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.

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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.

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Exploring a Hidden Epidemic: Drowning Among Adults Aged 65 Years and Older

Journal of Aging and Health ◽

10.1177/08982643211014770 ◽

2021 ◽

pp. 089826432110147

Author(s):

Tessa Clemens ◽

Amy E. Peden ◽

Richard C. Franklin

Keyword(s):

Older Adults ◽

New Zealand ◽

Retrospective Analysis ◽

Older Adult ◽

Total Population ◽

Downward Trend ◽

Population Projections ◽

Prevention Strategies ◽

Drowning Prevention

Objectives: To explore trends in unintentional fatal drowning among older adults (65 years and older). Methods: Total population retrospective analysis of unintentional fatal drowning among people aged 65 years and older in Australia, Canada and New Zealand (2005–2014) was conducted. Results: 1459 older adults died. Rates ranged from 1.69 (Canada) to 2.20 (New Zealand) per 100,000. Trends in crude drowning rates were variable from year to year. A downward trend was observed in New Zealand (y = −.507ln(x) + 2.9918), with upward trends in Australia (y = .1056ln(x) + 1.5948) and Canada (y = .1489ln(x) + 1.4571). Population projections suggest high annual drowning deaths by 2050 in Australia (range: 120–190; 1.69–2.76/100,000) and Canada (range: 209–430; 1.78–3.66/100,000). Significant locations and activities associated with older adult drowning differed by country and age band. Conclusions: Drowning among older adults is a hidden epidemic claiming increasing lives as the population ages. Targeted drowning prevention strategies are urgently needed in Australia, Canada, New Zealand and other similar countries.

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102 Wildfire Burns: Implications for Burn Care

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.105 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S67-S67

Author(s):

Tina L Palmieri ◽

Kathleen S Romanowski ◽

Soman Sen ◽

David G Greenhalgh

Keyword(s):

Length Of Stay ◽

Burn Injury ◽

Total Body Surface Area ◽

Ventilatory Support ◽

Mass Casualty ◽

Inhalation Injury ◽

Burn Injuries ◽

Injury Incidence ◽

Burn Centers ◽

Burn Care

Abstract Introduction Climate change, the encroachment of populations into wilderness, and carelessness have combined to increase the incidence of wildfire injuries. With the increased incidence has come an increase in the number of burn injuries. Prolonged extrication, delays in resuscitation, and the extreme fire and toxic air environment in a wildfire has the potential to cause more severe burn injury. The purpose of this study is to examine the demographics and outcomes of wildfire injuries and compare those outcomes to non-wildfire injuries. Methods Charts of patients admitted to a regional burn center during a massive wildfire in 2018 were reviewed for demographic, treatment, and outcome. We then obtained age, gender, and burn size matched controls from within 2 years of the incident, analyzed the same measures, and compared treatment and outcomes between the two groups. Results A total of 20 patients, 10 wildfire (WF) burns and 10 non-wildfire (NWF) burns, were included in the study. Age (59.6±7.8 WF vs. 59.4±7.4 years), total body surface area burn (TBSA) (14.9±4.7 WF vs. 17.2±0.9 NWF) and inhalation injury incidence (2 WF and 2 NWF) were similar between groups. Days on mechanical ventilation (24.3±19.4 WF vs. 9.4±9.8 NWF), length of stay (49.9±21.8 WF vs. 28.2±11.7 days) and ICU length of stay (43.0±25.6 WF vs 24.4±11.2 NWF) were higher in the WF group. WF patients required twice the number of operations. Mortality was similar in both groups (1 death/group). Conclusions Wildfire burn injuries, when compared to age, inhalation injury, and burn size matched controls, require more ventilatory support and have more operations. As a result, they have longer lengths of stay and have a prolonged ICU course. Burn centers should be prepared for the increased resource utilization that accompanies wildfire injuries. Applicability of Research to Practice All burn centers must be prepared for the possibility of wildfires and the increased resource utilzation that accompanies mass casualty events.

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Perception and Practice among Community People and Health Service Providers on Care and Management of Burn Injuries in Nepal: A Qualitative Study

Journal of Nepal Health Research Council ◽

10.33314/jnhrc.v17i3.1640 ◽

2019 ◽

Vol 17 (3) ◽

pp. 315-319

Author(s):

Santosh Bikram Bhandari ◽

Sujit Kumar Sah ◽

Khakindra Bahadur Bhandari ◽

Jaswan Sakya ◽

Laxmi Raj Pathak ◽

...

