SUMMARY. Types of burns and other aspects of burn injuries and case outcomes were assessed in a group of geriatric patients (> 60 years) and a younger group of patients (40-59 years). Between 1990 and 1999, 137 geriatric patients (47 [34 %] males and 90 [66 %] females) were admitted to the Burn Centre and Reconstructive Surgery Centre at University Hospital in Brno. We compared findings in this elderly group to those in 176 younger burn patients (126 [72 %] males and 50 [28 %] females) who were treated at the centre during the same time period. Age and concomitant chronic disease contribute to the high mortality and a higher frequency of complications in geriatric patients who suffer burn injuries. In this study, the complication rates for geriatrics during hospitalization (44 % in males and 32 % in females) and the elderly patients' mortality rates (26 % in males and 17 % in females) differed statistically from the corresponding rates in the younger patient group. It is important to know the special needs of elderly burn patients because this patient group is expected to grow in parallel with the rising average age of the Czech Republic's population.
Besondere Merkmale der Vebrennungsverletzung bei alteren Patienten
Koupil J., Brychta P., Filhovâ H., Kincovâ S.
Die Verbrennungsart, andere Aspekte der Verbrennungsverletzung und der Fallergebnis wurden festgestellt bei der Gruppen von geriatrischen Patienten (> 60 Jahre) und jüngeren Patienten (40-59 Jahre). In den Jahren 1990-1999 wurden am Verbrennungszentrum und Zentrum für plastische Chirurgie des Fakultâtskrankenhauses in Brünn insgesamt 137 geriatrischen Patienten (47 [34 %] Mânner und 90 [66 %] Frauen) behandelt. Wir verglichen diese Gruppe mit einer Gruppe von 176 jüngeren Patienten, die an der genannten Arbeitsstâte in gleicher Zeitspanne behandelt wurden. Das Alter und die begleitende chronische Erkrankung beitrâgt zur h&heren Sterblichkeit und h&herem Vorkommnis der Komplikationen bei geriatrischen Patienten, die von der Vebrennungsverletzung leiden. In dieser Studie wies die Gruppe von geriatrischen Patienten im Vergleich mit der Gruppe von jüngeren Patienten signifikant hbheres Vorkommnis der Komplikationen wâhrend Hospitalisierung (44 % bei den Mânner und 32 % bei den Frauen) und der Sterblichkeit (26 % bei den Mânner und 17 % bei den Frauen) auf. Es ist wichtig die spezifische Bedürfnisse der âlteren Verbrennungsverletzten zu erfassen, besonders hinsichtlich des Anstiegs dieser Patientengruppe infolge des steigenden Durch schnittsalters der Bevdlkerung der Tschechischen Republik.
Key words: burn accident, geriatric patient, complications of burn injury
Similar to the situation in other Central European countries, the average age of the Czech Republic's population is rising. Currently, 13 % of our people are over 60 years old, and 2.5 % are older than 80 years (3). From 1989 to the present date (since the totalitarian government was overthrown), the average age for men has increased by 3 years to reach 70.5 years, while that for women has risen 1.6 years to reach 77.6 years. It is predicted that 30 years from now, a quarter of our country's population will be of geriatric age.
We conducted an epidemiological study to retrospectively compare geriatric burn patients and younger burn patients in terms of mortality, morbidity, type of burn injury, patient age and systemic complications. Between 1990 and 1999, 137 geriatric patients (47 [34 %] males and 90 [66 %] females) were admitted to the Burn Centre and Reconstructive Surgery Centre at University Hospital in Brno. We compared findings in this elderly group to those in 176 younger burn patients (126 [72 %] males and 50 [28 %] females) who were treated at the centre during the same time period.
Patient age
In the elderly patients, the average age at hospitalization was 71 years for males and 75 years for females. The corresponding mean ages in the younger group were 47 years for males and 50 years for females.
Type of burn injury
The next figure illustrates the cause of burn injuries in the geriatric patients (Fig. 1). Scalding was most common and was involved in 79 of the cases (58 %). Many of these burns were caused by a hot-water bottle bursting or by falling into a bath. Some cases involved carelessness or a specific motor disability (e.g., disability after stroke, epilepsy, Parkinson's disease). In 39 cases (28 %; 22 females and 17 males), the barn caused by a flame or by an explosion due to gas leaks from tanks or malfunctioning electrical appliances. Carelessness and ignorance featured in many of these cases. All 14 cases (10 %) of contact burn were caused by electrical fire. The remaining 5 (4 %) burns were due to various other causes, such as chemical burns.
In the younger patient group, fire or explosion caused 84 of the barn cases (48 %). These accidents involved men more often than women, and there was a high incidence of work-related barn injury (Fig. 2). Scalding was the second most common cause, accounting for 66 cases (37 %). The findings indicated that these types of barns were most often seen in housewives who sustained barns from spilling boiling water. Nineteen (11 %) of the barns were contact barn injuries, and the remaining 4% of barns were caused by other mechanisms.
<% immagine "Fig. 1","gr0000041.gif","Distribution of the various types of barn injury in the geriatric patient group (> 60 years).",230 %> <% immagine "Fig. 2","gr0000042.gif","Distribution of the varions types of barn injury in the younger patient group (40-59 years).",230 %>Urban versus rural setting
A comparison of the incidence of barn accidents in urban and rural areas revealed that the younger patients living in urban settings were treated for barns twice as often as their counterparts from the rural environment. On the other hand, in the older patients, the proportion of older patients from urban settings was very similar to that from rural settings.
