A survey of risk factors for burns in the elderly and prevention strategies

Trends in Victorian burn injuries 2008-2017

OBJECTIVES

To describe incidence and characteristics of hospital presentations and deaths due to burn injury in the Australian state of Victoria from 2008 to 2017 and identify trends in incidence and patterns.

METHODS

Three population-based datasets were used to ascertain burn-related hospital admissions, emergency department presentations, and deaths. These were the Victorian Admitted Episodes Dataset (VAED), Victorian Emergency Minimum Dataset (VEMD), and the Cause of Death-Unit Record File (COD-URF), respectively. Descriptive statistics on demographics (age and gender), burn injury characteristics (intent, cause, burn size and body region) and hospital burden (length of stay (LOS) and costs) were used to present the profile of patients. Incidence rates by age, gender and intent were calculated. Trend analysis on incidence was carried out using forced Poisson Regression models with the natural logarithm of the annual populations as an offset. Incident rate ratios were used to interpret the models. Risk ratios were used to compare the risk differences between population sub-groups. A negative binomial model was used to test the association between LOS and age and the total body surface area (TBSA) of the burn.

RESULTS

Overall males had higher rates of death, admission and ED presentation. For adults, the elderly had the highest rates of deaths and admissions while for children, the very young had highest rates for admissions and presentations. Exposure to smoke, fire and flames was the most common cause of deaths, and contact with heat and hot substances was most common among ED presentations. The elderly and those with Total Body Surface Area (TBSA) burn ≥20% had a higher risk of longer hospital stay. Rates of severe burns and deaths from burns remained stable during the study period in the setting of an annual 2% increase in population. Paediatric hospital admission rates decreased over time.

CONCLUSION

The risk of sustaining burn injury, the types of burn and outcomes, varied by age and gender. We found evidence of a limited decrease in burn injury rates in some sub-groups: appropriate and effective targeted prevention strategies for burns are needed to avoid the significant short and long-term suffering experienced.

A survey of YouTube videos as a source of useful/un-useful information in the field of the prevention and management of burn injuries: A cross-sectional analysis of the English language content

The study was designed on whether YouTube videos are useful as an information resource in the field of burn injury prevention and management. Current literature on the educational content and quality of burn-related first aid videos on YouTube was reported as inadequate and inaccurate. However, the quality of YouTube videos on various medical and clinical topics has been the subject of many previous studies, and there has been increasing evidence that the content ratio of usefulness was higher than that of non-useful. While hours and even minutes in burn injuries are as precious as gold in terms of outcomes, it would be a significant loss not to use the most popular and easily accessible free social media platform of our time as a tool that can contribute to the prevention of burns and raise awareness. Analysis was conducted with the remaining 96 videos from 240 videos obtained from YouTube, according to possible search terms and exclusion of videos according to predetermined criteria. The Global Quality Score (GQS) and modified DISCERN (m.DISCERN) tools were used to assess the quality and reliability of the videos. Viewer engagement metrics and video properties were also investigated according to the usefulness criteria (e.g., video length, duration on YouTube, topic contents, source uploads, reliability, and quality). Finally, it was revealed that nearly 80 percent of the YouTube videos contained information in the field of the prevention and management of burn injuries deemed useful in this study, comparable to the other medical disciplines' reports in the literature.

Epidemiology of Burn-Related Morbidity and Mortality in Patients Over Eighty Years of Age

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.

Burn Prevention in the Elderly: Identifying Age and Gender Differences in Consumer Products Associated With Burn Injuries

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.

