Thermal injury in the elderly: incidence and cause

Epidemiology of burn injury in older adults: An Australian and New Zealand perspective

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.

Burn treatment in the elderly

The population of elderly patients is expected to rise continuously over the next decades due to global demographic changes. The elderly seem to be most vulnerable to burns and their management remains undoubtedly a challenge. A clear age margin for elderly patients is not yet defined, but most studies adhere to the inclusion of patients 65 years and above, but the general condition and social situation must be taken into account. The understanding of the physiological basis of aging and its related pathophysiological changes has only marginally influenced treatment and decision making in elderly burn patients. When looking at treatment regimens currently applied in elderly burn patients, the discussion of standards in intensive care as well as surgical strategies is ongoing. However, trends towards a moderate, non-aggressive resuscitation approach and careful inclusion of key parameters like physiological age, pre-burn functional status and premorbid conditions, seem to be useful guidelines for interdisciplinary treatment decisions. Once ordered for surgical treatment, the amount of body surface area operated in one session should be adapted to the general status of the patient. Even if older burn victims have a reported higher mortality rate than younger patients, improved therapeutic options have contributed to a reduced mortality rate even in the elderly over the last decades. As a result of improved outcome, more attention has to be given to a comprehensive rehabilitation program. This review will give an overview of the current literature and will draw attention to specific topics related to this important subpopulation of burn patients.

Burn epidemiology: the patient, the nation, the statistics, and the data resources

Throughout the years, bum care treatment in the United States has made major strides in the ability to save the lives of those once rendered helpless as a result of an extensive bum injury. Bum care professionals are able to assist these individuals to live as normal a life as possible as they heal from one of the most devastating injuries a human being can endure. The only way to remedy the suffering and the costs in health care resources and in productivity is to reduce the incidence of bum injuries and death. Communities must be concerned with consistently establishing preventive measures and with the proactive treatment of bums to help decrease incidence. Activities on the community, state, and national level to obtain accurate data regarding the epidemiologic characteristics must be implemented to provide a more accurate picture of bum injuries in the United States. Addressing issues surrounding the persons at high risk of bum injury will help to decrease the incidence of bum trauma. Funding must be strengthened to ensure the continued existence of bum programs that truly provide high-quality standards of care. In these programs, the burn victim is given every opportunity to become a survivor. In light of the recent terrorist activity in the United States, the nation must address another area that might affect the history of bum care and treatment, the multiple-trauma victim with an extensive burn injury caused by massive explosions, chemical warfare,missiles, and weapons of mass destruction. One out-come from the recent terrorist attack was recognition of the need for facilities to be capable of providing care for this type of patient. Efforts to strengthen these programs and bum care facilities must be continued to maintain and strengthen the care needed for bum patients of the future.

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.

A study of burn injuries in the elderly in a regional burn centre

We evaluated the epidemiology and outcome of 94 elderly burn patients of age 60 years or older treated in a local burn centre over a period of 6 years. There were 44 males and 50 females with a male to female ratio of 0.88 and an average age of 73.8+/-9 years. The mean extent of burn was 13.3+/-18.4% total body surface area (TBSA) with 14 patients (15%) suffering from a burn size >20% TBSA. The vast majority of injuries (90%) occurred at home. Scalds resulted in 62 admissions (66%) and flame burns accounted for another 29 admissions (31%). The burns predominantly involved the extremities and the trunk. Four patients had inhalation injuries and required admission to the Intensive Care Unit for ventilatory support. The majority of patients (60%) did not require any operations. The mean hospital stay of the survivors was 30.1+/-34.1 days and 35% of them stayed less than 2 weeks. Fifty-five patients (59%) had at least one pre-existing medical problem requiring long-term medication and 41 patients (44%) were living alone. Sixty-three patients (67%) presented more than 8 h after the burn injuries and 34 patients (36.2%) had no first aid treatment of their burn wounds. In addition, 40 patients (42.5%) had their wounds treated inappropriately. Seven patients died in this series which yielded a mortality rate of 7.4%. The outcomes of early versus late excision and grafting were also analyzed.

Epidemiology of elderly patients' burns in the South West of France

A retrospective study of 716 patients aged 60 years and above (324 men, 392 women) was undertaken in order to determine quality control in burns management in the South West of France. The following epidemiological data was obtained: high hospitalization rate (7 per cent of the general admissions); monthly and seasonal periodicity; predominance of indoor accidents (86 per cent) with domestic accidents being more frequent in women (63 vs. 37 per cent). Outdoor accidents were mainly recreational and were five times more frequent in men than in women. The overall mortality was 39 per cent and was influenced by the burns extent, depth, predisposing factors and early management. More burns occurred in urban areas (53 per cent) but mortality was higher in patients from rural areas (62 vs. 38 per cent). It was observed that delay in management, especially fluid resuscitation of patients from the rural areas, was partly responsible for this outcome. Propositions were made to diffuse more information on the importance of early management of burns in rural areas.

Burn injuries in the elderly

This study has shown that elderly males were more likely to be admitted to the Royal Brisbane Hospital Burns Unit than females. No high-risk period of the day, week or year could be identified for this group. Flame burns and scalds were most common as was the association with cooking and bathing activities. Predisposing factors were found to be common in the elderly burn population. Prevention programmes need to be directed to the home with safer cooking facilities and lower temperature or temperature outlet controls to lessen bathing scalds, as these patients found it difficult to escape a hot bath. Mortality rates were related to the percentage total body surface area burned and inhalation injury, and were well predicted by the Burn Severity Index. Complications were mainly pneumonias and venous thrombosis and reflect the need in this age group of maintaining active mobility and a quick resolution of the burn injury. Good nutrition, often lacking in this age group, must be maintained, along with meticulous wound care if infection is to be prevented. Early wound coverage is vital to prevent sepsis. Our approach is towards an early skin grafting programme while the patient is fit. This is aggressive, with as much skin coverage as possible, before the patient's condition deteriorates. Every effort is made to maintain the patient's health as near normal as possible. However, if deterioration occurs, then the patient is supported and grafting delayed until the patient is again fit for surgery. When this study was undertaken, it was hoped that an answer to the controversial subject of early versus late surgery could be answered.(ABSTRACT TRUNCATED AT 250 WORDS)

The elderly burn patient

During a 16-year period, 547 patients who were older than 64 years of age with a mean total body surface area (TBSA) (third-degree burns) of 25% were treated. Etiologies were flame/flash in 81% of patients, scald in 11%, solids in 7%, and electrical/chemical in 1%. Seventeen percent of patients had significant causal factors. An inhalation injury was present in 13% of patients, and the mortality in these patients was 100%. Burn excision was performed 239 times in 165 patients. The majority of excisions were for full-thickness burns. Excision did not improve overall survival in patients with third-degree burns of 0% to 10%, but the length of stay (LOS) in excised and nonexcised survivors was improved (9 versus 21 days, respectively). The LOS and survival were not significantly different in patients with burns between 11% and 20%. Postburn complications occurred in 28% of patients. Overall mortality was 50% (mean age: 77 years; TBSA: 40%). There were no survivors with over 47% TBSA burns. The leading cause of death was pulmonary sepsis. Most surviving patients returned to a satisfactory lifestyle after discharge.