Keyword(s):

Health Service ◽

Qualitative Study ◽

Service Providers ◽

Burn Injury ◽

Good Practice ◽

First Aid ◽

Burn Injuries ◽

Burn Care ◽

Health Service Providers ◽

Community People

Background: According to WHO, burns are a serious public health problem and the second most common cause for injury in rural Nepal, accounting for 5% of disabilities. The overall objective of the study is to assess the prevailing perception and practice among community people and health service providers on care and management of burn injuries in Nepal. Methods: This was a qualitative study conducted in 2016 representing all eco-development regions. A total of 40 key informants interviews with health personnel and 18 focus group discussions with the community people were conducted.Results: There are very limited dedicated burn care facilities in Nepal. During discussion, the service providers and community people mentioned that a burn injury can affect any one irrespective of their age and socioeconomic status. The study showed that females are at higher risk for burn injury which is associated mostly with wood fire cooking.The burn cases in the hospitals were more during winter than insummer season. Among all the ethnic groups, Dalit and indigenous population were found more vulnerable towards burn injuries. Intentional burn injuries such as self-inflicted burns/suicidal attemptwere found to occur more in females.The community people had a good practice of taking the majority ofpatients having burn injury immediately to the hospital,if not, they at least provided them with a first aid treatment. Conclusions: Majority of burn injured cases are getting first aid treatment at the incident places and taking hospital immediately. Main reasons, who reached late, are unaware about seeking services and financial constraint. Overall, the community people are partially aware about the burn injury.Keywords: Burn injuries; community practice; hospitals; incident and types.

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A Review of Burn Patients Requiring Extracorporeal Membrane Oxygenation at a Burns Facility

European Journal of Burn Care ◽

10.3390/ebj2040021 ◽

2021 ◽

Vol 2 (4) ◽

pp. 293-300

Author(s):

Stephen Frost ◽

Liz Davies ◽

Claire Porter ◽

Avinash Deodhar ◽

Reena Agarwal

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Burn Injury ◽

Burn Injuries ◽

Burn Patients ◽

Review Of The Literature ◽

Respiratory Compromise ◽

Burn Care ◽

Membrane Oxygenation ◽

Regular Time ◽

Major Burn

Respiratory compromise is a recognised sequelae of major burn injuries, and in rare instances requires extracorporeal membrane oxygenation (ECMO). Over a ten-year period, our hospital trust, an ECMO centre and burns facility, had five major burn patients requiring ECMO, whose burn injuries would normally be managed at trusts with higher levels of burn care. Three patients (60%) survived to hospital discharge, one (20%) died at our trust, and one patient died after repatriation. All patients required regular, time-intensive dressing changes from our specialist nursing team, beyond their regular duties. This review presents these patients, as well as a review of the literature on the use of ECMO in burn injury patients. A formal review of the overlap between the networks that cater to ECMO and burn patients is recommended.

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Pre-hospital care in burn injury

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-1699457 ◽

2010 ◽

Vol 43 (S 01) ◽

pp. S15-S22

Author(s):

Prabhat Shrivastava ◽

Arun Goel

Keyword(s):

Hospital Care ◽

Burn Injury ◽

Care Facility ◽

First Aid ◽

Vital Role ◽

Burn Injuries ◽

Care Providers ◽

Care Centre ◽

Burn Care ◽

Management Plans

ABSTRACTThe care provided to the victims of burn injury immediately after sustaining burns can largely affect the extent and depth of the wound. Although standard guidelines have been formulated by various burn associations, they are still not well known to public at large in our country. In burn injuries, most often, the bystanders are the first care providers. The swift implementation of the measures described in this article for first aid in thermal, chemical, electrical and inhalational injuries in the practical setting, within minutes of sustaining the burn, plays a vital role and can effectively reduce the morbidity and mortality to a great extent. In case of burn disasters, triage needs to be carried out promptly as per the defined protocols. Proper communication and transport from the scene of the accident to the primary care centre and onto the burn care facility greatly influences the execution of the management plans

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98 A 10-year Retrospective Review of Older Adult Admissions at a Regional Burn Center

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.101 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S64-S65

Author(s):

Stephanie Campbell ◽

Trina Andres

Keyword(s):

