A Case Report of Deterioration in a Non-frail Octogenarian Burn Patient

While advancements in critical care and burn treatment have improved over the decades, elderly burn victims continue to face high mortality rates. Measurements of frailty among patients have become popular tools for predicting burn outcomes over chronological age. In this report, we provide a case of a non-frail octogenarian burn victim who deteriorated rapidly during treatment, suggesting that frailty alone is not sufficient in predicting outcomes in older burn patients. An active 86-year-old male with hypertension presented to the emergency department with 35% total body surface area (TBSA) burns following a welding accident. He experienced second and third degree burns to his face, thorax, chest, back, and arms and had possible inhalation injury. Despite wound cleaning and fluid resuscitation, the patient's vitals and pain worsened while waiting for transfer to the burn unit, requiring an oxygen mask and intravenous hydromorphone to be administered multiple times. In the emergency department (ED), the patient also experienced myoglobinuria, decreased urine output, and progressive confusion. Frailty involves understanding how patient comorbidities and functional status influence the body's ability to respond to stressors. Unlike their younger counterparts, octogenarian patients appear to be vulnerable to worse burn outcomes even when non-frail. Thus, physicians should consider injury severity and systemic responses to injury on admission in addition to an elderly patient's pre-burn physiology to guide prognosis and treatment.