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Järbrink H, Forsberg A, Erhag HF, Lundälv J, Bjerså K, Engström M. Recovering from physical trauma in late life, a struggle to recapture autonomy: A grounded theory study. J Adv Nurs 2023. [PMID: 38130055 DOI: 10.1111/jan.16035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 11/30/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023]
Abstract
AIM The study aimed to explore the experiences of care and recovery among older patients treated for physical trauma. DESIGN A qualitative study with a constructivist grounded theory design. METHODS Fifteen in-depth interviews with older adults recovering from physical trauma were conducted and analysed between 2019 and 2023, in accordance with grounded theory methodology. RESULTS The findings show that for older patients who suffered physical trauma, the core category was the strive to recapture autonomy. This was achieved by means of Adaptation, Reflection and Interactions, which constitute the three main categories. Recovery involves facing and navigating various new life challenges, such as increased dependency on others, managing difficult symptoms and adapting in various ways to everyday life. The recovery process was influenced by fear, hope and the attitude towards new challenges. CONCLUSION Older adults being cared for after a traumatic event have a difficult path to recovery ahead of them. Dealing with increased unwanted dependency on others was a main concern for the participants. Undertreated symptoms can lead to undesired isolation, delayed recovery and further increase unwanted dependency. On the other hand, hope, which was defined as having a positive approach to life and longing for the future, was a strong accelerating factor in the recovery process. IMPACT As a result of this study, we have established that older patients experience the initial period after trauma as difficult and that support in the initial phase can be helpful when returning home. As healthcare services are under increasing pressure because of an ageing population, this study contributes by addressing an understudied population and clarifying their concerns. REPORTING METHOD Reporting adheres to the COREQ (COnsolidated criteria for REporting Qualitative research) Checklist. PATIENT OR PUBLIC CONTRIBUTION No patient or public involvement.
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Affiliation(s)
- Hanna Järbrink
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery Sahlgrenska, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Forsberg
- Institute of Health Sciences, Lund university, Lund, Sweden
- Department of Thoracic Surgery, Skåne University Hospital, Malmö, Sweden
| | - Hanna Falk Erhag
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Ageing and Health (AGECAP) at the University of Gothenburg, Gothenburg, Sweden
| | - Jörgen Lundälv
- Department of Social Work, University of Gothenburg, Gothenburg, Sweden
- Department of Surgical and Perioperative Sciences, Unit of Surgery, Umeå University, Umeå, Sweden
| | - Kristofer Bjerså
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Primary Care, Närhälsan Majorna, Region Västra Götaland, Gothenburg, Sweden
| | - My Engström
- Department of Surgery Sahlgrenska, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Clemens V, Saller MM, Meller R, Neuerburg C, Kammerlander C, Boecker W, Klein M, Pedersen V. Clinical Acuity in the Emergency Department and Injury Severity Determine Hospital Admission of Older Patients with Low Energy Falls: Outcomes from a Prospective Feasibility Study. J Clin Med 2023; 12:jcm12093144. [PMID: 37176584 PMCID: PMC10179013 DOI: 10.3390/jcm12093144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Low energy falls (LEF) in older adults constitute a relevant cause for emergency department (ED) visits, hospital admission and in-hospital mortality. Patient-reported outcome measures containing information about patients' medical, mental and social health problems might support disposition and therapy decisions. We investigated the value of a tablet-based (self-)assessment in predicting hospital admission and in-hospital mortality. METHODS Patients 65 years or older, consecutively presenting with LEF to our level I trauma center ED (from November 2020 to March 2021), were eligible for inclusion in this prospective observational study. The primary endpoint was hospital admission; secondary endpoints were in-hospital mortality and the use of the tablet for self-reported assessment. Multivariate logistic regression models were calculated to measure the association between clinical findings and endpoints. RESULTS Of 618 eligible patients, 201 patients were included. The median age was 82 years (62.7% women). The hospital admission rate was 45.3% (110/201), with an in-hospital mortality rate of 3.6% (4/110). Polypharmacy (odds ratio (OR): 8.48; 95% confidence interval (95%CI) 1.21-59.37, p = 0.03), lower emergency severity index (ESI) scores (OR: 0.33; 95%CI 0.17-0.64, p = 0.001) and increasing injury severity score (ISS) (OR: 1.54; 95%CI 1.32-1.79, p < 0.001) were associated with hospital admission. The Charlson comorbidity index (CCI) was significantly associated with in-hospital mortality (OR: 2.60; 95%CI: 1.17-5.81, p = 0.03). Increasing age (OR: 0.94; 95%CI: 0.89-0.99, p = 0.03) and frailty (OR: 0.71; 95%CI: 0.51-0.99, p = 0.04) were associated with the incapability of tablet use. CONCLUSIONS The severity of fall-related injuries and the clinical acuity are easily accessible, relevant predictors for hospital admission. Tablet-based (self-)assessment may be feasible and acceptable during ED visits and might help facilitate comprehensive geriatric assessments during ED stay.
