The Aging Male
ISSN: 1368-5538 (Print) 1473-0790 (Online) Journal homepage: http://www.tandfonline.com/loi/itam20
Outcomes of elderly burn patients requiring hospitalization Muhammed Eren Simsek, G. Yeşim Özgenel, Ramazan Kahveci, Selçuk Akın, Serhat Özbek & Fatih Tufan To cite this article: Muhammed Eren Simsek, G. Yeşim Özgenel, Ramazan Kahveci, Selçuk Akın, Serhat Özbek & Fatih Tufan (2015) Outcomes of elderly burn patients requiring hospitalization, The Aging Male, 18:2, 97-99, DOI: 10.3109/13685538.2014.920317 To link to this article: http://dx.doi.org/10.3109/13685538.2014.920317
Published online: 20 May 2014.
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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=itam20 Download by: [University of Pennsylvania]
Date: 05 November 2015, At: 15:28
http://informahealthcare.com/tam ISSN: 1368-5538 (print), 1473-0790 (electronic) Aging Male, 2015; 18(2): 97–99 ! 2014 Informa UK Ltd. DOI: 10.3109/13685538.2014.920317
ORIGINAL ARTICLE
Outcomes of elderly burn patients requiring hospitalization Muhammed Eren Simsek1, G. Ye¸sim O¨zgenel2, Ramazan Kahveci2, Selc¸uk Akın2, Serhat O¨zbek2, and Fatih Tufan3 Plastic, Reconstructive and Aesthetic Surgery Department, Bursa C¸ekirge State Hospital, Bursa, Turkey, 2Plastic, Reconstructive and Aesthetic Surgery Department, School of Medicine, Uludag University, Bursa, Turkey, and 3Geriatrics Unit, ¸Sevket Yılmaz Training and Research Hospital, Bursa, Turkey
Downloaded by [University of Pennsylvania] at 15:28 05 November 2015
1
Abstract
Keywords
Background: The elderly population is more likely to be affected by accidents, such as burns, compared to younger populations because of their diminished host defense. There is limited data about the outcomes of elderly burn patients requiring hospitalization. Methods: In this retrospective study, we assessed the epidemiology and outcomes of burn injuries in elderly patients (460 years old) admitted to a burn unit of a tertiary medical center based on patient characteristics, type and extent of burns, treatment, hospital stay and mortality rates. Results: Forty-eight elderly burn patients among 870 burn patients during the study period were evaluated. Fire was the most common cause of burns (77.1%). Most of the burns involved more than 20% of total body surface area. Twenty-six (54.2%) patients died during hospitalization. Although burn surface area slightly and non-significantly increased in patients over 75 years, there was a significantly increased mortality rate in these patients. Multivariate linear regression analysis revealed burn area and age as independent associates of mortality. Conclusion: Our data show a high mortality rate in elderly burn patients. Extensive burns and increased age seem to increase the mortality risk.
Burn, elderly patients, hospitalization, mortality
Introduction Along with the global aging, the older population in Turkey is expanding. Older people are vulnerable to aggressive burns because of skin atrophy, comorbidities, diminished host defense mechanisms and reduced mobility. Older people are more prone to complications of burns, and they have longer hospital stays and higher mortality rates [1–4]. Worldwide epidemiological research has revealed results and conclusions that reflect unique issues for each country related to burns in the older people [1–16]. However, there is a lacking data about the consequences of burns in older people in Turkey. This retrospective study investigated burn patients older than 60 years who were admitted to Uludag University Burn Unit during a period of 14 years. The aim of this study was to assess the epidemiology and outcomes of burn injuries involving the older population.
