SUMMARY. This is a retrospective analysis of a group of 67 senior citizens over 75 years of age who had been hospitalized at the Burn Center of the FNsP Hospital in Ostrava- Poruba in the years 1999 - 2003. We have studied a group of males and females, noting their average age, most common causes of burn injuries, mechanisms of burn injuries, average extent of burn injuries, and most commonly burned body parts. We have also reviewed the seriousness of burn injury in senior citizens, factors that complicated the course of treatment as well as its impact on the final therapeutic effect. The importance of specific approach and individual therapeutic strategy is emphasized. We would also like to emphasize the need for complex therapy approach due to secondary diseases that are very common in this age group. The treatment of burn patients in this age group is very challenging from a personal and economic point of view. The goals of therapy are a full recovery and the return of the patient to normal life. However, goals and therapeutic results are determined and limited by the above-mentioned factors. Nevertheless, every therapeutic success, although partial, should be perceived as positive. For the patient. every success from the point of view of the ability to take care of himself or herself and the overall quality of life is fundamental.
Key words: senior citizens over 75 years of age, burn trauma
This analysis focuses on burn injury in elderly patients. According to demographic data, it is obvious that median life expectancy is increasing. Our population is aging, and therefore the number of elderly people is increasing. We can therefore expect an increase in the number of senior citizens who will require treatment after burn injury. Furthermore, senior citizens arc a very specific group of patients who require special attention.
Characteristic of the data file
Our work retrospectively analyses data files of senior citizens aged 75 and older who were hospitalized at the Burn Center of the FNsP Hospital in Ostrava - Poruba between the years 1999 - 2003. During these years we hospitalized 67 senior citizens: 26 males and 41 females. Females constituted the majority of our patients.
Overall, people aged 75 or more represent only 3.9290 of all patients hospitalized at our workplace in the mentioned years. Therefore only a small number of patients are involved; however, this group. with its specific characteristics, is very remarkable from the point of view of age, as well as the course of burn treatment.
The average age of these patients was 80.2 years. The average age of males was slightly higher than of females.
Types and causes of burn injury
When we look at the types and causes of injuries it is apparent that they are associated with old age and the living situation of elderly people. These individuals frequently live alone, often have impaired functional mobility, coordination, and sensitivity. They may well suffer from vertigo as well as from various other- age-related mental conditions. As a result, the elderly have a decreased ability to manage tile activities of daily life, impaired capacity to judge their own ability to cope, as well as decreased safety while performing the tasks of daily life that arc simple and ordinary for the healthy population. We found that the majority of our patients (84%) sustained a burn injury at home.
The most common cause of burn trauma in our patients (in 43% of cases) was hot water - most commonly in the kitchen or bathroom, tire (25%) and heating systems (8%), as well as explosions of gas containers or Calor gas cylinders in 6% of cases. Eighteen percent of burn injuries were caused by other factors (hot oil, hot steam, ultraviolet treatment, sunburns, and a fall onto a soldering iron). (Fig. 1, 2.)
We did not find significant difference in the incidence of burn injury during various seasons of the year or months in the researched group.
<% immagine "Fig. 1","../images/gr0000038.jpg","Types of burns (the commonest location for burn injury)",230 %> <% immagine "Fig. 2","../images/gr0000039.jpg","Causes of burn injury",230 %>Extent and localization of burn injury
The average size of burn injury was 9%, though in patients who subsequently died it was 22%. The most commonly injured body parts were the lower extremities; the least common was a burn injury of the respiratory system. (From January 1999 to the end of 2003, we hospitalized four patients above 75 years of age with a burn injury of the respiratory system. This is only 6% of our data file; however, they displayed a high mortality , 75%. None of our patients had a burn injury only of the respiratory system.) (Fig. 3, 4.)
<% immagine "Fig. 3","../images/gr0000040.jpg","Inhalation injury in percentage proportion to other burns",230 %> <% immagine "Fig. 4","../images/gr0000041.jpg","Inhalation injury - mortality",230 %>Therapy
Therapy in the intensive care unit. 32 patients (47.8%) of the basic group of 67 patients (less than half) were hospitalised in the intensive care unit. The average length of stay in the intensive care unit was 26 days; total average length of hospitalization was 35 days. Mortality of patients hospitalized in the intensive unit was 56%. Total mortality of patients older than 75 years was 27%.