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Affiliation(s)
- Valentin Clemens
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig Maximilian University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Maximilian M Saller
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig Maximilian University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Rupert Meller
- Department of Orthopedics and Trauma Surgery, Klinikum Dritter Orden, Menzinger Str. 44, 80638 Munich, Germany
| | - Carl Neuerburg
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig Maximilian University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | | | - Wolfgang Boecker
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig Maximilian University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Matthias Klein
- Emergency Department, University Hospital, Ludwig Maximilian University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany
- Department of Neurology, University Hospital, Ludwig Maximilian University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Vera Pedersen
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig Maximilian University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany
- Emergency Department, University Hospital, Ludwig Maximilian University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany
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Krammel M, Drahohs V, Hamp T, Lemoyne S, Grassmann D, Schreiber W, Sulzgruber P, Schnaubelt S. The Epidemiology of Pre-Hospital EMS Treatment of Geriatric Patients in the City of Vienna-An Overview. J Clin Med 2023; 12:jcm12020643. [PMID: 36675572 PMCID: PMC9865411 DOI: 10.3390/jcm12020643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
Background: The city of Vienna, Austria, has a gradually aging population. Elderly people, over 65 years old and living at home or in nursing homes, frequently use Emergency Medical Services (EMS). However, there is no previous data comparing the EMS utilization of elderly- and non-elderly patients in Vienna. Methods: We retrospectively analyzed all EMS incidents in Vienna from 2012 to 2019. Transport- and emergency physician treatment rates, annual fluctuations, and the number of non-transports were compared between elderly (≥65 years) and non-elderly (18−64 years) patients. Results: Elderly people accounted for 42.6% of the total EMS responses in adult patients, representing an annual response rate of 223 per 1000 inhabitants ≥ 65 years. Compared to 76 per 1000 inhabitants in patients 18−64 years old, this results in an incidence rate ratio (IRR) of 2.93 [2.92−2.94]. Elderly people were more likely (OR 1.68 [1.65−1.70]) to need emergency physicians, compared to 18−64 year-olds. Nursing home residents were twice (OR 2.11 [2.06−2.17]) as likely to need emergency physicians than the rest of the study group. Non-transports were more likely to occur in patients over 65 years than in non-elderlies (14% vs. 12%, p < 0.001). Conclusions: The elderly population ≥ 65 years in Vienna shows higher EMS response rates than younger adults. They need emergency physicians more often, especially when residing in nursing homes. The economical and organizational strain this puts on the emergency response system should trigger further research and the development of solutions, such as specific response units dedicated to elderly people.
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Affiliation(s)
- Mario Krammel
- Austrian Cardiac Arrest Awareness Association (PULS), 1090 Vienna, Austria
- Emergency Medical Service, 1030 Vienna, Austria
| | - Valentin Drahohs
- Department of Anaesthesiology and Critical Care Medicine, Hospital St. Poelten, 3100 St. Poelten, Austria
| | - Thomas Hamp
- Emergency Medical Service, 1030 Vienna, Austria
- Department of Anaesthesiology, General Intensive Care Medicine, and Pain Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Sabine Lemoyne
- Department of Emergency Medicine, Antwerp University Hospital, 2650 Edegem, Belgium
| | - Daniel Grassmann
- Austrian Cardiac Arrest Awareness Association (PULS), 1090 Vienna, Austria
- Emergency Medical Service, 1030 Vienna, Austria
| | - Wolfgang Schreiber
- Austrian Cardiac Arrest Awareness Association (PULS), 1090 Vienna, Austria
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Patrick Sulzgruber
- Austrian Cardiac Arrest Awareness Association (PULS), 1090 Vienna, Austria
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria
| | - Sebastian Schnaubelt
- Austrian Cardiac Arrest Awareness Association (PULS), 1090 Vienna, Austria
- Department of Emergency Medicine, Antwerp University Hospital, 2650 Edegem, Belgium
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
- Correspondence:
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Age- and sex-related differences in community-acquired pneumonia at presentation to the emergency department: a retrospective cohort study. Eur J Emerg Med 2022; 29:366-372. [PMID: 35728060 DOI: 10.1097/mej.0000000000000933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND IMPORTANCE Because of its associated high morbidity and mortality, early identification and treatment of community-acquired pneumonia (CAP) are essential. OBJECTIVES To investigate age- and sex-related differences in clinical symptoms, radiologic findings and outcomes in patients presenting to the emergency department (ED) with CAP. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Patients admitted to one Swiss ED with radiologically confirmed CAP between 1 January 2017 and 31 December 2018. OUTCOME MEASURES AND ANALYSIS Primary aim was to evaluate differences in clinical and radiologic presentation of men vs. women and patients >65 years vs. <65 years with CAP. Secondary outcomes were age- and sex-related differences in terms of Pneumonia Severity Index (PSI) risk class, need for ICU referral, mechanical ventilation, in-hospital mortality, 30-day readmission and 180-day pneumonia recurrence. MAIN RESULTS In total 467 patients with CAP were included. 211 were women (45%). 317 were ≥65 years (68%), of which 145 were women (46%). Older patients less commonly reported chest pain (13 vs. 27%; effect size 14%; 95% CI, 0.07-0.23), fever (39 vs. 53%, effect size 14%; 95% CI, 0.05-0.24), chills (6 vs. 20%; effect size 14%; 95% CI, 0.08-0.0.214), cough (44 vs. 57%; effect size 13%; 95% CI, 0.03-0.22), headache (5 vs. 15%, effect size 10%, 95% CI, 0.04-0.17) and myalgias (5 vs. 19%; effect size 14%; 95% CI, 0.07-0.21). However, 85% of patients with no symptoms were ≥65 years. PSI was lower in women [95 (SD 31) vs. 104 (SD 31); 95% CI, -14.44 to 2.35] and sputum was more common in men (32 vs. 22%; effect size 10%; 95% CI, -0.18 to -0.02). Raw mortality was higher in elderly patients [14 vs. 3%; odds ratio (OR), 4.67; 95% CI, 1.81-12.05], whereas it was similar in men and women (11 vs. 10%; OR, 1.22; 95% CI, 0.67-2.23). CONCLUSION Patients, less than 65 years with CAP presenting to the ED had significantly more typical symptoms such as chest pain, fever, chills, cough, headache and myalgias than those being above 65 years. No relevant differences between men and women were found in clinical presentation, except for PSI on admission, and radiologic findings and neither age nor sex was a predictor for mortality in CAP.
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van Dam CS, Labuschagne HA, van Keulen K, Kramers C, Kleipool EE, Hoogendijk EO, Knol W, Nanayakkara PWB, Muller M, Trappenburg MC, Peters MJL. Polypharmacy, comorbidity and frailty: a complex interplay in older patients at the emergency department. Eur Geriatr Med 2022; 13:849-857. [PMID: 35723840 PMCID: PMC9378326 DOI: 10.1007/s41999-022-00664-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/22/2022] [Indexed: 11/30/2022]
Abstract
Aim To investigate the association of polypharmacy with adverse health outcomes, in relation to comorbidity and frailty. Findings Excessive polypharmacy (≥ 10 medications) is highly prevalent in older adults at the emergency department and associated with falls, mortality and readmission. Frailty and comorbidity partly drive the association of polypharmacy with adverse health outcomes. Message Trials that target polypharmacy and inappropriate prescribing are needed to answer the lingering question of causality in the observed polypharmacy–mortality association and to evaluate whether medication review improves health outcomes in older patients at the ED. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-022-00664-y. Purpose Older adults at the emergency department (ED) with polypharmacy, comorbidity, and frailty are at risk of adverse health outcomes. We investigated the association of polypharmacy with adverse health outcomes, in relation to comorbidity and frailty. Methods This is a prospective cohort study in ED patients ≥ 70 years. Non-polypharmacy was defined as 0–4 medications, polypharmacy 5–9 and excessive polypharmacy ≥ 10. Comorbidity was classified by the Charlson comorbidity index (CCI). Frailty was defined by the Identification of Seniors At Risk—Hospitalized Patients (ISAR-HP) score. The primary outcome was 3-month mortality. Secondary outcomes were readmission to an ED/hospital ward and a self-reported fall < 3 months. The association between polypharmacy, comorbidity and frailty was analyzed by logistic regression. Results 881 patients were included. 43% had polypharmacy and 18% had excessive polypharmacy. After 3 months, 9% died, 30% were readmitted, and 21% reported a fall. Compared with non-polypharmacy, the odds ratio (OR) for mortality ranged from 2.62 (95% CI 1.39–4.93) in patients with polypharmacy to 3.92 (95% CI 1.95–7.90) in excessive polypharmacy. The OR weakened after adjustment for comorbidity: 1.80 (95% CI 0.92–3.52) and 2.32 (95% CI 1.10–4.90). After adjusting for frailty, the OR weakened to 2.10 (95% CI 1.10–4.00) and OR 2.40 (95% CI 1.15–5.02). No significant association was found for readmission or self-reported fall. Conclusions Polypharmacy is common in older patients at the ED. Polypharmacy, and especially excessive polypharmacy, is associated with an increased risk of mortality. The observed association is complex given the confounding effect of comorbidity and frailty. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-022-00664-y.