Methods In this retrospective study, we manually explored the files of all burn patients who required hospitalization. Of the 870
Address for correspondence: Muhammed Eren S ¸ im¸sek, Plastic, Reconstructive and Aesthetic Surgery Department, Bursa C¸ekirge State Hospital, Bursa, Turkey. Tel: +90 532 6757520. E-mail: drerens@ yahoo.com
History Received 5 April 2014 Accepted 29 April 2014 Published online 20 May 2014
burn patients who were treated in our unit between 1997 (the year in which the burn unit was established) and 2011, 48 (5.5%) were above 60 years old and were included in this study. The study was conducted according to the principles of the Declaration of Helsinki. The policy at our burn unit is to admit any burned patient older than 60 years who meets any of the American burn association major burn injury criteria: (1) 410% total body surface area (TBSA) burned. (2) Localized deep burn affecting 5% TBSA. (3) Facial burn. (4) Suspected inhalation injury. (5) Hands, feet or perineum burns. (6) Chemical or electrical burns. (7) Associated fracture or chronic illness. All patients received first aid in the reception room of the emergency unit. There, intravenous access was established, the respiratory airway was cleared and endotracheal intubation was performed, if necessary. The burn patient was then transferred to the burn unit. The burned area was dressed using 1% silver sulfadiazine. Each elderly patient was evaluated on an individual basis, and excision/grafting was not performed in situations where a previous chronic illness was identified, such as severe, uncontrolled diabetes mellitus or aggravated cardiovascular diseases. The parameters investigated in this study were patient characteristics,
98
M. E. Simsek et al.
type and extent of burns, treatment, hospital stay and mortality rates. Statistical analysis Statistical analyses were performed using SPSS version 13 for Windows (SPSS Inc. Chicago, IL)’. Categorical variables are presented as counts and percentages. Continuous data are presented with mean ± standard deviations. Categorical variables are compared using chi-square test and continuous variables are compared using Student’s t-test. Gender, age, TBSA and burn type were included in linear regression analysis to define independent associates of mortality.
Downloaded by [University of Pennsylvania] at 15:28 05 November 2015
Results Of the 48 elderly patients, 27 were men and 21 were women with a mean age of 73.3 ± 9.9 years (range, 60–100 years). The corresponding mean ages of females and males were 74.8 ± 9.3 and 72.2 ± 10.4 years, respectively. Twenty-four (50%) of the patients, 12 (44.4%) males and 12 (57.1%) females were of 75 years old. The incidence of burns was higher during the cold months, with 37.5% (18 patients) of all burns occurring during the winter (December–February) and 29.1% (14 patients) occurring during the autumn months. Twenty-two patients (45.8%) lived in urban areas and 26 (54.2%) were from low income families. The home was the most common location where burns occurred. Figure 1 illustrates the percentage of the different types of burns. Fire was the most common factor involved in the majority of these cases. Six patients (12.5%) suffered from scalding. Hot water was the liquid involved in the majority of these cases. Three patients (6.3%) suffered electrical burns. Two of the admitted patients had inhalation injuries in addition to fire burns. Also two patients suffered from chemical burn and one patient suffered from steam burn. Eight patients (16.6%) sustained burns involving less than
Aging Male, 2015; 18(2): 97–99
10% TBSA; 14 (29.1%) sustained burns of 10–20% TBSA; 12 (25%) sustained burns of 20–40% TBSA; and 14 (29.1%) sustained burns of greater than 40% TBSA. Twenty-four (50%) of the 48 admitted patients were treated with excision and grafting during their second week at the hospital. Eleven (22.9%) patients underwent fasciotomy and escharotomy. The remainder of the group was treated with medical therapy and supportive measures. The average hospital stay for the 48 admitted cases was 14.5 days, and the range was 1–74 days. The mean hospital stay for the exitus group was 11.1 days, and for the survivor group it was 23.71 days (p ¼ 0.006). Mortality and morbidity Twenty-six (54.2%) of the 48 elderly burn patients died during the hospitalization. The mean age of the patients who died was 78.2 ± 9.4 years and the mean age of survivors was 67.5 ± 7.5 years (p50.001). Fire burns tended to cause more deaths than scalding burns (25 patients (67.6%) versus one patient (20%), p ¼ 0.06). Fourteen (53.8%) of the deceased patients had sustained burns of 40% TBSA; seven (26.9%) had received burns of 20–40% TBSA; and five (19%) had received burns to 10–20% TBSA. The mean TBSA was 44% in the patients who died and 14% in survivors. The mortality rate in patients with burns 40% TBSA was 100%, while it was 33.3% in patients with burns less than 40% of TBSA (p50.001). Although burns 440% TBSA was not significantly increased in patients 75 years old (37.5 vs. 25% in patients 75 years and 575 years old respectively, p ¼ 0.35), patients 75 years old had increased mortality rate compared to younger patients (79.2 versus 29.2%, p ¼ 0.001). Figure 2 depicts the relationship between mortality and the TBSA burned in the hospitalized patients. Linear regression analysis revealed TBSA (t ¼ 5.3, 95% confidence interval 0.008–0.018, p50.001) and age (t ¼ 3.4, 95% confidence interval 0.008–0.03, p ¼ 0.002) as independent associates of mortality.
