Burns in the elderly: a nationwide study on management and clinical outcomes

Abstract Background In modern-day burn care, advanced age remains an important predictor for mortality among burn victims. In this study, we compared the complete treatment trajectory (including pre-hospital and surgical treatment) and the outcomes between an elderly burn population and a younger adult burn population. Methods In this nationwide study, data from the Dutch Burn Repository were used. This is a uniform national registration for Dutch specialized burn care. All adult patients that were admitted to one of the three Dutch burn centres from the period 2009 to 2015 were included in the analysis. Burn patients were considered as elderly when ≥65 years of age, and were then further subdivided into three age categories: 65–74, 75–85 and 85+ years. Younger adults in the age category 18–64 years were used as the reference group. Surgical management was studied comprehensively and included timing of surgery, the number of procedures and details on the surgical technique, especially the technique used for debridement and the grafting technique that was applied. For the comparison of clinical outcome, the following parameters were included: mortality, wound infections, length of stay/TBSA (total body surface area) burned, discharge disposition and secondary reconstructions. Results During the study period, 3155 adult patients were included (elderly, n = 505). Burn severity, reflected by the median TBSA, varied between 3.2–4.0% and was comparable, but aetiology and pre-hospital care were different between elderly and the younger adult reference group. Surgical treatment was initiated significantly faster in elderly burn patients (p < 0.001). Less selective techniques for surgical debridement were used in the elderly burns patients (hydrosurgery, 42.0% vs 23.5–22.6%), and on the other hand more avulsion (5.3% vs 7.3–17.6%) and primary wound closure (6.7% vs 24.5%). The most frequently used grafting technique was meshed skin grafts (79.2–88.6%); this was not related to age. Mortality increased rapidly with a higher age and showed a high peak in the 85+ category (23.8%). Furthermore, considerable differences were found in hospital discharge disposition between the elderly and the reference group. Conclusions In conclusion, elderly burn patients who require specialized burn care are vulnerable and medically challenging. Differences in aetiology, comorbidity, physiology and the management prior to admission possibly affect the initial surgical management and result in significantly worse outcomes in elderly. Elderly patients need optimal, timely and specialized burn care to enhance survival after burn injuries.

Download Full-text

104 Comorbidity Does Not Predict Outcomes After Burn Injury in the Elderly

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.107 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S68-S68

Author(s):

Isabel Bernal ◽

Rosemary Paine ◽

Damien W Carter ◽

Carolyne Falank

Keyword(s):

Elderly Patients ◽

Wound Infection ◽

Burn Injury ◽

Pearson Correlation ◽

Graft Loss ◽

Kidney Injury ◽

The Elderly ◽

Burn Patients ◽

Discharge Disposition ◽

Burn Care

Abstract Introduction As the population ages; burn centers, especially those with a large rural catchment, will be expected to care for older adults with complex medical co-morbidities. Recent work has shown that %TBSA at which 50% of patients would be expected to die (LD50) for elderly patients is up to 20% lower than non-elderly patients. However, the factors contributing to mortality are unclear. We undertook this study to characterize our experience with elderly burn patients in our rural state and to understand how mortality is affected by comorbid disease. Methods We performed a retrospective review of all burn patients ≥50 years old admitted to our burn center over a 5 year period between January 2014 and December 2018. We collected demographic and injury data including %TBSA, mechanism, inhalation injury status, discharge disposition, length of stay as well as complications including pneumonia, kidney injury, wound infection and graft loss. We calculated the modified Baux score, Charlson Comorbidity Index (CCI) and overall mortality for each patient. The %TBSA and CCI were correlated with complications and mortality using the Pearson correlation coefficient analysis. Results There were 243 patients (35%) who met inclusion criteria out of total of 688 burn admissions during that period. The median age was 60 years (mean 62.2, range: 50–95) and 72.4% were male. The median TBSA was 4% (mean: 8.2%, range: 0.5% - 55%). We found weak correlations between CCI and both pneumonia (R=0.177, p=0.005) and mortality (R=0.1297, p=0.0434). There was also a weak correlation between %TBSA and pneumonia (R=0.3302, p < 0.001), kidney injury (R=0.205, p=0.001), wound infection (R=0.1295, p=0.045) and graft loss (R=0.2616, p< 0.001). Interestingly, in the subgroup with > 15% TBSA burns (n=35), there was no significant correlation with increased complications. For the entire cohort, the predicted mortality based on the mean modified Baux score was 16%. The actual observed mortality was 4.1%. Conclusions Our findings suggest that, in our center, CCI is not predictive of burn related complications or mortality and %TBSA is not predictive of complications or death. The observed to expected mortality ratio was remarkably low. Applicability of Research to Practice As we treat older burn patients, it is important to identify the individual patient factors and hospital specific burn care factors that may improve outcomes in the elderly population.