The most common cause of death in patients hospitalized in the intensive care unit was sepsis, which was the cause of death in 56% of patients, next bronchopneumonia and MOF, both with the same incidence of 50%, while the fourth most common cause of death was shock (in 39%).
Time factor in the specialized treatment. We hospitalized 54% of patients immediately. The majority of these 54% suffered from bum injury covering 10% and 30% of the body surface, or 3rd degree burn injury on up to 10% of the body surface. Patients in the second group, who were not hospitalized immediately, received treatment on average 6 days after their injury.
The most common reason for the treatment delay (in 45% of the cases) was the patient's decision not to neck medical help. The second most common reason for the delay (29%) was that the patient was initially treated in a general surgery unit an an inpatient or as an outpatient. These patients were sent to us for non-healing wounds or for deepening of the burn areas. The average extent of the burn was 7.9%. 8 out of 9 patients had 3rd degree burns, 4 patients required therapy in the intensive care unit anti the following course of therapy was fatal. In 19% of the cases, the delay was caused by h-ealment by a primary care doctor. Average size of these burns wan 1.4% and all areas were 2nd or 3rd degree. None of the patients required treatment in the intensive care and mortality was zero.
Based on the data outlined above, we would like to comment that we treated patients with more serious burns immediately after burn injury. The overall status in more than 2/3 of the patients, as well as extent of their injuries, required therapy in the intensive care unit. In this context, the higher mortality of these patients corresponds to these facts, as is obvious from Table 1.
<% immagine "Table 1","../images/gr0000042.jpg","Relationship, between immediate and delayed specialized treatment",230 %>Correlation between the extent of burn injury, incidence of 3rd degree burns, and mortality. We have divided patients into four groups A. B, C, D according to the extent of their burn injury and depth of 3rd degree burns. The largest group was B: patients with 10% - 30% of body surface burns or patients with 3rd degree burns of up to 10% of the body surface. When we closely examine mortality of patients in the individual groups. we can see a significant increase of mortality between group B and C. In the D group, the mortality is 100%
Mortality sharply increased with tire extent of burn injury greater than 30% of the body surface or 3rd degree burn Injury of more than 10% of the body surface. 10(190 mortality was noted in patients with burn injury more than 50% of the body surface or with 3rd degree injury on more than 30% of the body surface (Table 2).
<% immagine "Table 2","../images/gr0000043.jpg","Relation between TBSA -FTSL and mortality",230 %>Secondary disease. Most of hospitalized senior citizens (97%) had an additional secondary disease. 67% of patients had more than one secondary disease. Most commonly. the patients suffered cardiovascular diseases (79%), diabetes mellitus (27%). followed by lower incidence of respiratory diseases (19%), and renal diseases (7.5%). Cardiovascular disease was again the most common secondary disease in the majority of patients who expired (72%). Respiratory diseases and diabetes with the same incidence of 22% were the second most common secondary diseases of patients who expired. 11% of patients who expired had a renal disease. The majority of expired patients (89%) had a secondary disease, while one third of expired patients (33%) had more than one secondary disease. Only 11% of all patients had no diagnose of a secondary disease.
Therapy results. Complete recovery and home discharge was achieved in 38 patients. 1 patient was transferred to a rehabilitation institute. 6 patients were transferred to a longterm care facility for completion of their treatment or treatment of other diseases. Patients were also transferred to other units (out of 4 patients: one patient was transferred to a coronary intensive care unit after successful resuscitation, 2 patients were transferred prior to complete healing to a medical unit for cardiac stabilization, and one patient was transferred to a dermatology unit with diagnosis of erysipelas).
In summary, 57% of patients were completely healed and discharged. 16% of patients were transferred to a rehabilitation institute and to a long-term care facility. Treatment was successful in 73% of our patients.
In conclusion. it is important to stress that. the treatment plan must be complex, individual, and balanced. The majority of elderly people with burn injury have to be treated for other secondary diseases as well. The secondary disease has an impact on the course of treatment. It increases risks and complications, and it worsens the overall prognosis for the patient, from the point of view of survival as well as quality of life after discharge. Treatment of these patients is demanding for the nursing staff as well as very expensive. In contrast. the result is frequently only a partial therapeutic success, particularly due to a reduced ability of patients to care for themselves, limited possibility for social reintegration and closely associated psycho-organic changes of the patient's personality. However, every success and therapeutic result, 'although partial, must be perceived positively, because it can be fundamental in the patient's life.
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