The Descriptive Epidemiology and Outcomes of Hospitalized Burn Patients in Southern Turkey: Age-Specific Mortality Patterns

The current descriptive analysis was designed to document the common epidemiologic characteristics and outcomes of burn injuries, and age-specific mortality patterns covering all age groups admitted for treatment to the Burn Center of Adana City Training and Research Hospital. Medical records were retrospectively analyzed. The patients were stratified into two age groups as pediatric and adults, and then into 10 sub-age groups. Among the 946 patients of the study population, there were 24 mortalities with a mortality rate of 2.5%. Patients within the age range of 70 to 79 years had the highest mortality rate of 33.3%; followed by 60 to 69, 80+, 18 to 29, 10 to 17, and <5 sub-age groups, whose mortality rates were 13.0%, 7.8%, 7.2%, 2.4%, and 0.5%, respectively. In terms of multivariate regression analysis of factors predicting mortality among burn patients in all age groups, fire-flame related burns, age ≥18 years, TBSA burned ≥20% (TBSA ≥20%), the existence of inhalation injury, deep partially/full-thickness burns were found to be significant prognostic factors of mortality. The strongest association was seen in TBSA ≥60% segment (P < .0001), which had 25.9 times more death risk. As expected, a similar trend was detected when the age groups stratified into age groups, and the strongest association was in the 60+ sub-age group (P < .0001), whose had 5.84 times more likely death; followed by 29 to 59 and 18 to 29 sub-age groups, with the odds ratios of 2.12 (95% confidence interval = 1.25-3.61) and 2.08 (95% confidence interval = 1.90-4.05), respectively. Oppose to these findings; the 0 to 17 sub-age group was not found to have a statistically significant effect in predicting mortality.

Epidemiology of burn injury in older adults: An Australian and New Zealand perspective

INTRODUCTION

The ageing global population presents a novel set of challenges for trauma systems. Less research has focused on the older adult population with burns and how they differ compared to younger patients. This study aimed to describe, and compare with younger peers, the number, causes and surgical management of older adults with burn injuries in Australia and New Zealand.

METHODS

The Burns Registry of Australia and New Zealand was used to identify patients with burn injuries between 1 July 2009 and 31 December 2018. Temporal trends in incidence rates were evaluated and categorised by age at injury. Patient demographics, injury severity and event characteristics, surgical intervention and in-hospital outcomes were investigated.

RESULTS

There were 2394 burn-injured older adults admitted during the study period, accounting for 13.4% of adult admissions. Scalds were the most common cause of burn injury in older adults. The incidence of older adult burns increased by 2.96% each year (incidence rate ratio = 1.030, 95% confidence interval = 1.013-1.046, P < 0.001). Compared to their younger peers, a smaller proportion of older adult patients were taken to theatre for a surgical procedure, though a larger proportion of older adults received a skin graft.

DISCUSSION

Differences in patient and injury characteristics, surgical management and in-hospital outcomes were observed for older adults. These findings provide the Australian and New Zealand burn care community with a greater understanding of burn injury and their treatments in a unique group of patients who are at risk of poorer outcomes than younger people.

LAY SUMMARY

The number and proportion of older persons in every country of the world is growing. This may create challenges for healthcare systems. While burn injuries are a unique subset of trauma that affect individuals of all ages, less is known about burns in older adults and how they differ from younger patients.We wanted to look at the number, type, management, and outcomes of burns in older adults in Australia and New Zealand. To do this, we used data from the Burns Registry of Australia and New Zealand, or BRANZ. The BRANZ is a database that collects information on patients that present to Australian and New Zealand hospitals that have a specialist burns unit.Our research found that one in eight adult burns patients was over the age of 65, and that the rate of burn injuries in older adults has increased over the last decade. Older adult burns patients were most commonly affected by scalds after coming in contact with wet heat such as boiling liquids or steam. Fewer older adults went to theatre for an operation or surgical procedure compared to their younger counterparts. However, a larger proportion of older adults that went to theatre had a skin graft (where skin is removed from an uninjured part of the body and placed over the injured part).This research provides important information about a unique and growing group of patients to the local burn care community. It also highlights potential avenues for injury prevention initiatives.

