Predictors of Mortality and Outcomes in Older Adult Burn Patient Subgroups: A Comparative Meta-analysis of Age, Burn Severity, and Intervention Strategies

Older adult burn patients experience disproportionately high morbidity and mortality due to age-related physiological decline and comorbidities. Understanding predictors of mortality is essential for risk stratification and improving outcomes. This meta-analysis evaluates mortality predictors and clinical outcomes among older adult burn patients, stratified into a younger cohort (60-79 y) and an older cohort (80+ y).

A systematic search of PubMed, Scopus, and Web of Science was conducted on February 2, 2024. Meta-analyses were performed using R (version 4.4.1) with random-effects models. Relative risks (RRs) with 95% confidence intervals (CIs) were calculated. Risk of bias was assessed using the Newcastle-Ottawa Scale, and certainty of evidence was evaluated using GRADE.

Fifty-eight studies comprising 37,732 older adult burn patients were included. Patients aged 60-79 had significantly lower intensive care unit admission risk (RR: 0.75, 95% CI: 0.63-0.88) and lower mortality (RR: 0.65, 95% CI: 0.58-0.73) compared with those aged 80 or older. Total burn surface area (TBSA) strongly predicted mortality: TBSA 1%-9% versus 10%-19% (RR: 0.31, 95% CI: 0.21-0.44) and 10%-19% versus ≥20% (RR: 0.17, 95% CI: 0.11-0.27). Flame burns significantly increased mortality compared with scald burns (RR: 3.98, 95% CI: 2.68-5.91). Inhalation injury (RR: 2.95) and intubation (RR: 5.66) further elevated mortality risk. Grafting reduced mortality compared with conservative management (RR: 0.67, 95% CI: 0.54-0.82).

Age 80 years or older, larger TBSA, flame burns, inhalation injury, and intubation substantially increase mortality in older adult burn patients, whereas grafting is associated with improved survival. These findings support age-specific risk stratification and tailored management strategies to optimize outcomes.