Burns in the elderly: a nationwide study on management and clinical outcomes
| Autor: | Margriet E. van Baar, Esther Middelkoop, H. Goei, Jan Dokter, G.I.J.M. Beerthuizen, Kees H van der Vlies, J.F. Vloemans |
|---|---|
| Přispěvatelé: | Surgery |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Population Biomedical Engineering Dermatology Critical Care and Intensive Care Medicine Avulsion 030207 dermatology & venereal diseases 03 medical and health sciences 0302 clinical medicine Elderly Clinical outcomes medicine Hospital discharge Immunology and Allergy education education.field_of_study business.industry Discharge disposition 030208 emergency & critical care medicine medicine.disease Comorbidity Younger adults Nationwide study Emergency medicine Emergency Medicine Etiology Surgical management Surgery business Burns Total body surface area Research Article |
| Zdroj: | Burns & Trauma, 8:tkaa027. Oxford University Press Burns & Trauma |
| ISSN: | 2321-3868 |
| Popis: | 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 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. |
| Databáze: | OpenAIRE |
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