07/02/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION While the benefits of early excision in burn surgery are clear, the advantages may be lost in low income countries with limited resources. It is important to identify the right timing of excision in different groups of patients, particularly those in low-income countries (LIC), as the burden of disease contributes to the highest global mortality and has the least resources. This systematic review and meta-analysis aims to determine the timing of excision in LICs and the outcomes associated with surgery: (1) mortality, (2) sepsis and (3) length of stay (LOS) compared to high income countries (HICs). METHODOLOGY The PRISMA guidelines and MOOSE checklist were followed for this review. Publications in English from year 1990 to 2017 that included data on the timing and type of burn surgery and outcomes were included. Searches were done using Web of Science, Cochrane collaboration and Pubmed using keywords "Burn and surgery", "Burn and excision", "Burn and excision and grafting" and "burn and skin grafting". Trial quality was evaluated using the Newcastle-Ottawa scale. Outcomes compared for early and late excisions were length of stay (LOS), sepsis and mortality between LICs and HICs. RESULTS From 278 citations, we selected 41 for full text evaluation, and identified 16 eligible trials. LOS is shorter in early excision compared to late excision in both LICs and HICs. Mortality is lower in late excision compared to early excision in both LICs and HICs. Further subgroup analysis of elderly patients in HICs confirmed that mortality is lower in late excision and unchanged if the elderly are excluded. Early excision reduces sepsis in both LIC and HIC. DISCUSSION The variable definitions of age, timing of excision, variable nature of % TBSA comparison, mixed inclusion of inhalation injury, co-morbidities and unquantified access to resources make the data difficult to interpret and it is not possible to draw accurate conclusions on the role of early excision for burns in low-middle income countries. A prospective study is needed in order to answer this question.
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Affiliation(s)
- Lingwei Wong
- Trauma Sciences, Queen Mary University of London, Mile End Rd, Bethnal Green, London E1 4NS, United Kingdom.
| | - Retnagowri Rajandram
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
| | - Nikki Allorto
- Department of Surgery, Pietermaritzburg Metropolitan Complex, University of Kwa-zulu Natal, South Africa.
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Bayuo J, Aniteye P, Richter S, Agbenorku P. Exploring The Background, Context And Stressors Of Caregiving To Elderly Burned Patients: A Qualitative Inquiry. J Burn Care Res 2021; 43:196-201. [PMID: 33970253 DOI: 10.1093/jbcr/irab077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
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 hospitalisation. A qualitative descriptive design was utilised. Purposive sampling approach was used to recruit fourteen (14) informal caregivers who rendered care to elderly burned persons during hospitalisation. Interviews were conducted and transcribed verbatim following which directed content analysis was undertaken deductively. Three categories and six sub-categories emerged which characterise 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 post-burn emotional responses which characterised 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 post-burn stress response among informal caregivers. Increasing frailty levels, adequacy of household safety measures and financial issues were key concerns which emphasise the need for psychosocial/ transitional support, innovative healthcare financing measures and continuing education on burns prevention in the home setting.
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Affiliation(s)
- Jonathan Bayuo
- Department of Nursing, Faculty of Health and Medical Sciences, Presbyterian University College- Ghana
| | | | | | - Pius Agbenorku
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Division of Plastic & Reconstructive Surgery, Department/Directorate of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
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Abstract
The coronavirus disease pandemic has affected our practice as healthcare professionals. As burn surgeons, we are obliged to provide the best possible care to our patients. However, due to the risk of viral transmission, the goal should be to provide safe care to our patients as well as ensure the safety of the whole team providing burn care. The burn patients are usually debilitated and require a prolonged hospital stay and multiple operative procedures which put them and everyone involved in their care at increased risk of coronavirus infections and transmission. This warrants special caution to the burn team while managing such patients. In this review, we aim to highlight the key considerations for burn care teams while dealing with burn patients during the COVID-19 pandemic.
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Affiliation(s)
- Shivangi Saha
- Department of Plastic Reconstructive and Burns Surgery, All India Institute of Medical Sciences New Delhi, India
| | - Aditya Kumar
- Minimal Access & General Surgery, Department of Surgical Disciplines, All India Institute of Medical Sciences New Delhi, India
| | - Suvashis Dash
- Department of Plastic Reconstructive and Burns Surgery, All India Institute of Medical Sciences New Delhi, India
| | - Maneesh Singhal
- Department of Plastic Reconstructive and Burns Surgery, All India Institute of Medical Sciences New Delhi, India
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Castanon L, Asmar S, Bible L, Chehab M, Ditillo M, Khurrum M, Hanna K, Douglas M, Joseph B. Early Enteral Nutrition in Geriatric Burn Patients: Is There a Benefit? J Burn Care Res 2020; 41:986-991. [PMID: 32598455 DOI: 10.1093/jbcr/iraa109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
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.