Effect of an auditory feedback substitution, tactilo-kinesthetic, or visual feedback on kinematics of pouring water from kettle into cup

Pouring hot water from a kettle into a cup may prove a hazardous task, especially for the elderly or the visually-impaired. Individuals with deteriorating eyesight may endanger their hands by performing this task with both hands, relaying on tactilo-kinesthetic feedback (TKF). Auditory feedback (AF) may allow them to perform the task singlehandedly, thereby reducing the risk for injury. However since relying on an AF is not intuitive and requires practice, we aimed to determine if AF supplied during the task of pouring water can be used naturally as visual feedback (VF) following practice. For this purpose, we quantified, in young healthy sighted subjects (n = 20), the performance and kinematics of pouring water in the presence of three isolated feedbacks: visual, tactilo-kinesthetic, or auditory. There were no significant differences between the weights of spilled water in the AF condition compared to the TKF condition in the first, fifth or thirteenth trials. The subjectively-reported difficulty levels of using the TKF and the AF were significantly reduced between the first and thirteenth trials for both TKF (p = 0.01) and AF (p = 0.001). Trunk rotation during the first trial using the TKF was significantly lower than the trunk rotation while using VF. Also, shoulder adduction during the first trial using the TKF was significantly higher than the shoulder adduction while using the VF. During the AF trials, the median travel distance of the tip of the kettle was significantly reduced in the first trials so that in the thirtieth trial it did not differ significantly from the median travel distance during the thirtieth trial using TKF and VF. The maximal velocity of the tip of the kettle was constant for each of the feedback conditions but was higher in 10 cm s(-1) using VF than TKF, which was higher in 10 cm s(-1) from using AF. The smoothness of movement of the TKF and AF conditions, expressed by the normalized jerk score (NJSM), was one and two orders of magnitude higher from the VF, respectively. The median NJSM then decreased significantly by the fifth trial. Monitoring in-house activity via motion capture and classification of movements, i.e. liquid pouring, can assist with daily activities via AF. As a built-in feature in a smart home, this task-specific AF may prevent burn injuries of the visually-impaired.

A new algorithm to allow early prediction of mortality in elderly burn patients

INTRODUCTION

The elderly are the fastest growing population segment, and particularly susceptible to burns. Predicting outcomes for these patients remains difficult. Our objective was to identify early predictors of mortality in elderly burn patients.

METHODS

Our Burn Center's prospective database was reviewed for burn patients 60+ treated in the past 10 years. Predictor variables were identified by correlative analysis and subsequently entered into a multivariate logistic regression analysis examining survival to discharge.

RESULTS

203 patients of 1343 (15%) were eligible for analysis. The average age was 72 ± 10 (range 60-102) and the average total body surface area (TBSA) burned was 23 ± 18% (range 1-95). Age, TBSA, base deficit, pO(2), respiratory rate, Glasgow Coma Score (GCS), and Revised Trauma Score (RTS, based on systolic blood pressure, respiratory rate, and GCS) all correlated with mortality (p ≤0 .05). Using multiple logistic regression analysis, a model with age, TBSA and RTS was calculated, demonstrating: In this model, β(0) is a constant that equals -8.32.

CONCLUSIONS

Predicting outcomes in elderly burn patients is difficult. A model using age, TBSA, and RTS can, immediately upon patient arrival, help identify patients with decreased chances of survival, further guiding end-of-life decisions.

Factors associated with duration of hospitalization and outcome in burns patients: a cross sectional study from Government Tertiary Care Hospital in Karachi, Pakistan

OBJECTIVE

Burns are important contributors toward mortality in trauma related injuries in Karachi, Pakistan. The aim of the present study was to delineate the factors contributing to the duration of hospitalization and mortality in such patients.