Download Full-text

Management of burns in the ICU

10.1093/med/9780199600830.003.0347 ◽

2016 ◽

Author(s):

Shahriar Shahrokhi ◽

Marc G. Jeschke

Keyword(s):

Total Body Surface Area ◽

The Elderly ◽

Similar Data ◽

Burn Patients ◽

Burn Care ◽

Future Developments ◽

Appropriate Treatment ◽

Total Body ◽

Critical Components ◽

Current Standards

Outcomes of burn patients have significantly improved over the last two decades. A recent study in The Lancet showed that a burn size of over 60% total body surface area (TBSA) burned is now recognized as being associated with high risks; a decade ago similar risks resulted from a 40% TBSA burned. Similar data have been obtained in severely-burned adults and the elderly. This chapter discusses current standards, recent evidence, and future developments in burn care to improve outcomes of these patients. Critical components in the management of patients with burns are early adequate resuscitation, recognition and management of airway burns and appropriate treatment of the different stages of burn care—prehospital, early, and late management.

Download Full-text

Ten-year experience with surgical treatment of adults with congenital cardiac disease

Cardiology in the Young ◽

10.1017/s1047951110001332 ◽

2010 ◽

Vol 21 (1) ◽

pp. 39-45 ◽

Cited By ~ 8

Author(s):

Pierre Wauthy ◽

Jacques Massaut ◽

Ahmed Sanoussi ◽

Hélène Demanet ◽

Marielle Morissens ◽

...

Keyword(s):

Risk Factors ◽

Surgical Treatment ◽

Surgical Management ◽

Cardiac Disease ◽

Functional Class ◽

Adult Patients ◽

Morbidity And Mortality ◽

Curative Treatment ◽

Previous Operation ◽

Congenital Cardiac Disease

AbstractThe number of adults with congenital cardiac disease continues to increase, and adult patients are now more numerous than paediatric patients. We sought to identify risk factors for perioperative death and report our results with surgical management of adult patients with congenital cardiac disease. We retrospectively analysed in-hospital data for 244 consecutive adult patients who underwent surgical treatment of congenital cardiac disease in our centre between January, 1998 and December, 2007. The mean patient age was 27.2 plus or minus 11.9 years, 29% were in functional class III or IV, and 25% were cyanosed. Of the patients, half were operated on for the first time. A total of 61% of patients underwent curative operations, 36% a reoperation after curative treatment, and 3% a palliative operation. Overall mortality was 4.9%. Predictive factors for hospital death were functional class, cyanosis, non-sinus rhythm, a history of only palliative previous operation(s), and an indication for palliative treatment. Functional class, cyanosis, type of initial congenital cardiac disease (single ventricle and double-outlet right ventricle), and only palliative previous operation were risk factors for prolonged intensive care stay (more than 48 hours). The surgical management of adult patients with congenital cardiac disease has improved during recent decades. These generally young patients, with a complex pathology, today present a low post-operative morbidity and mortality. Patients having undergone palliative surgery and reaching adulthood without curative treatment present with an increased risk of morbidity and mortality. Univentricular hearts and double-outlet right ventricles were associated with the highest morbidity.

