Burns in the elderly: a nationwide study on management and clinical outcomes

Harold Goei; Margriet E van Baar; Jan Dokter; J Vloemans; Gerard I J M Beerthuizen; Esther Middelkoop; Kees H van der Vlies; the Dutch Burn Repository group

doi:10.1093/burnst/tkaa027

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Burns in the elderly: a nationwide study on management and clinical outcomes

更新时间：2022-06-09

- Burns in the elderly: a nationwide study on management and clinical outcomes
- Burns & Trauma Vol. 8, Issue 1, (2020)
- 作者机构：
  
  1. Association of Dutch Burn Centres, Burn Centre, Maasstad Hospital
  2. Department of Plastic
  3. VU University Medical Centre
  4. Burn Centre Maasstad Hospital
  5. Burn Centre Red Cross Hospital, Beverwijk
  6. Burn Centre, Martini Hospital
  7. Association of Dutch Burn Centres, Burn Centre Red Cross Hospital, Beverwijk
  8. Department of Public Health, Erasmus Medical Centre
- 作者简介：
- 基金信息：
- DOI：10.1093/burnst/tkaa027
  CLC：
- Published：2020，
  
  Published Online：22 October 2020，
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Harold Goei, Margriet E van Baar, Jan Dokter, J Vloemans, Gerard I J M Beerthuizen, Esther Middelkoop, Kees H van der Vlies, the Dutch Burn Repository group, Burns in the elderly: a nationwide study on management and clinical outcomes, Burns & Trauma, Volume 8, 2020, tkaa027, https://doi.org/10.1093/burnst/tkaa027
DOI：

Harold Goei, Margriet E van Baar, Jan Dokter, J Vloemans, Gerard I J M Beerthuizen, Esther Middelkoop, Kees H van der Vlies, the Dutch Burn Repository group, Burns in the elderly: a nationwide study on management and clinical outcomes, Burns & Trauma, Volume 8, 2020, tkaa027, https://doi.org/10.1093/burnst/tkaa027 DOI：

摘要

Abstract

BackgroundIn modern-day burn care

advanced age remains an important predictor for mortality among burn victims. In this study

we compared the complete treatment trajectory (including pre-hospital and surgical treatment) and the outcomes between an elderly burn population and a younger adult burn population.MethodsIn this nationwide study

data from the Dutch Burn Repository were used. This is a uniform national registration for Dutch specialized burn care. All adult patients that were admitted to one of the three Dutch burn centres from the period 2009 to 2015 were included in the analysis. Burn patients were considered as elderly when ≥65 years of age

and were then further subdivided into three age categories: 65–74

75–85 and 85+ years. Younger adults in the age category 18–64 years were used as the reference group.Surgical management was studied comprehensively and included timing of surgery

the number of procedures and details on the surgical technique

especially the technique used for debridement and the grafting technique that was applied.For the comparison of clinical outcome

the following parameters were included: mortality

wound infections

length of stay/TBSA (total body surface area) burned

discharge disposition and secondary reconstructions.ResultsDuring the study period

3155 adult patients were included (elderly

n = 505). Burn severity

reflected by the median TBSA

varied between 3.2–4.0% and was comparable

but aetiology and pre-hospital care were different between elderly and the younger adult reference group.Surgical treatment was initiated significantly faster in elderly burn patients (p < 0.001). Less selective techniques for surgical debridement were used in the elderly burns patients (hydrosurgery

42.0% vs 23.5–22.6%)

and on the other hand more avulsion (5.3% vs 7.3–17.6%) and primary wound closure (6.7% vs 24.5%). The most frequently used grafting technique was meshed skin grafts (79.2–88.6%); this was not related to age.Mortality increased rapidly with a higher age and showed a high peak in the 85+ category (23.8%). Furthermore

considerable differences were found in hospital discharge disposition between the elderly and the reference group.ConclusionsIn conclusion

elderly burn patients who require specialized burn care are vulnerable and medically challenging. Differences in aetiology

comorbidity

physiology and the management prior to admission possibly affect the initial surgical management and result in significantly worse outcomes in elderly. Elderly patients need optimal

timely and specialized burn care to enhance survival after burn injuries.

关键词

Keywords

BurnsNationwide studyElderlySurgical managementClinical outcomes

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