Original ContributionsGeriatric Burn Injuries Presenting to the Emergency Department of a Major Burn Center: Clinical Characteristics and Outcomes
Introduction
Burn injuries in geriatric patients are common (1). Older adults are particularly susceptible to burn injury due to increasing dementing illness, sensory impairment, poor mobility, slow reaction times, and adverse effects of medication (2,3). Adults 60 years and older represent > 14% of patients admitted to U.S. burn centers (4). The population of older adults is projected to double by 2050 and, as a result, the incidence of burn injuries will also rise (5,6).
Burns can have higher morbidity and mortality for older adults compared with younger patients, partially due to comorbidities, thin and fragile skin, and reduced immunologic response (2,3). According to the Centers for Disease Control and Prevention, these injuries are currently the fourth leading cause of unintentional injury mortality among people 65 years and older (7). The importance of age in predicting mortality from burn injury has long been recognized, with all published prediction formulas including age as a factor, beginning with Bull and Fisher's graphical mortality risk assessment method in 1954 and the Baux score in 1961 (2,8, 9, 10, 11, 12, 13, 14, 15). Recent research suggests that older adults are twice as likely to die from their burn injuries as younger adults and have increased morbidity, including long-term disability and loss of independence (2,16, 17, 18, 19). After inhalational injury, older adults are particularly susceptible to pneumonia and their morbidity and mortality rises significantly (4). Although outcomes in burn treatments in younger patients have improved dramatically in the last 50 years, these improvements are less dramatic in older adults (2,20,21).
Much research to date has focused exclusively on the treatment of older adult patients with severe burns who are hospitalized in burn centers (2,4,6,22, 23, 24, 25, 26, 27). There is limited information available regarding the clinical characteristics of all geriatric burn victims who present to the emergency department (ED), including those with less severe injuries who may be discharged from the ED and followed up in an outpatient setting. Furthermore, the assessment and management of geriatric burn patients in the ED has not been well-studied. Our objective with the present study was to describe the clinical characteristics and outcomes of geriatric patients presenting to the ED with burn injuries.
Section snippets
Materials and Methods
We performed retrospective chart review on all patients 60 years and older with a burn injury presenting to New York-Presbyterian Hospital from January 2011 through September 2015. Weill Cornell Medical Center is a large, urban, academic ED that treated more than 90,000 patients each year, 30% of whom were 60 years and older during the period under study. The hospital is both an American College of Surgeons–verified level I trauma center and an American College of Surgeons/American Burn
Results
From January 2011 through September 2015, there were 459 patients 60 years and older treated for burn injuries in the New York Presbyterian Hospital / Weill Cornell Medical Center ED. Patients treated for burn injuries were more commonly women (56.6% vs. 43.4%). Median age of burn patients was 71 years; 45.1% were aged 60–69 years, 31.1% were aged 70–79 years, and 23.7% were 80 years or older. Characteristics of these patients, their injuries, and their ED treatment categorized by sex and age
Discussion
To our knowledge, this is the first study to describe the clinical characteristics and outcomes of geriatric patients presenting to the ED with burn injuries. Although substantial literature exists about management of geriatric patients who are admitted to burn centers, including analysis of the ABA registry, our work adds important new insight into both the initial assessment and management of burns in older adults who present to the ED, as well as their ultimate disposition after this ED
Conclusions
Our work describes in detail geriatric patients with burn injuries treated in the ED, offering insight and improving understanding of this common problem that may be challenging to manage. Common patterns of burn injuries presenting to the ED change with increasing age, with cooking a common associated cause in older adults in the youngest age category and bathing more common in the oldest age category. Many older adults, even 80 years and older, with burn injuries may be safely discharged from
Acknowledgments
The authors would like to thank Jamie Heffernan, the Burn Program Manager at Weill Cornell Medicine, New York-Presbyterian Hospital, for assistance with data gathering and analysis. Dr. Rosen's participation was supported the National Institute on Aging, (grant numbers: R03 AG048109, K76 AG054866). Dr. Rosen is also the recipient of a Jahnigen Career Development Award, supported by the John A. Hartford Foundation, the American Geriatrics Society, the Emergency Medicine Foundation, and the
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