Download Full-text

Surgical Management Evolution Between 2 Massive Burn Cases at 17-Year Interval: Contribution of Cell Therapies in Improving the Surgical Care

Cell Transplantation ◽

10.1177/0963689720973642 ◽

2020 ◽

Vol 29 ◽

pp. 096368972097364

Author(s):

Sandra Monnier ◽

Philippe Abdel-Sayed ◽

Anthony de Buys Roessingh ◽

Nathalie Hirt-Burri ◽

Michèle Chemali ◽

...

Keyword(s):

Intensive Care ◽

Surgical Management ◽

Total Body Surface Area ◽

Young Patients ◽

Surgical Care ◽

The Body ◽

Burn Patients ◽

Cell Therapies ◽

Burn Care ◽

Technical Specifications

We report the cases of 2 patients admitted to our hospital at a 17-year interval, both with 90% total body surface area (TBSA) burns. These two young patients were in good health before their accident, but major differences in time of intensive care and hospitalization were observed: 162 versus 76 days in intensive care unit and 18 versus 9.5 months for hospitalization, respectively. We have analyzed the different parameters side-by-side during their medical care and we have identified that the overall improved outcomes are mainly due to a better adapted fluid reanimation in combination with the evolution of the surgical management to encompass allogenic cellular therapy (Biological Bandages). Indeed, autologous cell therapy using keratinocytes has been used for over 30 years in our hospital with the same technical specifications; however, we have integrated the Biological Bandages and routinely used them for burn patients to replace cadaver skin since the past 15 years. Thus, patient 1 versus patient 2 had, respectively, 83% versus 80% TBSA for autologous cells, and 0% versus 189% for allogenic cells. Notably, it was possible that patient 2 was able to recover ∼6% TBSA with the use of Biological Bandages, by stimulating intermediate burn zones toward a spontaneous healing without requiring further skin grafting (on abdomen and thighs). The body zones where Biological Bandages were not applied, such as the buttocks, progressed to deeper-stage burns. Despite inherent differences to patients at their admission and the complexity of severe burn care, the results of these two case reports suggest that integration of innovative allogenic cell therapies in the surgical care of burn patients could have major implications in the final outcome.

Download Full-text

Modeling Fluid Resuscitation by Formulating Infusion Rate and Urine Output in Severe Thermal Burn Adult Patients: A Retrospective Cohort Study

BioMed Research International ◽

10.1155/2015/508043 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8

Author(s):

Qizhi Luo ◽

Wei Li ◽

Xin Zou ◽

Yongming Dang ◽

Kaifa Wang ◽

...

Keyword(s):

Fluid Resuscitation ◽

Urine Output ◽

Infusion Rate ◽

Initial Period ◽

Adult Patients ◽

Burn Patients ◽

Severe Burn ◽

Burn Treatment ◽

Thermal Burn ◽

Burn Care

Acute burn injuries are among the most devastating forms of trauma and lead to significant morbidity and mortality. Appropriate fluid resuscitation after severe burn, specifically during the first 48 hours following injury, is considered as the single most important therapeutic intervention in burn treatment. Although many formulas have been developed to estimate the required fluid amount in severe burn patients, many lines of evidence showed that patients still receive far more fluid than formulas recommend. Overresuscitation, which is known as “fluid creep,” has emerged as one of the most important problems during the initial period of burn care. If fluid titration can be personalized and automated during the resuscitation phase, more efficient burn care and outcome will be anticipated. In the present study, a dynamic urine output based infusion rate prediction model was developed and validated during the initial 48 hours in severe thermal burn adult patients. The experimental results demonstrated that the developed dynamic fluid resuscitation model might significantly reduce the total fluid volume by accurately predicting hourly urine output and has the potential to aid fluid administration in severe burn patients.

Download Full-text

Surgical management of congenital heart defects in adolescent and adult patients, between years 2001–2008

Orvosi Hetilap ◽

10.1556/oh.2009.28683 ◽

2009 ◽

Vol 150 (37) ◽

pp. 1739-1743 ◽

Cited By ~ 3

Author(s):

István Hartyánszky ◽

Andrea Székely ◽

László Király ◽

Zsolt Prodán ◽

Sándor Mihályi ◽

...