Discussion In this study, we found a rather high frequency of mortality in elderly burn patients requiring hospitalization. The most frequent cause was fire burns and occurred in winter and
Figure 1. Percentages of burn types.
Figure 2. Mortality and TBSA.
Outcomes of elderly burn patients
Downloaded by [University of Pennsylvania] at 15:28 05 November 2015
DOI: 10.3109/13685538.2014.920317
autumn. Although older age was not significantly associated with more extensive burns, increased age seemed to independently increase the mortality risk. Furthermore, extensive burns were significantly associated with an increased mortality risk. Burn accidents cause relatively more morbidity and mortality in the elderly population because age has an effect on the types of burns and the efficacy of clinical treatment. In this study, the elderly group was defined as individuals over 60 years old because of the shorter average life expectancy in Turkey relative to European countries. The mean age of exitus group was 78.2 in our study. Recent data demonstrate that mortality rates rise with increasing age [5–10]. Our data suggest that although the burn surface area tends to increase with increasing age, there is a significantly higher mortality rate in patients over 75 years. In line with the results of other studies [6,8], we did not observe any gender effects in burn victims despite the higher age of female patients in our study. In Turkey, individuals who live in rural regions use stoves for heating, and in those areas, the water supply systems are insufficient and kerosene stoves are used to heat water for bathing; thus, burn accidents are higher during the autumn and winter months. Moreover, the etiology associated with this parameter and the most common etiologic factor is fire. However, the effect of etiologic factors on mortality rates could not be estimated because of fewer incidences of other etiologic factors in this study including scalding, electrical burns and chemical injury. In our study, all of the patients who underwent escharotomy and fasciotomy died possibly because these individuals had more extensive burns. When the patient could move directly to the second surgical stage, which consists of debridement and split thickness skin graft operation, mortality rates decreased as it is previously reported [7,17–20]. Our mortality rate of 54.2% is relatively higher compared to other studies [5,8,21]. This result may be associated with the inclusion criteria of this study. According to the hospitalization data, extensive burns and major injuries were chosen. The limitations of our study include the retrospective design, small sample size and absence of a control group.
Conclusions Burn injuries in the elderly patients are associated with high mortality rates. To prevent burns in the geriatric population, the number of public education programs and their effectiveness should be expanded.
99
Declaration of interest The authors report no declarations of interest.
References 1. Peleg K, Liran A, Tessone A, et al. Do burns increase the severity of terror injuries? J Burn Care Res 2008;29:887–92. 2. Maguire S, Moynihan S, Mann M, et al. A systematic review of the features that indicate intentional scalds in children. Burns 2008;34: 1072–81. 3. Thombs BD. Patient and injury characteristics, mortality risk, and length of stay related to child abuse by burning: evidence from a national sample of 15,802 pediatric admissions. Ann Surg 2008; 247:519–23. 4. Mashreky SR, Rahman A, Chowdhury SM, et al. Epidemiology of childhood burn: yield of largest community based injury survey in Bangladesh. Burns 2008;34:856–62. 5. Bloemsma GC, Dokter J, Boxma H, Oen IM. Mortality and causes of death in a burn centre. Burns 2008;34:1103–7. 6. McGwin Jr G, George RL, Cross JM, Rue LW. Improving the ability to predict mortality among burn patients. Burns 2008;34: 320–7. 7. Gomez M, Cartotto R, Knighton J, et al. Improved survival following thermal injury in adult patients treated at a regional burn center. J Burn Care Res 2008;29:130–7. 8. Lumenta DB, Hautier A, Desouches C, et al. Mortality and morbidity among elderly people with burns – evaluation of data on admission. Burns 2008;34:965–74. 9. Mahar P, Wasiak J, Bailey M, Cleland H. Clinical factors affecting mortality in elderly burn patients admitted to a burns service. Burns 2008;34:629–36. 