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Affiliation(s)
- Lourdes Castanon
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, USA
| | - Samer Asmar
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, USA
| | - Letitia Bible
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, USA
| | - Mohamad Chehab
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, USA
| | - Michael Ditillo
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, USA
| | - Muhammad Khurrum
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, USA
| | - Kamil Hanna
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, USA
| | - Molly Douglas
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, USA
| | - Bellal Joseph
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, USA
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Tracy LM, Singer Y, Schrale R, Gong J, Darton A, Wood F, Kurmis R, Edgar D, Cleland H, Gabbe BJ. Epidemiology of burn injury in older adults: An Australian and New Zealand perspective. Scars Burn Heal 2020; 6:2059513120952336. [PMID: 33062309 PMCID: PMC7534068 DOI: 10.1177/2059513120952336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION The ageing global population presents a novel set of challenges for trauma systems. Less research has focused on the older adult population with burns and how they differ compared to younger patients. This study aimed to describe, and compare with younger peers, the number, causes and surgical management of older adults with burn injuries in Australia and New Zealand. METHODS The Burns Registry of Australia and New Zealand was used to identify patients with burn injuries between 1 July 2009 and 31 December 2018. Temporal trends in incidence rates were evaluated and categorised by age at injury. Patient demographics, injury severity and event characteristics, surgical intervention and in-hospital outcomes were investigated. RESULTS There were 2394 burn-injured older adults admitted during the study period, accounting for 13.4% of adult admissions. Scalds were the most common cause of burn injury in older adults. The incidence of older adult burns increased by 2.96% each year (incidence rate ratio = 1.030, 95% confidence interval = 1.013-1.046, P < 0.001). Compared to their younger peers, a smaller proportion of older adult patients were taken to theatre for a surgical procedure, though a larger proportion of older adults received a skin graft. DISCUSSION Differences in patient and injury characteristics, surgical management and in-hospital outcomes were observed for older adults. These findings provide the Australian and New Zealand burn care community with a greater understanding of burn injury and their treatments in a unique group of patients who are at risk of poorer outcomes than younger people. LAY SUMMARY The number and proportion of older persons in every country of the world is growing. This may create challenges for healthcare systems. While burn injuries are a unique subset of trauma that affect individuals of all ages, less is known about burns in older adults and how they differ from younger patients.We wanted to look at the number, type, management, and outcomes of burns in older adults in Australia and New Zealand. To do this, we used data from the Burns Registry of Australia and New Zealand, or BRANZ. The BRANZ is a database that collects information on patients that present to Australian and New Zealand hospitals that have a specialist burns unit.Our research found that one in eight adult burns patients was over the age of 65, and that the rate of burn injuries in older adults has increased over the last decade. Older adult burns patients were most commonly affected by scalds after coming in contact with wet heat such as boiling liquids or steam. Fewer older adults went to theatre for an operation or surgical procedure compared to their younger counterparts. However, a larger proportion of older adults that went to theatre had a skin graft (where skin is removed from an uninjured part of the body and placed over the injured part).This research provides important information about a unique and growing group of patients to the local burn care community. It also highlights potential avenues for injury prevention initiatives.
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Affiliation(s)
- Lincoln M Tracy
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Yvonne Singer
- Victorian Adult Burns Service, Alfred Hospital, Melbourne, VIC, Australia
| | - Rebecca Schrale
- Tasmanian Burns Unit, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Jennifer Gong
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Anne Darton
- Statewide Burn Injury Service, NSW Agency for Clinical Innovation, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Fiona Wood
- Burn Injury Research Unit, University of Western Australia, Perth, WA, Australia
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Rochelle Kurmis
- Adult Burns Service, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Dale Edgar
- Burn Injury Research Unit, University of Western Australia, Perth, WA, Australia
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, WA, Australia
- Burn Injury Research Node, The University of Notre Dame, Fremantle, WA, Australia
| | - Heather Cleland
- Victorian Adult Burns Service, Alfred Hospital, Melbourne, VIC, Australia
- Department of Surgery, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Singleton Park, Swansea, Wales
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Epidemiology and outcomes of burn injury among older adults in a Ghanaian tertiary hospital. BURNS OPEN 2018. [DOI: 10.1016/j.burnso.2017.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Zanni GR. Thermal burns and scalds: clinical complications in the elderly. THE CONSULTANT PHARMACIST : THE JOURNAL OF THE AMERICAN SOCIETY OF CONSULTANT PHARMACISTS 2012; 27:16-22. [PMID: 22231994 DOI: 10.4140/tcp.n.2012.16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
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.
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Albornoz CR, Villegas J, Sylvester M, Peña V, Bravo I. Burns are more aggressive in the elderly: Proportion of deep burn area/total burn area might have a role in mortality. Burns 2011; 37:1058-61. [DOI: 10.1016/j.burns.2011.03.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Revised: 01/31/2011] [Accepted: 03/12/2011] [Indexed: 11/29/2022]
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