Keyword(s):

Surgical Management ◽

Congenital Heart Defects ◽

Congenital Heart ◽

Heart Defects ◽

Adult Patients

A felnőttkorban operált veleszületett szívhibák között vezetnek az I. rekonstrukciós beavatkozások: a) frissen felismert betegségek, b) megelőzően inoperábilisnak ítélt kórképek, c) pulmonalis hypertonia, jobbkamra-elégtelenség miatt „elkésett” műtétek. Növekszik a II. REDO műtétek száma: a) residuumok korrigálása, b) kinőtt, diszfunkciós homograftok cseréje, c) műtéti/intervenciós korrigálás utáni recoarctatio (aneurysma, dissectio) sebészete, d) aorta valvulotomia/valvuloplastica, illetve társvitiumok (TGA) korrigálásának következményeként Ross-műtét, műbillentyű-beültetés . Betegek, eredmények: A 2001–2008 között végzett 4496 műtét közül 166 volt fiatal-felnőtt korú (16–52, átlagéletkor: 28 év) (Ia: 77, Ib: 15, Ic: 4, IIa: 11, IIb: 22, IIc: 9, IId: 28). Műtéti mortalitás nem volt, 1 beteg pulmonalis hypertoniás krízisben, 1 jobbkamra-elégtelenség miatti malignus ritmuszavarban, 2 többszerv-elégtelenségben halt meg. Konklúzió: A rizikófaktorokat a pulmonalis hypertonia és a jobbkamra-elégtelenség jelenti. A bonyolult sebészi megoldások a „congenitalis szívsebész” számára nem jelentenek problémát, de koraibb diagnózisok, terápiában az extracorporalis membránoxigenátor használata az eredményeket javíthatja.

Download Full-text

The use of Integra dermal regeneration matrix in the surgical treatment of a recurrent, extensive malignant skin lesion in the temporal region

Orvosi Hetilap ◽

10.1556/oh.2013.29535 ◽

2013 ◽

Vol 154 (6) ◽

pp. 225-227 ◽

Cited By ~ 1

Author(s):

Csaba Halmy ◽

Zoltán Nádai ◽

Krisztián Csőre ◽

Adrienne Vajda ◽

Róbert Tamás

Keyword(s):

Surgical Treatment ◽

Skin Lesion ◽

Surgical Management ◽

Skin Grafting ◽

Skin Tumor ◽

Temporal Region ◽

Aesthetic Result ◽

Malignant Skin ◽

Dermal Regeneration Template ◽

Dermal Regeneration

Authors report on the use of Integra dermal regeneration template after excision of an extended, recurrent skin tumor in the temporal region. The area covered with Integra was 180 cm2. Skin grafting to cover Integra was performed on the 28th day. Both Integra and the skin transplant were taken 100%. Integra dermal regeneration template can provide good functional and aesthetic result in the surgical management of extended skin tumors over the skull. Orv. Hetil., 2013, 154, 225–227.

Download Full-text

Comprehensive Surgical Management of Chronic Suppurative Osteomyelitis Extending to The Lower Border of Mandible – A Case Report

International Journal of Recent Advances in Science and Technology ◽

10.30750/ijarst.532 ◽

2018 ◽

Vol 5 (3) ◽

Author(s):

Deepak Kaul ◽

Farahnaz Muddebihal ◽

Mohammed Anwar Ul Haque Chand

Keyword(s):

Developing Countries ◽

Case Report ◽

Surgical Treatment ◽

Surgical Management ◽

Surgical Debridement ◽

Reconstruction Plate ◽

Left Posterior ◽

High Nutrient ◽

Inferior Border ◽

Precipitating Factor

Osteomyelitis of maxillofacial skeleton is common in developing countries such as India. This case report describes successful surgical treatment of chronic suppurative osteomyelitis {CSO} of the mandible of a 35yr old female. The precipitating factor was thought to be eventful extraction in the {left } posterior body at the inferior border of mandible. Methods: Presurgical course of antibiotics ( Amoxycillin and metronidazole for 7 days and later followed by doxycycline for 1 month).Surgical debridement of the affected bone and reinforcing it with reconstruction plate using AO principles was done . Patient was kept on a high nutrient diet consisting of proteins. Conclusion: The case report demonstrates the typical features of CSO . The combination of the antibiotics therapy and surgical debridement was successful in the treatment of chronic suppurative osteomylitis.