Mortality
The overall mortality in the elderly patients was 21 % (29 cases), with a rate of 26 % in mates and 17 % in females (Fig. 3). Of the 29 deaths, 48 % resulted from a fire in the home, 17 % from a gas explosion, 18 % from a scald injury, 7 % from barns caused by flammable liquids, and 10 % were due to other types of barns. In the younger patient group, overall mortality was 3 %, wfth 5 mate deaths (4 %) and 1 female (2 %). The groups' mortality rates differed significantly.
<% immagine "Fig. 3","gr0000043.gif","Mortality in the elderly patients, listed according to cause of accident (29 cases).",230 %> <% createTable "Table I","Extent of barns in geriatric patients",";TBSA ;< 1 %; 1-4 %;5-9 %;10-14 %;15-30 %; > 30 %@;Superficial and partial thickness barn wound ;5 (3 %); 25 (18 %);18 (13%);8 (6 %);3 (2 %);3 (2 %)@;Full thickness barn wound ;21(16 %); 12 (8 %);17 (12 %); 12 (8 %);8 (6 %);5 (3 %)","",4,400,true %>Extent of burns in elderly patients
Twenty-Pive patients sustained burns involving less than 1 % total body surface area (TBSA). All of these patients survived. Forty patients had burns between 1-5 percent TBSA. Thirty-Pive patients sustained burns of 5-9 % TBSA, twenty patients between 10-14 % and nineteen patients had burns of more than 15 % TBSA (Tab. 1). All patients who died had burns greater than 30 percent of TBSA.
Hospital stay
The average hospitalization time in thé geriatric group was 24 days for males and 18 days for females. The corresponding means for thé younger patients were 17 days for males and 21 days for females. The différence between thé younger and older groups was not statistically significant.
Treating thé burn wound
In thé elderly patients, conservative treatment was used in 41 % of thé male cases (21 cases) and 31 % of thé female cases (28 cases). Surgical management (excision and autografting) was significantly différent in this group: 59 % (26 cases) of thé males and 69 % (62 cases) of thé females. However, thé rate différences between thé two groups (younger and elderly patients) were not statistically significant (Tab. 2).
<% createTable "Table II","Treating thé burn wound",";;40-59 years;;> 60 years;@;Type of treatment;Male;Female;Male;Female@;Conservative treatment;44 (34 %);31 (57 %);21 (41 %);28 (31 %)@;Excision and autografting;82 (66 %);19 (43 %);26 (59 %);62 (69 %)","",4,300,true %> <% createTable "Table III","Incidence of systemic complications during hospital stay",";; 40-59 years;; > 60 years;@;Type of complication;Male;Female;Male;Female@;Pneumonia ;4;1;3;12@;Acute r‚nal failure;4;1;5;2@;Hepatic dysfunction;3;0;1;1@;ARDS;3;0;1;1@;Sepsis ;2;1;4;3@;Cardiac failure;1;1;1;2@;Coagulation disorders;0;1;1;1@;Multiorgan failure;1;0;4;7@;Curling's ulcer;2;0;1;0@;Total;20;5;21;29","",4,300,true %>System complications
In thé geriatric group, 21 mates (45 %) and 29 females (32 %) developed complications. In thé younger patients, 20 mates (16 %) and 5 females (10 %) encountered problems. The rate différences between thé groups were significant. Pneumonia and sepsis were thé most common complications (Tab. 3).
Anatomical distribution of barn injuries
In males, thé upper limbs were more often involved than other parts of thé body: 32 % of cases in elderly mates and 33 % in younger mates. The lower limbs were more often injured in both elderly (39 %) and younger females (33 %). Next came thé trunk, head and neck (Tab. 4).
<% createTable "Table IV","Anatomical distribution of burn injuries (%)",";;40-59 years;; > 60 years;@;Anatomical r‚gion ; Male; Female; Male; Female@;Head and neck;15;11;15;7@;Trunk ;13;14;12;15@;Upper limbs;33;25;32;22@;Abdomen;11;12;5;6@;Back;7;2;10;8@;G‚nital ;3;3;4;3@;Lower limbs;18;33;22;39","",4,300,true %>Burn injury ranks fourth among thé causes of injury-related death in thé geriatric age group. The risk factors that affect thé incidence and severity of complications after thermal injury are age, pré-existing disease, associated injury and type of burn. The seriousness of burn injuries in thé elderly is increased by a characteristic delay in seeking médical attention. The relatively superficial appearance and small surface area of a burn tan be deceptive, and this is why some older patients put off treatrnent. Advanced age and chronic disease contrebute to high morbidity and mortality in this group (1). In treatment, preexisting cardiovascular or pulmonary diseases often complicate thé restoration and maintenance of proper fluid volume. Pneumonia, prolonged immobilization and physical stress are other éléments that significantly impact morbidity (4). The mortality rate increases with thé extent of thé thermal injury. The treatment of geriatric patients bas been one of thé most controversial topics in modem burn therapy. Conservative wound tare bas historically been advocated for this group. Elderly patients may tolerate thé stress of early excision better than complications of wound sepsis (2).
Elderly patients with burns require specialized care. Many of these individuals live alone and are often physically or mentally unable to respond appropriately in an emergency situation.Often, by the time they get treatment the injury has progressed significantly. Once treatment is initiated, the most important factors for survival in this group are early excision and grafting, ensuring sufficient nutrition and maintaining functional mobility.
Geriatric burn patients need special medical attention. It is important to recognize the problems in this group because the average age in the Czech Republic and European populations is on the rise, and this will result in greater number ofelderly burn patients.
Jan Koupid Burn and Plastic Surgery Centre University Hospital Brno, Jihlauskci 20 639 00 Brno, Czech Republic jkoupil@fnbrno.cz
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