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Lachs DK, Stern ME, Elman A, Gogia K, Clark S, Mulcare MR, Greenway A, Golden D, Sharma R, Bessey PQ, Rosen T. Geriatric Burn Injuries Presenting to the Emergency Department of a Major Burn Center: Clinical Characteristics and Outcomes. J Emerg Med 2022; 63:143-158. [PMID: 35637048 PMCID: PMC9489596 DOI: 10.1016/j.jemermed.2022.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 01/05/2022] [Accepted: 01/25/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Burn injuries in geriatric patients are common and may have significant associated morbidity and mortality. Most research has focused on the care of hospitalized patients after admission to burn units. Little is known about the clinical characteristics of geriatric burn victims who present to the emergency department (ED) and their ED assessment and management. OBJECTIVE Our aim was to describe the clinical characteristics and outcomes of geriatric patients presenting to the ED with burn injuries. METHODS We performed a comprehensive retrospective chart review on all patients 60 years and older with a burn injury presenting from January 2011 through September 2015 to a large, urban, academic ED in a hospital with a 20-bed burn center. RESULTS A total of 459 patients 60 years and older were treated for burn injuries during the study period. Median age of burn patients was 71 years, 23.7% were 80 years and older, and 56.6% were female. The most common burn types were hot water scalds (43.6%) and flame burns (23.1%). Median burn size was 3% total body surface area (TBSA), 17.1% had burns > 10% TBSA, and 7.8% of patients had inhalation injuries. After initial evaluation, 46.4% of patients were discharged from the ED. Among patients discharged from the ED, only 1.9% were re-admitted for any reason within 30 days. Of the patients intubated in the ED, 7.1% were extubated during the first 2 days of admission, and 64.3% contracted ventilator-associated pneumonia. CONCLUSIONS Better understanding of ED care for geriatric burn injuries may identify areas in which to improve emergency care for these vulnerable patients.
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Affiliation(s)
- David K Lachs
- Department of Emergency Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Michael E Stern
- Department of Emergency Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Kriti Gogia
- Department of Emergency Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Sunday Clark
- Boston Trauma Institute, Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Mary R Mulcare
- Department of Emergency Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Andrew Greenway
- Division of Trauma, Burns, Acute and Critical Care, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Daniel Golden
- Department of Emergency Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Rahul Sharma
- Department of Emergency Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Palmer Q Bessey
- Division of Trauma, Burns, Acute and Critical Care, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York.
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Sen S, Romanowski K, Miotke S, Palmieri T, Greenhalgh D. Burn Prevention in the Elderly: Identifying Age and Gender Differences in Consumer Products Associated With Burn Injuries. J Burn Care Res 2021; 42:14-17. [PMID: 33031521 DOI: 10.1093/jbcr/iraa175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Elderly suffer worse outcomes from burns; thus, it is important to identify the causes of burns in the elderly to develop burn prevention campaigns. We performed a 10-year review of burns that were registered in the NEISS database. We included patients at least 65 years old and analyzed the top five products that caused burn injury. In adults 65 to 74 years old, hot water was the most common cause of burns. Women suffered more burns by candles and cookware. Heaters/heating systems and gasoline were among the top five causes of burns in only men. For the age group 75 to 84 years old, the most common burn was from hot water in women and gasoline in men. For women, the top five included candles, nightwear, and cookware. Only men suffered gasoline burns. The majority of daywear, home/room fire, and ranges/ovens caused burns occurred in men. The majority of burns from hot water, ranges/ovens, electric heating pads, and bathtubs/showers occurred in women. For men, burns from gasoline, structural fires, and heaters are more prevalent. This data can be used to develop age- and gender-specific prevention campaigns to reduce the risk of burn injury.
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Affiliation(s)
- Soman Sen
- Department of Surgery, University of California Davis, Sacramento.,Division of Burn Surgery, Shriners Hospital for Children Northern California, Sacramento
| | - Kathleen Romanowski
- Department of Surgery, University of California Davis, Sacramento.,Division of Burn Surgery, Shriners Hospital for Children Northern California, Sacramento
| | - Sam Miotke
- Department of Surgery, University of California Davis, Sacramento.,Division of Burn Surgery, Shriners Hospital for Children Northern California, Sacramento
| | - Tina Palmieri
- Department of Surgery, University of California Davis, Sacramento.,Division of Burn Surgery, Shriners Hospital for Children Northern California, Sacramento
| | - David Greenhalgh
- Department of Surgery, University of California Davis, Sacramento.,Division of Burn Surgery, Shriners Hospital for Children Northern California, Sacramento
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Clothing Flammability and Burn Injuries: Public Opinion Concerning an Overlooked, Preventable Public Health Problem. J Burn Care Res 2014; 37:e196-204. [PMID: 25501786 DOI: 10.1097/bcr.0000000000000213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of this study was to describe knowledge of clothing flammability risk, public support for clothing flammability warning labels, and stronger regulation to reduce the risk. As part of a national survey of homeowners about residential sprinkler systems, the authors included questions about clothing flammability. The authors used an online web panel to sample homeowners and descriptive methods to analyze the resulting data. The sample included 2333 homeowners. Knowledge of clothing flammability and government oversight of clothing flammability risk was low. Homeowners were evenly split about the effectiveness of current standards; however, when presented with clothing-related burn injury and death data, a majority (53%) supported stricter standards. Most homeowners (64%) supported warning labels and indicated that such labels would either have no effect on their purchasing decisions (64%) or be an incentive (24%) to purchase an item. Owners of sprinkler-equipped homes were more likely to support these interventions than owners of homes without sprinkler systems. Public knowledge about clothing flammability risks is low. Most homeowners supported clothing labels to inform consumers of this risk and increased government intervention to reduce the risk.