Download Full-text

Treatment of Anaemia in Patients with Acute Burn Injury: A Study of Blood Transfusion Practices

Journal of Clinical Medicine ◽

10.3390/jcm10030476 ◽

2021 ◽

Vol 10 (3) ◽

pp. 476

Author(s):

Ioana Tichil ◽

Samara Rosenblum ◽

Eldho Paul ◽

Heather Cleland

Keyword(s):

Blood Transfusion ◽

Surgical Management ◽

Burn Injury ◽

Total Body Surface Area ◽

Perioperative Period ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Burn Care ◽

Transfusion Requirements ◽

Total Body

Objective: To determine blood transfusion practices, risk factors, and outcomes associated with the use of blood products in the setting of the acute management of burn patients at the Victorian Adult Burn Service. Background: Patients with burn injuries have variable transfusion requirements, based on a multitude of factors. We reviewed all acute admissions to the Victorian Adult Burns Service (VABS) between 2011 and 2017: 1636 patients in total, of whom 948 had surgery and were the focus of our analysis. Method and results: Patient demographics, surgical management, transfusion details, and outcome parameters were collected and analyzed. A total of 175 patients out of the 948 who had surgery also had a blood transfusion, while 52% of transfusions occurred in the perioperative period. The median trigger haemoglobin in perioperative was 80mg/dL (IQR = 76–84.9 mg/dL), and in the non-perioperative setting was 77 mg/dL (IQR = 71.61–80.84 mg/dL). Age, gender, % total body surface area (TBSA) burn, number of surgeries, and intensive care unit and hospital length of stay were associated with transfusion. Conclusions: The use of blood transfusions is an essential component of the surgical management of major burns. As observed in our study, half of these transfusions are related to surgical procedures and may be influenced by the employment of blood conserving strategies. Furthermore, transfusion trigger levels in stable patients may be amenable to review and reduction. Risk adjusted analysis can support the implementation of blood transfusion as a useful quality indicator in burn care.

Download Full-text

Impact of Surgical Resection and Reasons for Poor Prognosis of Pelvic Osteosarcoma Based on the Bone Tumor Registry in Japan

Cancers ◽

10.3390/cancers13133320 ◽

2021 ◽

Vol 13 (13) ◽

pp. 3320

Author(s):

Satoshi Takenaka ◽

Hironari Tamiya ◽

Toru Wakamatsu ◽

Sho Nakai ◽

Yoshinori Imura ◽

...

Keyword(s):

Surgical Treatment ◽

Propensity Score ◽

Surgical Resection ◽

Bone Tumor ◽

Poor Prognosis ◽

Propensity Score Analysis ◽

The Elderly ◽

Tumor Stage ◽

Tumor Registry ◽

Score Analysis

Pelvic osteosarcoma has a poor prognosis compared to osteosarcomas in other locations, and the reasons for this remain unknown. Surgical resection of pelvic osteosarcoma is technically demanding and often results in dysfunction and complications. In this study, we investigated the reasons underlying the poor prognosis of pelvic osteosarcoma by comparing it to femoral osteosarcoma using data from the Bone Tumor Registry in Japan. We used propensity score analysis to determine whether surgical resection of pelvic osteosarcoma improved its prognosis. We demonstrated that pelvic osteosarcoma had a poor prognosis because it occurred more often in the elderly, often had larger tumor size, and had metastasis at presentation more often in comparison to femoral osteosarcoma. These three factors were also associated with the non-surgical treatment of pelvic osteosarcoma, which also led to a poor outcome. The overall survival rate was only comparable in pelvic osteosarcoma and femoral osteosarcoma in cases treated with surgical resection. Propensity score analysis revealed that surgical treatment improved the prognosis of pelvic osteosarcoma. As such, we propose that surgical resection should be considered based on tumor stage and patient age in order to improve the prognosis of pelvic osteosarcoma.

Download Full-text