Older Adults ◽

Older Adult ◽

Retrospective Review ◽

Tap Water ◽

Burn Injuries ◽

Age Group ◽

Prevention Programming ◽

Burn Center ◽

Number Of Patients ◽

Fire Flame

Abstract Introduction A verified regional burn center conducted a 10-year retrospective review of older adult patients admitted to the burn service. The primary goal of the review was to examine trends in mechanisms of injury, demographics, and outcomes to inform burn prevention programming. Methods Admission data from 2009–2018 was retrieved from burn center databases and combined into a Microsoft Excel spreadsheet. Older adults were defined as age 65 years and older. Patients admitted to the burn service for skin disorders or soft tissue infections were excluded. Patients with cutaneous burn injuries or inhalation only injuries were included. Results The total number of patients included was 697. Nearly a third of the patients were 65 to 69 years old, with incidence declining with each subsequent 5-year age group. Males accounted for 61.3% of admissions. Two thirds of the patients were White (67.6%). The other third consisted of Black (18.4%) and Hispanic (9.8%), Asian (1.9%) and Native American (0.14%) patients. Overall mortality was 14%. Mortality generally increased per 5-year age group: 65–69 (7.8%), 70–74 (10.6%), 75–79 (13.7%), 80–84 (20.6%), 85–89 (29.8%), 90–94 (24.2%), and 95–99 (42.9%). Baux scores ranged from 65 to 180. The highest Baux score that lived to discharge was 119. The average Baux score of the mortality group was 114 and the average of the lived group was 82. No patients with a Total Body Surface Area (TBSA) above 43% lived. Fire/flame burns accounted for 72.7%. Scald burns made up 19.9%, contact burns 3%, chemical burns 2.3% and electrical burns < 1%. Nearly a quarter (24.6%) of fire/flame burns were related to smoking on home oxygen therapy (HOT), which was also the overall most common mechanism at 17.8%. Other fire/flame mechanisms included housefires (21.2%), clothing catching on fire (16.9%), and gasoline-related injuries (11.7%). More than 70% of scald burns came from the three mechanisms: hot tap water, boiling water, and hot grease. For the mortality group, a third of patients had been injured in housefires (32.7%), followed by clothing catching on fire (17.4%) and HOT burns (12.2%). Conclusions Incidence rates decline with increasing age but mortality rates climb. Burn injuries with a TBSA greater than 40% are generally fatal in the older adult. Flame burns account for the majority of injuries with HOT and house fire injuries as the leading mechanisms. Scald burns were most often caused by hot tap water or boiling water. White older adults accounted for more than double the number of patients identified in all other races combined. Applicability of Research to Practice The demographics and mechanism of injury insight gained from this review can be utilized to inform prevention programming design in this region. Trends in mortality can help emphasize the seriousness of preventing older adult burn injuries and anticipate the mortality risk for older adults admitted to the burn center.

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A qualitative study of health professionals’ views on using iPads to facilitate distraction during paediatric burn dressing changes

Scars Burns & Healing ◽

10.1177/2059513118764878 ◽

2018 ◽

Vol 4 ◽

pp. 205951311876487 ◽

Cited By ~ 2

Author(s):

Elizabeth Green ◽

Julia Cadogan ◽

Diana Harcourt

Keyword(s):

Health Professionals ◽

Burn Injury ◽

Burn Injuries ◽

Management Technique ◽

Burn Care ◽

Paediatric Burns ◽

Wide Range ◽

Pharmacologic Pain Management ◽

Care Training ◽

Burns Unit

Introduction: Distraction is a non-pharmacologic pain management technique commonly used to avert a person’s attention from procedural pain and distress during stressful procedures such as treatment after a burn injury. In recent years, computer tablets (such as iPads) have been used within paediatric burns services to facilitate distraction by way of apps, games, cartoons and videos during dressing changes. However, we know very little about health professionals’ experiences of using them in this context. Methods: The current study explored health professionals’ experiences of using iPads to facilitate distraction during paediatric burn dressing changes. Fifteen health professionals from a single paediatric burns unit were interviewed. Thematic analysis revealed two key themes: (1) the iPad is a universal panacea for distraction; and (2) trials and tribulations. Discussion: Participants considered iPads to be potentially useful and effective distraction tools, suitable for use with a wide range of patients with burn injuries including young children, adolescents and young adults. However, issues including health professionals’ understandings of one another’s roles, the challenge of working in a busy burns service, and lack of experience and confidence were identified as possible barriers to their use within routine burn care. Training for staff on the use of iPads as a means of facilitating distraction, development of guidelines and a review of how they are incorporated into routine burn care are recommended.

