Annals ofBurns and Fire Disasters - vol. VIII - n. A - Deceinber 1995


lliopoulou E, Lochaitis A, Kalophonou M, Kapositas E, Komninakis E, Poulikakos, L, Daniel-Seferi A.

Department of Plastic and Reconstructive Surgery and Burn Unit, K.A.T. District Hospital, Athens, Greece

SUMMARY. In the four-year period 1990-1994, 185 patients aged over 65 years with mixed full- and partial -thickness burns in a mean total body surface area (TBSA) of 26.8% were admitted to our Bum Unit. In the majority of cases the aetiology was therrial injury (11ame 63%, scalding 19%, contact 10%, friction 5%, chemical burns 3%). Over one~third of the accidents occurred in a closed environment and were domestic. Inhalation injury was present in 23% of the patients (mortality 100%). Overall mortality was 33% (mean age 79.7 years vs. 72.0 years in surviving patients, mean TBSA 40% vs. 23% in surviving patients). The leading causes of death were major cardiopulmonary complications (70%), infection (18%) and hypovolaernic shock (3%). Our results have led us to the conviction that immediate and intensive treatment in combination with very early mobilization will lead to rapid healing and rehabilitation in many of these eleterly patients.


The improved quality of life and the great progress in medical and social assistance in Greece in recent decades have led to a considerable rise in life expectancy. This progress, together with the phenomenon of the continuously falling birth rate, has led to a doubling of the percentage of the elderly in the overall Greek population from 6.8% in 1951 to 13.9% in 1990.
This considerable rise in the life expectancy of the Greek population has resulted in an increased incidence of accidents, including burns, while a variety of social and financial problems have complicated facilities for treatment and rehabilitation.
The definition of "elderly" is generally accepted as corresponding to the age of 65 years and older. Parallel to the increase in life expectancy there has been an increased rate of hospitalized burns among the elderly. Geriatric patients have decreased physiological reserves and a significant number of previous pathologies, both of which factors give rise to increased risks of complications and death following burn injury.

Materials and methods

During a four-year period (1990-1994) 185 patients aged 65 years and over were treated at K.A.T. General District Hospital Burn Unit. This represented 17% of all burn admissions.

Age and sex
The mean age of the patients was 74.5 years (range 65-96 years). Women predominated in all age groups (ratio 100:85), except in the over 85-year-old age group (Fig. 1).

Fig. 1 - Distribution by age and sex. Fig. 2 - Location of burns,
Fig. 1 - Distribution by age and sex.

Fig. 2 - Location of burns,





0 - 30%



31 - 60%



61 - 100%



Table 1 - Percentage of surface area involved

In terms of depth of injury most patients presented mixed partial- and full-thickness lesions (60%). Twenty-two per cent suffered superficial partial-thickness burns and 18% presented isolated full-thickness burns (Table II).




Mixed partial and full-thickness



Superficial partial thickness






Table II  - Depth of injury


The most commonly affected body parts were the lower limbs alone (82%) or in association with burns elsewhere. The upper limbs were affected in 107 patients (58%), the head and neck in 55 patients (33%), and the trunk in 65 patients (35%) (Fig. 2).

Aetiology and circumstances
Thermal burns were the commonest cause of injury (flame, 63%; scalding, 19%; contact, 10%, friction, 5%; chemical bums, 3%) (Table 111). Over one-third occurred in closed spaces and were domestic. Elderly patients who lived alone represented one-third of our series and tended to present burns of greater extent (36% TBSA) than patients living with their family (25% TBSA). Four patients presented flame lesions sustained in traffic accidents, and ten presented friction injuries due to being dragged along the ground by vehicles. Only five cases were registered as suicide attempts.




Flame and contact












Table III - Burn aetiology

Sociofinancial circumstances
Loneliness and low financial status (with or without social support) were common to most patients. Only 25% of the patients enjoyed a medium/high financial status.Previous pathology The majority of cases presented significant chronic prebum morbidity. Cardiorespiratory and circulatory problems predominated among the patients who died (Table IV).






Circulatory insufficiency








Respiratory insufficiency




Psychiatric problems








Coronary insufficiency








Table IV - Previous pathology and the correlation between survival and death

Concomitant pathology
Only ten patients presented concomitant lesions (fractures in seven cases, craniocerebral contusion in three cases).

Delay in admission
One hundred and fifty-four patients were admitted 28 hours after the accident and 21 after 2-10 days, following transportation from other hospitals or regions at some distance from Athens. This delay influenced overall mortality.

The mean hospitalization period was 15 days (range 090 days).