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Affiliation(s)
- Carmen S van Dam
- Department of Internal Medicine and Geriatrics, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands.
| | - Helena A Labuschagne
- Department of Internal Medicine and Geriatrics, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
| | - Kris van Keulen
- Department of Pharmacy, Amstelland Hospital, Amstelveen, the Netherlands
| | - Cornelis Kramers
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Emma E Kleipool
- Department of Internal Medicine and Geriatrics, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
| | - Emiel O Hoogendijk
- Department of Epidemiology and Data Science, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
| | - Wilma Knol
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Prabath W B Nanayakkara
- Section General and Acute Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
| | - Majon Muller
- Department of Internal Medicine and Geriatrics, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
| | - Marijke C Trappenburg
- Department of Internal Medicine and Geriatrics, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands.,Department of Pharmacy, Amstelland Hospital, Amstelveen, the Netherlands
| | - Mike J L Peters
- Department of Internal Medicine and Geriatrics, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands.,Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Colussi G, Perrotta G, Pillinini P, Dibenedetto AG, Da Porto A, Catena C, Sechi LA. Prognostic scores and early management of septic patients in the emergency department of a secondary hospital: results of a retrospective study. BMC Emerg Med 2021; 21:152. [PMID: 34876007 PMCID: PMC8650550 DOI: 10.1186/s12873-021-00547-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/24/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Sequential Organ Failure Assessment (SOFA) and other illness prognostic scores predict adverse outcomes in critical patients. Their validation as a decision-making tool in the emergency department (ED) of secondary hospitals is not well established. The aim of this study was to compare SOFA, NEWS2, APACHE II, and SAPS II scores as predictors of adverse outcomes and decision-making tool in ED. METHODS Data of 121 patients (age 73 ± 10 years, 58% males, Charlson Comorbidity Index 5.7 ± 2.1) with a confirmed sepsis were included in a retrospective study between January 2017 and February 2020. Scores were computed within the first 24 h after admission. Primary outcome was the occurrence of either in-hospital death or mechanical ventilation within 7 days. Secondary outcome was 30-day all-cause mortality. RESULTS Patients older than 64 years (elderly) represent 82% of sample. Primary and secondary outcomes occurred in 40 and 44%, respectively. Median 30-day survival time of dead patients was 4 days (interquartile range 1-11). The best predictive score based on the area under the receiver operating curve (AUROC) was SAPS II (0.823, 95% confidence interval, CI, 0.744-0.902), followed by APACHE II (0.762, 95% CI 0.673-0.850), NEWS2 (0.708, 95% CI 0.616-0.800), and SOFA (0.650, 95% CI 0.548-0.751). SAPS II cut-off of 49 showed the lowest false-positive rate (12, 95% CI 5-20) and the highest positive predictive value (80, 95% CI 68-92), whereas NEWS2 cut-off of 7 showed the lowest false-negative rate (10, 95% CI 2-19) and the highest negative predictive value (86, 95% CI 74-97). By combining NEWS2 and SAPS II cut-offs, we accurately classified 64% of patients. In survival analysis, SAPS II cut-off showed the highest difference in 30-day mortality (Hazards Ratio, HR, 5.24, 95% CI 2.99-9.21, P < 0.001). Best independent negative predictors of 30-day mortality were body temperature, mean arterial pressure, arterial oxygen saturation, and hematocrit levels. Positive predictors were male sex, heart rate and serum sodium concentration. CONCLUSIONS SAPS II is a good prognostic tool for discriminating high-risk patient suitable for sub-intensive/intensive care units, whereas NEWS2 for discriminating low-risk patients for low-intensive units. Our results should be limited to cohorts with a high prevalence of elderly or comorbidities.