METHODS

We performed a single center retrospective study of patients admitted during a 2 year period (January 2009 till December 2010) in Burns Center, Karachi. Patients with incomplete record were excluded. Variables included were age and gender of the patient, the percent total body surface area (%TBSA) burn, the cause of the burn and the body parts affected along with the micro-organisms isolated from the burn wounds. The relationship of these variables with the duration of hospitalization and the outcome of patients was assessed by means of Pearson Chi Square test in SPSS version 14.

RESULTS

Mean age of patients was 26.64 years (± 13.430). More males (56.6%) were admitted than females (43.4%), giving a male to female ratio of 1.3:1. Mean percent total body surface area (%TBSA) burnt and mortality were 24.69% and 26.38% respectively with both having higher values in females (p<0.001). Males had a mean longer duration of hospitalization compared to females (35.94 days vs. 27.63 days). The most common micro-organism colonizing the wounds was found to be Staphylococcus aureus. Factors significantly (p<0.05) associated with increased duration of hospitalization and mortality include the age and gender of the patient, the cause of burn, inhalation injury, the region affected and %TBSA burnt.

CONCLUSION

The relationship of age and gender of the patient, the cause of burn, inhalation injury, the region affected and %TBSA burnt are important factors in determining the duration of hospitalization of the patients and whether the patients will survive or succumb to injuries.

Epidemiologic investigation of burns in the elderly in Sichuan Province

OBJECTIVE

This study analysed the epidemiology of burns in the elderly in Sichuan Province, China, with the objective of formulating a prevention programme.

METHODS

A retrospective review of elderly patients admitted to the Burn Centre of West China Hospital during 2003-2009 was performed, including patient demographics, education and burn aetiology.

RESULTS

A total of 103 patients, mean age 69.5 years (range 60-95 years; 58 male, 45 female) were admitted. The most common causes of burn were flames (51.5%), scalding (37.9%), electrical (4.9%) and chemical (2.9%), respectively. The majority occurred at home (68.9%), principally in the kitchen (35.9%), while 19.4% occurred in the workplace. Burns with total body surface area (TBSA) of 0-10% accounted for 52.5% of those admitted for treatment; 10-30% TBSA burns accounted for 20.3%; 30-50% TBSA burns accounted for 15.5%; and burns with a TBSA >50% accounted for 11.7%. Only 6% of patients received appropriate first aid, and 32% did not receive treatment until more than 24h after injury. The education level was lower in the rural group. Both urban and rural groups had little knowledge of first aid for burns.

CONCLUSIONS

Burn-prevention programmes should promote improved living conditions and medical insurance, with prevention education for the elderly, especially in rural areas.

Pediatric burn injuries treated in US emergency departments between 1990 and 2006

OBJECTIVE

The goal was to examine comprehensively the patterns and trends of burn-related injuries in children, adolescents, and young adults treated in US emergency departments between 1990 and 2006.

METHODS

Through use of the National Electronic Injury Surveillance System database, cases of nonfatal burn-related injuries were selected by using diagnosis codes for burns (scalds, thermal, chemical, radiation, electrical, and not specified). Sample weights were used to calculate national estimates. US Census Bureau data were used to calculate injury rates per 10000 individuals <or=20 years of age. Computation of relative risks with 95% confidence intervals was performed.

RESULTS

An estimated 2054563 patients <or=20 years of age were treated in US emergency departments for burn-related injuries, with an average of 120856 cases per year. Boys constituted 58.6% of case subjects. Children <6 years of age sustained the majority of injuries (57.7%), and more than one half of all injuries (59.5%) resulted from thermal burns. The body parts injured most frequently were the hand/finger (36.0%), followed by the head/face (21.1%). Of the 1542913 cases for which locale was recorded, 91.7% occurred at home. The rate of burn-related injuries per 10000 children decreased 31% over the 17-year time period.

CONCLUSIONS

Burn-related injuries are a serious problem for individuals <or=20 years of age and are potentially preventable. Children <6 years of age consistently sustained a disproportionately large number of injuries during the study period. Increased efforts are needed to improve burn-prevention strategies that target households with young children.