10. Macrino S, Slater H, Aballay A, et al. A three-decade review of thermal injuries among the elderly at a regional burn centre. Burns 2008;34:509–11. 11. Farrell RT, Gamelli RL, Aleem RF, Sinacore JM. The relationship of body mass index and functional outcomes in patients with acute burns. J Burn Care Res 2008;29:102–8. 12. Jeschke MG, Mlcak RP, Finnerty CC, et al. Gender differences in pediatric burn patients: does it make a difference? Ann Surg 2008; 248:126–36. 13. Thombs BD, Bresnick MG. Mortality risk and length of stay associated with self-inflicted burn injury: evidence from a national sample of 30,382 adult patients. Crit Care Med 2008;36:118–25. 14. Singerman J, Gomez M, Fish JS. Long-term sequelae of lowvoltage electrical injury. J Burn Care Res 2008;29:773–7. 15. Kallinen O, Partanen TA, Maisniemi K, et al. Comparison of premortem clinical diagnosis and autopsy findings in patients with burns. Burns 2008;34:595–602. 16. Murphy AD, Healy C, Purcell E, et al. An assessment of burn care professionals’ attitudes to major burn. Burns 2008;34:512–15. 17. Deitch EA. A policy of early excision and grafting in elderly burn patients shortens the hospital stay and improves survival. Burns Incl Therm Inj 1985;12:109–14. 18. Demarest GB, Osler TM, Clevenger FW. Injuries in the elderly: evaluation and initial response. Geriatrics 1990;45:36–8, 41–2. 19. Housinger T, Saffle J, Ward S, Warden G. Conservative approach to the elderly patient with burns. Am J Surg 1984;148:817–20. 20. Kara M, Peters WJ, Douglas LG, Morris SF. An early surgical approach to burns in the elderly. J Trauma 1990;30:430–2. 21. McGill V, Kowal-Vern A, Gamelli RL. Outcome for older burn patients. Arch Surg 2000;135:320–5.
ISSN: 1368-5538 (Print) 1473-0790 (Online) Journal homepage: http://www.tandfonline.com/loi/itam20
Outcomes of elderly burn patients requiring hospitalization Muhammed Eren Simsek, G. Yeşim Özgenel, Ramazan Kahveci, Selçuk Akın, Serhat Özbek & Fatih Tufan To cite this article: Muhammed Eren Simsek, G. Yeşim Özgenel, Ramazan Kahveci, Selçuk Akın, Serhat Özbek & Fatih Tufan (2015) Outcomes of elderly burn patients requiring hospitalization, The Aging Male, 18:2, 97-99, DOI: 10.3109/13685538.2014.920317 To link to this article: http://dx.doi.org/10.3109/13685538.2014.920317
Published online: 20 May 2014.
Submit your article to this journal
Article views: 25
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=itam20 Download by: [University of Pennsylvania]
Date: 05 November 2015, At: 15:28
http://informahealthcare.com/tam ISSN: 1368-5538 (print), 1473-0790 (electronic) Aging Male, 2015; 18(2): 97–99 ! 2014 Informa UK Ltd. DOI: 10.3109/13685538.2014.920317
ORIGINAL ARTICLE
Outcomes of elderly burn patients requiring hospitalization Muhammed Eren Simsek1, G. Ye¸sim O¨zgenel2, Ramazan Kahveci2, Selc¸uk Akın2, Serhat O¨zbek2, and Fatih Tufan3 Plastic, Reconstructive and Aesthetic Surgery Department, Bursa C¸ekirge State Hospital, Bursa, Turkey, 2Plastic, Reconstructive and Aesthetic Surgery Department, School of Medicine, Uludag University, Bursa, Turkey, and 3Geriatrics Unit, ¸Sevket Yılmaz Training and Research Hospital, Bursa, Turkey
Downloaded by [University of Pennsylvania] at 15:28 05 November 2015
1
Abstract
Keywords
Background: The elderly population is more likely to be affected by accidents, such as burns, compared to younger populations because of their diminished host defense. There is limited data about the outcomes of elderly burn patients requiring hospitalization. Methods: In this retrospective study, we assessed the epidemiology and outcomes of burn injuries in elderly patients (460 years old) admitted to a burn unit of a tertiary medical center based on patient characteristics, type and extent of burns, treatment, hospital stay and mortality rates. Results: Forty-eight elderly burn patients among 870 burn patients during the study period were evaluated. Fire was the most common cause of burns (77.1%). Most of the burns involved more than 20% of total body surface area. Twenty-six (54.2%) patients died during hospitalization. Although burn surface area slightly and non-significantly increased in patients over 75 years, there was a significantly increased mortality rate in these patients. Multivariate linear regression analysis revealed burn area and age as independent associates of mortality. Conclusion: Our data show a high mortality rate in elderly burn patients. Extensive burns and increased age seem to increase the mortality risk.