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Gaucher S, Grabar S, Fragny D, Lecam B, Stéphanazzi J, Wassermann D. Burns in older people. Epidemiology, surgical management and outcome in a university hospital referral burn unit, 1994–2004. Eur Geriatr Med 2012. [DOI: 10.1016/j.eurger.2011.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ehrlich AR, Kathpalia S, Boyarsky Y, Schechter A, Bijur P. Elderly patients discharged home from the emergency department with minor burns. Burns 2005; 31:717-20. [PMID: 16039785 DOI: 10.1016/j.burns.2004.12.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2004] [Accepted: 12/08/2004] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To describe the risk factors, etiology and referral patterns of elderly patients treated for minor burns in an urban emergency department (ED). METHODS A retrospective chart review was conducted of persons aged 65 years and older who were treated for a minor burn and discharged home from the ED. Medical records were reviewed for 77 burn patients that presented over a 6-year period. RESULTS Burn patients had significant co-morbid medical illness. The etiology of the burns was scalds (58%), contact (27%) and flame (12%). Sixty-eight percent of the burns were cooking related. Heating pads, curling irons or hot pipes accounted for the majority of contact burns. Three percent of burn patients were referred to a home care agency for a home safety evaluation at the time of discharge from the ED. CONCLUSION Cooking-related activities accounted for the majority of minor burns in this series. Common consumer items or environmental hazards were responsible for most contact burns. Elderly patients seen in the ED with minor burns were rarely referred to a home care agency.
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Affiliation(s)
- Amy R Ehrlich
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10467, USA.
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Tan J, Banez C, Cheung Y, Gomez M, Nguyen H, Banfield J, Medeiros L, Lee R, Cartotto R, Fish JS. Effectiveness of a Burn Prevention Campaign for Older Adults. ACTA ACUST UNITED AC 2004; 25:445-51. [PMID: 15353939 DOI: 10.1097/01.bcr.0000138293.18189.25] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Older adults are involved in one fifth of burn injury admissions in the Province of Ontario Canada. Most burn injuries in this population occur at home while cooking, bathing, or smoking. The purpose of this study was to evaluate the effectiveness of an educational campaign to improve burn prevention knowledge in older adults of a major metropolitan city. Changes in participants' burn prevention knowledge were determined using standardized precampaign and postcampaign (4-6 weeks) surveys. Of 209 older adult participants, 126 (60.3%) completed the precampaign and postcampaign surveys. There was a significant increase (P <.05) in burn prevention knowledge postintervention. Age, education level, and living conditions did not influence the change in burn prevention knowledge. This burn prevention campaign for older adults was effective in improving burn prevention knowledge, but it remains unclear as to whether this will ultimately result in a change in burn prevention behavior.
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Affiliation(s)
- Jensen Tan
- University of Toronto, Toronto, Ontario, Canada
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Abstract
With the aim of identifying patterns of burn injury, remediable risk factors, and policies in the overall surgical and medical management a retrospective review of 111 octogenarian burn victims admitted between 1983 and 1993 is presented. The mean age was 84 years, with the mean percentage body surface area burned (%BSAB) being 9.6 per cent (range 0.5-65 per cent). Contrary to expectations, the annual incidence appears to be declining, the possible reasons for which are discussed. Surgery was required in 69 patients; in 11 this was performed within 1 week of injury. When compared to the more traditional delayed surgical approach, early surgery conveyed no benefits in either mortality (early group, 18 per cent; delayed group, 13 per cent) or length of hospital stay (early group survivors, 38 days; delayed group survivors, 42 days). Medical and social problems were very common and led to an often difficult and frequently prolonged rehabilitation, with the mean length of hospital stay for all patients being 29 days. The mortality of the whole group was 26 per cent, the patients on average faring better than their predicted mortalities as derived using either the Baux index, the Bull table or the Abbreviated Burn Severity Score.
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Affiliation(s)
- M A Cadier
- Wessex Regional Burns Centre, Department of Plastic, Reconstructive and Burns Surgery, Odstock Branch, Salisbury District Hospital, Wiltshire, UK
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Abstract
Between 1 August 1988 and 31 January 1992, 421 burn patients were admitted to the Burn Unit at Beilinson Medical Center. Name, age, sex, month of the year, cause of burn, area and degree of burn and duration of stay in hospital were recorded. Of these patients, 37 per cent were treated surgically and the remainder were treated conservatively. The male to female ratio was 2:1. Burns occurred most frequently in July and January; the peak average age was the first decade of life. The most frequent cause in children was scalding (domestic burns), and in adults open fires (work accidents). Patients treated by early tangential excision and skin grafting (204 operations on 157 patients) had a shorter stay in hospital than conservatively treated patients. In accordance with others, we suggest that early surgery of burn injuries decreases morbidity and mortality and leads to better aesthetic results and improved motor function. Secondly, burn injury can be prevented in children and the elderly by increasing safety measures at home, and in adults by enforcing strict safety measures at work.
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Affiliation(s)
- Y Milo
- Department of Plastic Surgery, Beilinson Medical Center, Petah Tiqva, Israel
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