The patients were treated uniformly. Antishock resuscitation formulae based on the Parkland method were the rule in the majority of patients, together with close attention to vital parameters, previous pathology, and the development of complications. Intubation was performed in patients suffering from inhalation injury. None of these survived.
Low molecular heparin (Fraxiparine, Clexane) was started as a preventive measure in the first hours post~burn. Antibiotics were used in relation to concomitant illnesses. Early excision and skin grafting were performed in 38% of the patients (TBSA 1-30%). In five cases amputation of the lower or upper limbs was the elective treatment, owing to the severity of the burn lesions (deep burns involving fat, muscle, or bone.) Early kinesiotherapy and respiratory gymnastics were initiated 2-4 days post-burn (when patients were haemodynamically stable). Nutritional management was intensive, with enteral administration as the mode of choice.

The majority of our patients suffered at least one complication due to previous pathology, the post-burn condition, or failure of treatment.

The overall mortality rate was 33% (61 deaths). The mean age of the deceased was 79.7 years vs. 72.0 years for those who survived (Fig. 3). Although females were predominant in all age groups, there was higher mortality in younger men (60-75 years). In the over 75-year-old age group, this proportion was inverted.

Fig. 3 - Mortality distribution by age and sex. Fig. 4 - Correlation between TBSA and mortality.
Fig. 3 - Mortality distribution by age and sex. Fig. 4 - Correlation between TBSA and mortality.

The mean burn extent among the patients who died was 40% TBSA versus 23% TBSA among the survivors (Fig. 4). The majority of the deceased had full-thickness burns (56%). Face burns, when associated with inhalatory injury, were fatal. Previous pathology played an impportant role in the course of the burn disease. All the deceased patients presented at least one previous pathological condition. Concomitant pathology also greatly influenced the outcome, ten cases (fractures, craniocerebral lesions) having a fatal outcome.


Our series of 185 cases represents 17% of all our bum admissions over a four-year period (1990-1994). In line with the demographic characteristics of the Greek population there was a prevalence of female patients (female/male ratio: 100:85).
Most patients (75%) presented a burn extent of 1-30% TBSA, and most patients (60%) suffered mixed partialand full-thickness lesions. The body region most frequently burned was the lower limbs alone or in association with other regions. Lower extremity burns, requiring longer decubitus, were associated with increased mortality, due to diminished speed of reaction and of life support reflexes in general. In addition, these patients frequently presented a greater number of previous diseases than younger age groups, which put them at increased risk of post-burn complications and death. One-third of our patients suffered inhalation injury in closed-space accidents.
The post-burn evolution of our cases presented no special features. The 33% mortality rate was lower than that of elderly patients reported by other Burn Centres.
The improved survival after early excision and skin-grafting was important; in a few cases amputation was the elective treatment. In our Burn Unit the surgical strategy in elderly patients is two or three quick minor operations lasting only 20-45 minutes, and early initiation of gymnastics, independently of the burn localization. As many other authorS2, 1,1 have stated, surgical therapy must be carefully planned days in advance and the correct type of anaesthesia discussed. Local anaesthesia has been used successfully, in correlation with light doses of morphine.


Elderly burn patients present particular problems that require prevention or care by a well-organized team of physicians of all specialities, social workers, and kinesitherapists. The impaired senses and slow reaction times of geriatric patients tend to provoke burns of greater thickness and extent. The skin of these patients is atrophic and the dermis thinner than in younger patients, and their burns thus tend to be deeper. A slow rate of epidermal proliferation leads to a decrease in healing capacity. The physiological reserves of the body and the host immune defence mechanism are all diminished. Skin donor sites are more liable to infection. Infected open wounds prolong decubitus and aggravate respiratory function, which is usually already inadequate. Intensive and efficient rehabilitation is imperative in order to prevent respiratory and vascular complications. The effective handling of elderly burn victims is the task of a multidisciplinary team.

RESUME. Pendant les quatre ans 1990-94, les auteurs ont traité 185 patients âgés plus de 65 ans hospitalisés dans leur Unité de Brûlures atteints de brûlures à toute épaisseur ou de premier et second degré en moyenne dans 26,8% de la surface totale corporelle. Dans la plupart des cas l'étiologie était la lésion thermale (feu 63%, ébouillantement 19%, contact 10%, friction 5%, brûlures chimiques 3%). Plus d'un tiers des accidents se sont produits à la maison dans un environnement clos. Les lésions dues à l'inhalation étaient présentes en 23% des patients (mortalité 100%). La mortalité complessive était 33% (âge moyen 79,7 ans contre 72,0 ans dans les patients survécus, surface corporelle brûlée moyenne 40% contre 23% dans les patients survécus). Les causes principales de la mort était les graves complications cardiopulmonaires (70%), l'infection (18%) et le choc hypovolémique (3%). Nos résultats nous ont persuadés que le traitement immédiat et intensif en association avec la mobilisation précoce peut conduire rapidement à la guérison et la rééducation de la plupart de ces patients.


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This paper was presented at the Ninth ISBI Congress, 27 June - 1 July 1994, Paris, France and was received by MBC on 14 March 1995.

Address correspondence to: E. Iliopoulou M.D., 3is Sept. 119, Athens 1125 1, Greece


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