Burn, elderly patients, hospitalization, mortality
Introduction Along with the global aging, the older population in Turkey is expanding. Older people are vulnerable to aggressive burns because of skin atrophy, comorbidities, diminished host defense mechanisms and reduced mobility. Older people are more prone to complications of burns, and they have longer hospital stays and higher mortality rates [1–4]. Worldwide epidemiological research has revealed results and conclusions that reflect unique issues for each country related to burns in the older people [1–16]. However, there is a lacking data about the consequences of burns in older people in Turkey. This retrospective study investigated burn patients older than 60 years who were admitted to Uludag University Burn Unit during a period of 14 years. The aim of this study was to assess the epidemiology and outcomes of burn injuries involving the older population.
Methods In this retrospective study, we manually explored the files of all burn patients who required hospitalization. Of the 870
Address for correspondence: Muhammed Eren S ¸ im¸sek, Plastic, Reconstructive and Aesthetic Surgery Department, Bursa C¸ekirge State Hospital, Bursa, Turkey. Tel: +90 532 6757520. E-mail: drerens@ yahoo.com
History Received 5 April 2014 Accepted 29 April 2014 Published online 20 May 2014
burn patients who were treated in our unit between 1997 (the year in which the burn unit was established) and 2011, 48 (5.5%) were above 60 years old and were included in this study. The study was conducted according to the principles of the Declaration of Helsinki. The policy at our burn unit is to admit any burned patient older than 60 years who meets any of the American burn association major burn injury criteria: (1) 410% total body surface area (TBSA) burned. (2) Localized deep burn affecting 5% TBSA. (3) Facial burn. (4) Suspected inhalation injury. (5) Hands, feet or perineum burns. (6) Chemical or electrical burns. (7) Associated fracture or chronic illness. All patients received first aid in the reception room of the emergency unit. There, intravenous access was established, the respiratory airway was cleared and endotracheal intubation was performed, if necessary. The burn patient was then transferred to the burn unit. The burned area was dressed using 1% silver sulfadiazine. Each elderly patient was evaluated on an individual basis, and excision/grafting was not performed in situations where a previous chronic illness was identified, such as severe, uncontrolled diabetes mellitus or aggravated cardiovascular diseases. The parameters investigated in this study were patient characteristics,
98
M. E. Simsek et al.
type and extent of burns, treatment, hospital stay and mortality rates. Statistical analysis Statistical analyses were performed using SPSS version 13 for Windows (SPSS Inc. Chicago, IL)’. Categorical variables are presented as counts and percentages. Continuous data are presented with mean ± standard deviations. Categorical variables are compared using chi-square test and continuous variables are compared using Student’s t-test. Gender, age, TBSA and burn type were included in linear regression analysis to define independent associates of mortality.