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56 Reduced Length of Stay with Autologous Skin Cell Suspension Reduces Burn Injuries

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.060 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S37-S38

Author(s):

Jeffrey E Carter ◽

Blake Platt ◽

Charles T Tuggle

Keyword(s):

Length Of Stay ◽

Cell Suspension ◽

Burn Injury ◽

Point Of Care ◽

Statistical Significance ◽

Burn Injuries ◽

Burn Care ◽

Skin Cell ◽

Donor Skin ◽

Injured Patients

Abstract Introduction Burn injuries remain a surgical challenge with few recent innovations. Grafting with split-thickness skin grafts (STSGs) has been the standard of care for decades. Although shown to have mortality benefits, STSGs are associated with significant morbidity in the form of pain and additional open wounds. For years, surgeons have looked for ways to decrease this associated morbidity. To that end, autologous skin cell suspension (ASCS) is a recently FDA-approved point of care regenerative medicine technology that reduces donor skin requirements without compromising clinical outcomes. Our study evaluated the cost and length of stay comparing STSG alone versus ASCS. Methods We obtained IRB-approval for single institution, retrospective chart review of patients age >14 years admitted with burn injuries from March 2018 – September 2018. Primary outcome was length of stay/%TBSA for patients undergoing STSG alone as compared to patients undergoing ASCS. The 2016 American Burn Association National Burn Repository (NBR) was used to benchmark LOS/%TBSA. Age, percentage burn injury (TBSA), LOS, mortality, and number of surgeries were reviewed. Student’s t-test was used to assess statistical significance of intragroup analysis. Results 36 patients were treated with ASCS in combination with meshed autografts for full-thickness acute burn injuries. 37 patients were treated with STSGs at our center. Mean age and %TBSA was 45.2 years and 6.6% for the STSG group and 46.0 years and 18.6% for the ASCS group. The LOS/%TBSA for the STSG was 1.72 versus 1.19 for the ASCS patients (p-value=0.02). The NBR predicts a LOS/%TBSA of 3.38 and 3.42 for the STSG and ASCS groups. Patients in the STSG group and ASCS group had statistically similar surgeries and mortalities. Conclusions Burn injured patients treated with ASCS had a decreased LOS/%TBSA when compared to both the STSGs and NBR predictions. ASCS is a novel technology allowing for point-of-care treatment that may decrease LOS for burn injured patients and should be considered as an adjunct to traditional techniques for burn patients. Applicability of Research to Practice Reduced length of stay compared to traditional burn care.

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National programme for prevention of burn injuries

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-1699455 ◽

2010 ◽

Vol 43 (S 01) ◽

pp. S6-S10 ◽

Cited By ~ 3

Author(s):

J. L. Gupta ◽

L. K. Makhija ◽

S. P. Bajaj

Keyword(s):

Health Care ◽

Burn Injury ◽

Care Delivery ◽

National Level ◽

Burn Injuries ◽

Adequate Treatment ◽

National Programme ◽

Burn Care ◽

District Hospitals ◽

Medical Colleges

ABSTRACTThe estimated annual burn incidence in India is approximately 6-7 million per year. The high incidence is attributed to illiteracy, poverty and low level safety consciousness in the population. The situation becomes further grim due to the absence of organized burn care at primary and secondary health care level. But the silver lining is that 90% of burn injuries are preventable. An initiative at national level is need of the hour to reduce incidence so as to galvanize the available resources for more effective and standardized treatment delivery. The National Programme for Prevention of Burn Injuries is the endeavor in this line. The goal of National programme for prevention of burn injuries (NPPBI) would be to ensure prevention and capacity building of infrastructure and manpower at all levels of health care delivery system in order to reduce incidence, provide timely and adequate treatment to burn patients to reduce mortality, complications and provide effective rehabilitation to the survivors. Another objective of the programme will be to establish a central burn registry. The programme will be launched in the current Five Year Plan in Medical colleges and their adjoining district hospitals in few states. Subsequently, in the next five year plan it will be rolled out in all the medical colleges and districts hospitals of the country so that burn care is provided as close to the site of accident as possible and patients need not to travel to big cities for burn care. The programme would essentially have three components i.e. Preventive programme, Burn injury management programme and Burn injury rehabilitation programme.

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