Outcomes of older adult burn patients – have we made any progress?

Author(s):
Diana Tedesco; Marc Jeschke

Background:

Over the past several decades, advancements in burn care have improved mortality and outcomes overall. However, older adults (≥60 y) remain a vulnerable and medically challenging group, with recent studies determining that they experience higher mortality rates compared to adults, alongside distinct physiological challenges, including delayed hypermetabolic response, altered inflammatory response, and delayed wound healing. For this reason, this study seeks to compare two cohorts of older adult patients admitted to a burn centre over a 10-year period to identify whether a deeper understanding of older adults’ response to burns has led to improvements in mortality and clinical outcomes associated with burn injuries.

Hypothesis:

We hypothesize that a greater awareness of older adults’ response to burn injuries has led to improvements in mortality and clinical outcomes over the 10-year study period.

Methods:

Between July 1, 2011 and June 30, 2021, 2245 patients admitted to a provincial adult burn center were assessed for eligibility. Older adults (≥ 60 y) admitted within 120 hours of their injury with recorded total body surface area (%TBSA) burn were included. Adults (<60 y), non-burn patients, and patients who died within 96 hours of admission were excluded. Patients were stratified into two cohorts based on admission date: early (July 2011 to June 2016) and late (July 2016 to June 2021) to compare outcomes over time. Additionally, %TBSA comparison was conducted based on moderate (<10% TBSA) and severe (≥10% TBSA) burns.

Results:

369 patients were included, 184 patients in the early and 185 in the late cohort. The early and late cohorts showed similar age and %TBSA. Mortality was similar, despite patients in the early cohort having a greater proportion of pre-admission comorbidities: respiratory disease (p<0.01), illicit drug use (p<0.05), and current smoker (p<0.01). Despite the similar length of stay (LOS), OR and procedure count (p<0.05), invasive ventilation (p<0.01), wound infections (p<0.01), pleural effusions (p<0.01) and cardiovascular complications (p<0.01) were greater in the early cohort. A comparison of patients with moderate burns showed similar age, %TBSA, inhalation injury, and mortality between cohorts. However, the use of invasive ventilation was greater in the early cohort (p<0.05), and LOS was greater in the later cohort (p<0.05). In contrast, patients with severe burns had similar age, %TBSA, pre-admission comorbidities, mortality, invasive ventilation use, and LOS.

Conclusions:

Despite increased awareness of the response to burn injuries in older adults, mortality and clinical complications have not improved for both moderate and severe burns.