Prognostic indicators in the elderly patient with burns

Elderly patients with burns present unique challenges to the burn team. The present study was designed to evaluate the impact of specific preinjury health conditions, mechanisms of injury, and postinjury complications on their survival. A retrospective review of 252 patients more than 55 years of age evaluated demographic information, premorbid medical conditions, burn characteristics, clinical management, complications, and survival during a 12-year period. For comparison, these individuals were divided into four age groups: I (55 to 65), II (66 to 75), III (76 to 85), and IV (86 to 96). Although burn size did not change with age, patients more than 75 years of age experienced a significantly higher mortality rate (60.1%, groups III, IV vs 33.9%, groups I, II, p < 0.05). Preinjury health problems were observed in more than two thirds of the patients, and when two or more were present, there was a higher incidence of complications (65.4% vs 45.3%, p < 0.05) and death (53.0% vs 33.5%, p < 0.01). The effect of premorbid health problems on outcome was most evident in the youngest age group. Prolonged hospital stays and lower survival rates were observed when more than one complication occurred during hospitalization (1 complication, 60.8% survival; 2 or more, 28.0%, p < 0.001). Older age groups more commonly had infections (IV, 76.2%) and a fatal outcome when systemic sepsis occurred (IV, 100%). The lower respiratory tract was the most common site of infection (24.6%) and carried the highest incidence of sepsis (15.1%) and death (13.1%). Certain predictors of poor outcome have been identified in elderly patients with burns, which will aid our treatment of this patient population and facilitate family counselling.