Epidemiological and clinical characteristics of burns in the older person: a seven-year retrospective analysis of 693 cases at a burn center in south-west China

Abstract

Background: Burns are one of the major traumas that may affect older individuals. The purpose of this study was to investigate the epidemiological and clinical characteristics of geriatric burns at a major center in south-west China. Methods: This retrospective study was conducted at the Institute of Burn Research, Southwest Hospital of Army Medical University between 2010 and 2016, and the data collected from medical records included admission date, age, gender, premorbid disease, burn etiology, injured anatomical location, burn area and depth, inhalation injury, number of surgeries, length of stay (LOS), clinical outcome, and medical cost. Results: Of the 693 older burn patients included, 60.75% were male and 56.85% were aged 60–69 years. Burns peaked in December–March and June. Flame was the most common cause of burns, making up 51.95% of all cases, and also dominated in the burn patients aged 60–69 years. Limbs were the most common anatomical sites of burns (69.41%), and the median total body surface area (TBSA) was 5% (interquartile range [IQR]: 2%–15%). The percentage of the patients who underwent surgeries and number of surgeries significantly increased in the cases of contact burns, younger age and full-thickness burns. Six deaths resulted in a mortality of 0.9%. The median LOS was 16 days (IQR: 8–29 days), and the main risk factors were more surgeries, better outcomes, and full-thickness burns. The median cost was 20,228 CNY (IQR: 10,457–46,581.5 CNY), and major risk factors included longer LOS, larger TBSA, and more surgeries. Furthermore, compared to the earlier data from our center, the proportion of older adults among all burns (7.50% vs. 4.15%), proportion of flame burns (51.95% vs. 33.90%), and mean age (69.05 years vs. 65.10 years) were significantly higher, while the proportion of premorbidities (16.9% vs. 83.9%), mortality (0.9% vs. 7.5%) and median TBSA (5% vs. 21%) were significantly lower. Conclusions: This study suggested that closer attention should be paid to prevent burn injuries in older people aged 60–69 years, especially males, regarding incidents in the summer and winter, and flame burns. Moreover, tailored intervention strategies based on related risk factors should be under special consideration.

Keywords

Geriatric burns / Epidemiology / Outcome / Cost / Risk factors

References

[1] No. 1 Communique on the Sixth National Population Census. National Bureau of Statistics of the People’s Republic of China 2011. Available at: http://www.stats.gov.cn.

[2] Liu Y, Chen JJ, Crook N, Yu R, Xu XW, Cen Y. Epidemiologic investigation of burns in the elderly in Sichuan Province. Burns. 2013; 39: 389-94.

[3] Emami SA, Motevalian SA, Momeni M, Karimi H. The epidemiology of geriatric burns in Iran: a national burn registry-based study. Burns. 2016; 42: 1128-32.

[4] Li XL, Peng Y, Shang XZ, Liu SL. Epidemiologic investigation of geriatric burns in Southwest China. Burns. 2009; 35: 714-8.

[5] Jeschke MG, David P, Mile S, Abdikarim A, Sarah R, Ruxandra P, et al. Pathophysiologic response to burns in the elderly. Ebiomedicine. 2015; 2: 1536-48.

[6] Mabrouk A, Maher A, Nasser S. An epidemiologic study of elderly burn patients in Ain Shams University burn unit, Cairo, Egypt. Burns. 2003; 29: 687-90.

[7] Gaucher S, Grabar S, Fragny D, Lecam B, Stéphanazzi J, Wassermann D. Burns in older people. Epidemiology, surgical management and outcome in a university hospital referral burn unit, 1994-2004. Eur Geriatr Med. 2012; 3: 43-8.

[8] Keck M, Lumenta DB, Andel H, Kamolz LP, Frey M. Burn treatment in the elderly. Burns. 2009; 35: 1071-9.

[9] Abu-Sittah GS, Chahine FM, Janom H. Management of burns in the elderly. Ann Burns Fire Disasters. 2016; 29: 249-54.

[10] Li H, Wang S, Tan J, Zhou J, Wu J, Luo G. Epidemiology of pediatric burns in Southwest China from 2011 to 2015. Burns. 2017; 43: 1306-17.

[11] Luo G, Peng Y, Yuan Z, Cheng W, Wu J, Tang J, et al. Fluid resuscitation for major burn patients with the TMMU protocol. Burns. 2009; 35: 1118-23.

[12] Forster NA, Zingg M, Haile SR, Künzi W, Giovanoli P, Guggenheim M. 30 years later-does the ABSI need revision? Burns. 2011; 37: 958-63.

[13] Osler T, Glance LG, Hosmer DW. Simplified estimates of the probability of death after burn injuries: extending and updating the baux score. J Trauma. 2010; 68: 690-7.

[14] Nakae H, Wada H. Characteristics of burn patients transported by ambulance to treatment facilities in Akita prefecture, Japan. Burns. 2002; 28: 73-9.

[15] Yin Z, Qin Z, Xin W, Gomez M, Liao ZJ. The characteristics of elderly burns in Shanghai. Burns. 2010; 36: 430-5.

[16] Sarhadi NS, Kincaid R, Mcgregor JC, Watson JD. Burns in the elderly in the south east of Scotland: review of 176 patients treated in the Bangour burns unit (1982-1991) and burn inpatients in the region (1975-1991). Burns. 1995; 21: 91-5.