Downloaded by [University of Pennsylvania] at 15:28 05 November 2015
Results Of the 48 elderly patients, 27 were men and 21 were women with a mean age of 73.3 ± 9.9 years (range, 60–100 years). The corresponding mean ages of females and males were 74.8 ± 9.3 and 72.2 ± 10.4 years, respectively. Twenty-four (50%) of the patients, 12 (44.4%) males and 12 (57.1%) females were of 75 years old. The incidence of burns was higher during the cold months, with 37.5% (18 patients) of all burns occurring during the winter (December–February) and 29.1% (14 patients) occurring during the autumn months. Twenty-two patients (45.8%) lived in urban areas and 26 (54.2%) were from low income families. The home was the most common location where burns occurred. Figure 1 illustrates the percentage of the different types of burns. Fire was the most common factor involved in the majority of these cases. Six patients (12.5%) suffered from scalding. Hot water was the liquid involved in the majority of these cases. Three patients (6.3%) suffered electrical burns. Two of the admitted patients had inhalation injuries in addition to fire burns. Also two patients suffered from chemical burn and one patient suffered from steam burn. Eight patients (16.6%) sustained burns involving less than
Aging Male, 2015; 18(2): 97–99
10% TBSA; 14 (29.1%) sustained burns of 10–20% TBSA; 12 (25%) sustained burns of 20–40% TBSA; and 14 (29.1%) sustained burns of greater than 40% TBSA. Twenty-four (50%) of the 48 admitted patients were treated with excision and grafting during their second week at the hospital. Eleven (22.9%) patients underwent fasciotomy and escharotomy. The remainder of the group was treated with medical therapy and supportive measures. The average hospital stay for the 48 admitted cases was 14.5 days, and the range was 1–74 days. The mean hospital stay for the exitus group was 11.1 days, and for the survivor group it was 23.71 days (p ¼ 0.006). Mortality and morbidity Twenty-six (54.2%) of the 48 elderly burn patients died during the hospitalization. The mean age of the patients who died was 78.2 ± 9.4 years and the mean age of survivors was 67.5 ± 7.5 years (p50.001). Fire burns tended to cause more deaths than scalding burns (25 patients (67.6%) versus one patient (20%), p ¼ 0.06). Fourteen (53.8%) of the deceased patients had sustained burns of 40% TBSA; seven (26.9%) had received burns of 20–40% TBSA; and five (19%) had received burns to 10–20% TBSA. The mean TBSA was 44% in the patients who died and 14% in survivors. The mortality rate in patients with burns 40% TBSA was 100%, while it was 33.3% in patients with burns less than 40% of TBSA (p50.001). Although burns 440% TBSA was not significantly increased in patients 75 years old (37.5 vs. 25% in patients 75 years and 575 years old respectively, p ¼ 0.35), patients 75 years old had increased mortality rate compared to younger patients (79.2 versus 29.2%, p ¼ 0.001). Figure 2 depicts the relationship between mortality and the TBSA burned in the hospitalized patients. Linear regression analysis revealed TBSA (t ¼ 5.3, 95% confidence interval 0.008–0.018, p50.001) and age (t ¼ 3.4, 95% confidence interval 0.008–0.03, p ¼ 0.002) as independent associates of mortality.
Discussion In this study, we found a rather high frequency of mortality in elderly burn patients requiring hospitalization. The most frequent cause was fire burns and occurred in winter and
Figure 1. Percentages of burn types.
Figure 2. Mortality and TBSA.
Outcomes of elderly burn patients
Downloaded by [University of Pennsylvania] at 15:28 05 November 2015
DOI: 10.3109/13685538.2014.920317
autumn. Although older age was not significantly associated with more extensive burns, increased age seemed to independently increase the mortality risk. Furthermore, extensive burns were significantly associated with an increased mortality risk. Burn accidents cause relatively more morbidity and mortality in the elderly population because age has an effect on the types of burns and the efficacy of clinical treatment. In this study, the elderly group was defined as individuals over 60 years old because of the shorter average life expectancy in Turkey relative to European countries. The mean age of exitus group was 78.2 in our study. Recent data demonstrate that mortality rates rise with increasing age [5–10]. Our data suggest that although the burn surface area tends to increase with increasing age, there is a significantly higher mortality rate in patients over 75 years. In line with the results of other studies [6,8], we did not observe any gender effects in burn victims despite the higher age of female patients in our study. In Turkey, individuals who live in rural regions use stoves for heating, and in those areas, the water supply systems are insufficient and kerosene stoves are used to heat water for bathing; thus, burn accidents are higher during the autumn and winter months. Moreover, the etiology associated with this parameter and the most common etiologic factor is fire. However, the effect of etiologic factors on mortality rates could not be estimated because of fewer incidences of other etiologic factors in this study including scalding, electrical burns and chemical injury. In our study, all of the patients who underwent escharotomy and fasciotomy died possibly because these individuals had more extensive burns. When the patient could move directly to the second surgical stage, which consists of debridement and split thickness skin graft operation, mortality rates decreased as it is previously reported [7,17–20]. Our mortality rate of 54.2% is relatively higher compared to other studies [5,8,21]. This result may be associated with the inclusion criteria of this study. According to the hospitalization data, extensive burns and major injuries were chosen. The limitations of our study include the retrospective design, small sample size and absence of a control group.