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Affiliation(s)
- GianLuca Colussi
- Division of Internal Medicine and Emergency Medicine Residency Program, Department of Medicine, University of Udine, 1st floor, Building n.8, Piazzale Santa Maria della Misericordia 1, 33100, Udine, UD, Italy.
| | - Giacomo Perrotta
- Division of Internal Medicine and Emergency Medicine Residency Program, Department of Medicine, University of Udine, 1st floor, Building n.8, Piazzale Santa Maria della Misericordia 1, 33100, Udine, UD, Italy
| | - Pierpaolo Pillinini
- Emergency Department, San Antonio Abate Hospital, ASUFC, 33028, Tolmezzo, Italy
| | | | - Andrea Da Porto
- Division of Internal Medicine and Emergency Medicine Residency Program, Department of Medicine, University of Udine, 1st floor, Building n.8, Piazzale Santa Maria della Misericordia 1, 33100, Udine, UD, Italy
| | - Cristiana Catena
- Division of Internal Medicine and Emergency Medicine Residency Program, Department of Medicine, University of Udine, 1st floor, Building n.8, Piazzale Santa Maria della Misericordia 1, 33100, Udine, UD, Italy
| | - Leonardo A Sechi
- Division of Internal Medicine and Emergency Medicine Residency Program, Department of Medicine, University of Udine, 1st floor, Building n.8, Piazzale Santa Maria della Misericordia 1, 33100, Udine, UD, Italy
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Sahan M, Yarımoğlu S, Savun M, Erdemoglu O, Degirmenci T. The Influence of Aging on Outcomes in Patients Undergoing Percutaneous Nephrolithotomy for Complete Staghorn Stones: A Retrospective Comparative Study. Cureus 2021; 13:e20001. [PMID: 34984150 PMCID: PMC8715892 DOI: 10.7759/cureus.20001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 11/05/2022] Open
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Secanho MS, Rajesh A, Menezes Neto BF, de Oliveira Maciel ABP, Chequim MM, Rocha C, Palhares Neto AA. Epidemiology of Burn-Related Morbidity and Mortality in Patients Over Eighty Years of Age. J Burn Care Res 2021; 43:1042-1047. [PMID: 34687314 DOI: 10.1093/jbcr/irab205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Burns cause greater morbidity and mortality in older patients owing to the physiological changes and functional status declines with age. We sought to characterize the epidemiology of burn injuries in the patient population aged over eighty years. A retrospective analysis of all patients aged >80 years admitted to a tertiary burn center in Brazil over a 10-year period was conducted. Multiple parameters including comorbidities, body surface area(BSA) burned, intensive care unit(ICU) admissions, inhalation injury and revised Baux score were analyzed to assess association with mortality. 26 patients were identified. The overall mortality rate was 42.3%. The mortality rate increased with the TBSA, with 100% mortality at >20% total BSA involvement(p<0.001). Inhalation injury occurred in 3(11.5%) patients, all of whom suffered mortality(p<0.001). ICU admission was necessary for 14(53.8%) patients, out of which 11(78.6%) did not survive(p<0.001). The revised Baux score had a significant impact on the mortality, with higher values among patients who did not survive(89.2 ± 6.2 versus 110.7 ± 17.9,p < 0.001). Burns cause high mortality in the octogenarian and nonagenarian populations. It is important to stratify patients at high risk, institute prompt treatment and discuss goals of care early on for optimal patient outcomes.
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Affiliation(s)
- Murilo Sagrbi Secanho
- Plastic Surgery Resident at Botucatu Medical School - São Paulo State University (UNESP)Discipline of Plastic Surgery - Department of Surgery and Orthopedic - Botucatu Medical School - São Paulo State University (UNESP)
| | - Aashish Rajesh
- Bachelor of Medicine and Bachelor of Surgery - General Surgery Resident at University of Texas - Department of Surgery - University of Texas Health Science Center at San Antonio
| | - Balduino Ferreira Menezes Neto
- Plastic Surgery Resident at Botucatu Medical School - São Paulo State University (UNESP)Discipline of Plastic Surgery - Department of Surgery and Orthopedic - Botucatu Medical School - São Paulo State University (UNESP)
| | | | | | | | - Aristides Augusto Palhares Neto
- Plastic Surgery at Botucatu Medical School - São Paulo State University (UNESP)Discipline of Plastic Surgery - Department of Surgery and Orthopedic - Botucatu Medical School - São Paulo State University (UNESP)
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