[17] Cutillas M, Sesay M, Perro G, Bourdarias B, Castede JC, Sanchez R. Epidemiology of elderly patients’ burns in the south west of France. Burns. 1998; 24: 134-8.

[18] Jeschke MG, Pinto R, Costford SR, Amininik S. Threshold age and burn size associated with poor outcomes in the elderly after burn injury. Burns. 2016; 42: 276-81.

[19] Lewandowski R, Pegg S, Fortier K, Skimmings A.Burn injuries in the elderly. Burns. 1993; 19: 513-5.

[20] Wong P, Choy VY, Ng JS, Yau TT, Yip KW, Burd A. Elderly burn prevention: a novel epidemiological approach. Burns. 2007; 33: 995-1000.

[21] Edgar DW, Homer L, Phillips M, Gurfinkel R, Rea S, Wood FM. The influence of advancing age on quality of life and rate of recovery after treatment for burn. Burns. 2013; 39: 1067-72.

[22] Tan J, Chen J, Zhou J, Song H, Deng H, Ao M, et al. Joint contractures in severe burn patients with early rehabilitation intervention in one of the largest burn intensive care unit in China: a descriptive analysis. Burns Trauma 2019; 7: 17. doi: 10.1186/s41038-019-0151-6.

[23] Li H, Zhou J, Peng Y, Zhang J, Xi P, Luo Q, et al. The progress of Chinese burn medicine from the Third Military Medical University-in memory of its pioneer, Professor Li Ao. Burns Trauma. 2017; 5: 16. doi: 10.1186/s41038-017-0082-z.

[24] Ying C, Chai J, Chen H, Jian C, Guo G, Han C, et al. Guidelines for burn rehabilitation in China. Burns Trauma. 2015; 3: 20. doi: 10.1186/s41038-015-0019-3.

[25] Still JM, Law EJ, Belcher K, Thiruvaiyaru D. A regional medical center’s experience with burns of the elderly. J Burn Care Rehabil. 1999; 20: 218-23.

[26] Ho WS, Ying SY, Chan HH. A study of burn injuries in the elderly in a regional burn centre. Burns. 2001; 27: 382-5.

[27] Engrav LH, Heimbach DM, Reus JL, Harnar TJ, Marvin JA. Early excision and grafting vs. nonoperative treatment of burns of indeterminant depth: a randomized prospective study. J Trauma. 1983; 23: 1001-4.

[28] Tompkins RG, Burke JF, Schoenfeld DA, Bondoc CC, Quinby WC Jr, Behringer GC, et al. Prompt eschar excision: a treatment system contributing to reduced burn mortality. A statistical evaluation of burn care at the Massachusetts General Hospital (1974-1984). Ann Surg. 1986; 204: 272-81.

[29] Herndon DN, Barrow RE, Rutan RL, Rutan TC, Desai MH, Abston S. A comparison of conservative versus early excision. Therapies in severely burned patients. Ann Surg. 1989; 209: 547-53.

[30] Slater AL, Slater H, Goldfarb IW. Effect of aggressive surgical treatment in older patients with burns. J Burn Care Rehabil. 1989; 10: 527-30.

[31] Covington DS, Wainwright DJ, Parks DH. Prognostic indicators in the elderly patient with burns. J Burn Care Rehabil. 1996; 17: 222-30.

[32] Ahuja RB, Gibran N, Greenhalgh D, Jeng J, Mackie D, Moghazy A, et al. ISBI practice guidelines for burn care. Burns. 2016; 42: 953-1021.

[33] Kirn DS, Luce EA. Early excision and grafting versus conservative management of burns in the elderly. Plast Reconstr Surg. 1998; 102: 1013-7.

[34] Housinger T, Saffle J, Ward S, Warden G. Conservative approach to the elderly patient with burns. Am J Surg. 1984; 148: 817-20.

[35] Wearn C, Hardwicke J, Kitsios A, Siddons V, Nightingale P, Moiemen N. Outcomes of burns in the elderly: revised estimates from the Birmingham burn Centre. Burns. 2015; 41: 1161-8.

[36] Hendrix L, Charles A, Buchholz V, Jones S, Cairns B. Influence of race and neighborhood on the risk for and outcomes of burns in the elderly in North Carolina. Burns. 2011; 37: 762-9.

[37] 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.

[38] Alden NE, Rabbitts A, Yurt RW. Contact burns: Is further prevention necessary? J Burn Care Res. 2006; 27: 472-5.

[39] Li H, Tan J, Zhou J, Yuan Z, Zhang J, Peng Y, et al. Wound management and outcome of 595 electrical burns in a major burn center. J Surg Res. 2017; 214: 182-9.

[40] Pham TN, Kramer CB, Jin W, Rivara FP, Heimbach DM, Gibran NS, et al. Epidemiology and outcomes of older adults with burn injury: an analysis of the National Burn Repository. J Burn Care Res. 2009; 30: 30-6.

[41] Ahn CS, Maitz PK. The true cost of burn. Burns. 2012; 38: 967-74.

[42] Tang Y, Wang L, Xie W, Shen C, Guo G, Chen J, et al. Multicenter epidemiological investigation of hospitalized elderly, young and middle-aged patients with severe burn. Chin J Burns. 2017; 33: 537-44.