Conclusions Burn injuries in the elderly patients are associated with high mortality rates. To prevent burns in the geriatric population, the number of public education programs and their effectiveness should be expanded.
99
Declaration of interest The authors report no declarations of interest.
References 1. Peleg K, Liran A, Tessone A, et al. Do burns increase the severity of terror injuries? J Burn Care Res 2008;29:887–92. 2. Maguire S, Moynihan S, Mann M, et al. A systematic review of the features that indicate intentional scalds in children. Burns 2008;34: 1072–81. 3. Thombs BD. Patient and injury characteristics, mortality risk, and length of stay related to child abuse by burning: evidence from a national sample of 15,802 pediatric admissions. Ann Surg 2008; 247:519–23. 4. Mashreky SR, Rahman A, Chowdhury SM, et al. Epidemiology of childhood burn: yield of largest community based injury survey in Bangladesh. Burns 2008;34:856–62. 5. Bloemsma GC, Dokter J, Boxma H, Oen IM. Mortality and causes of death in a burn centre. Burns 2008;34:1103–7. 6. McGwin Jr G, George RL, Cross JM, Rue LW. Improving the ability to predict mortality among burn patients. Burns 2008;34: 320–7. 7. Gomez M, Cartotto R, Knighton J, et al. Improved survival following thermal injury in adult patients treated at a regional burn center. J Burn Care Res 2008;29:130–7. 8. Lumenta DB, Hautier A, Desouches C, et al. Mortality and morbidity among elderly people with burns – evaluation of data on admission. Burns 2008;34:965–74. 9. Mahar P, Wasiak J, Bailey M, Cleland H. Clinical factors affecting mortality in elderly burn patients admitted to a burns service. Burns 2008;34:629–36. 10. Macrino S, Slater H, Aballay A, et al. A three-decade review of thermal injuries among the elderly at a regional burn centre. Burns 2008;34:509–11. 11. Farrell RT, Gamelli RL, Aleem RF, Sinacore JM. The relationship of body mass index and functional outcomes in patients with acute burns. J Burn Care Res 2008;29:102–8. 12. Jeschke MG, Mlcak RP, Finnerty CC, et al. Gender differences in pediatric burn patients: does it make a difference? Ann Surg 2008; 248:126–36. 13. Thombs BD, Bresnick MG. Mortality risk and length of stay associated with self-inflicted burn injury: evidence from a national sample of 30,382 adult patients. Crit Care Med 2008;36:118–25. 14. Singerman J, Gomez M, Fish JS. Long-term sequelae of lowvoltage electrical injury. J Burn Care Res 2008;29:773–7. 15. Kallinen O, Partanen TA, Maisniemi K, et al. Comparison of premortem clinical diagnosis and autopsy findings in patients with burns. Burns 2008;34:595–602. 16. Murphy AD, Healy C, Purcell E, et al. An assessment of burn care professionals’ attitudes to major burn. Burns 2008;34:512–15. 17. Deitch EA. A policy of early excision and grafting in elderly burn patients shortens the hospital stay and improves survival. Burns Incl Therm Inj 1985;12:109–14. 18. Demarest GB, Osler TM, Clevenger FW. Injuries in the elderly: evaluation and initial response. Geriatrics 1990;45:36–8, 41–2. 19. Housinger T, Saffle J, Ward S, Warden G. Conservative approach to the elderly patient with burns. Am J Surg 1984;148:817–20. 20. Kara M, Peters WJ, Douglas LG, Morris SF. An early surgical approach to burns in the elderly. J Trauma 1990;30:430–2. 21. McGill V, Kowal-Vern A, Gamelli RL. Outcome for older burn patients. Arch Surg 2000;135:320–5.