The characteristics of elderly burns in Shanghai

OBJECTIVE

This study aims to analyse the epidemiologic characteristics of severe burn in the elderly in Shanghai and to discusses a possible prevention programme for this population.

METHODS

A retrospective review of all medical records of elderly patients (aged 60 and older) admitted with acute burns to the Burn Center of the RuiJin Hospital between January 1996 and December 2004 was carried out. Patient demographics, etiology of burn, mechanism of injury, burn extent, anatomical areas burned, number of operations, and outcomes were reviewed.

RESULTS

A total of 201 (5.8% of hospitalised patients) elderly patients (mean age (+/-SD) of 69.3+/-7.1 years (range 60-90 years)) were admitted. Majority of the patients were men (62.2%) and the most common etiologies were flames (52.7%) and scalds (39.8%). The majority of burns occurred at home (73.6%), followed by burns at workplace (15.9%) and public areas (10.5%). The median total body area burned was 11.7% (range 0-84%), and the majority of burns were classified as mild (60.2%) and moderate (32.8%). Predominant anatomical areas involved were the legs (76.1%), arms (67.2%), head and neck (49.8%) and hands (49.3%). The most common pre-injury conditions were cardiovascular diseases (25.9%), diabetes (8.5%) and neurological diseases (6%). Eighty-seven patients (43.3%) required surgical treatment. The most common complications were multiple organ failure (2%), pneumonia (1%) and wound infection (1%). Sixteen patients (8%) died: half of them in hospital, and the rest at home. There was a significant correlation between post-injury complications and death (r=0.69, p<0.001). The mean total hospitalisation cost was yen 22993.09 (US$ 3381.34).

CONCLUSIONS

Domestic and workplace burns with devastating consequences are very common in the elderly population in Shanghai. Burn prevention education and implementation of safety measures at home and at workplace would help reduce such incidences.

Burn treatment in the elderly

The population of elderly patients is expected to rise continuously over the next decades due to global demographic changes. The elderly seem to be most vulnerable to burns and their management remains undoubtedly a challenge. A clear age margin for elderly patients is not yet defined, but most studies adhere to the inclusion of patients 65 years and above, but the general condition and social situation must be taken into account. The understanding of the physiological basis of aging and its related pathophysiological changes has only marginally influenced treatment and decision making in elderly burn patients. When looking at treatment regimens currently applied in elderly burn patients, the discussion of standards in intensive care as well as surgical strategies is ongoing. However, trends towards a moderate, non-aggressive resuscitation approach and careful inclusion of key parameters like physiological age, pre-burn functional status and premorbid conditions, seem to be useful guidelines for interdisciplinary treatment decisions. Once ordered for surgical treatment, the amount of body surface area operated in one session should be adapted to the general status of the patient. Even if older burn victims have a reported higher mortality rate than younger patients, improved therapeutic options have contributed to a reduced mortality rate even in the elderly over the last decades. As a result of improved outcome, more attention has to be given to a comprehensive rehabilitation program. This review will give an overview of the current literature and will draw attention to specific topics related to this important subpopulation of burn patients.

Epidemiology of Hospitalized Burn Patients in Shandong Province: 2001–2005

The aim of the article was to describe the epidemiology of burn injuries requiring hospitalization at Shandong Provincial Hospital and to provide information necessary for the design and implementation of effective prevention programs. The records of patients with burn injury admitted to our burn unit over a 5-year period (1 January 2001 to 31 December 2005) were reviewed. Medical record review provided basic demographic information and details on the extent of injury, time of day burns occurred, month of admission, cause of burn, accident site, first aid, number of operations, length of hospital stay, and mortality. There was no trend in annual admissions. The male-to-female ratio was 3:1. The age distribution of burn patients showed peaks occurring at the age groups of 0 to 10 and 20 to 30 years. Over the course of a day, burn injuries occurred most frequently from 1700 to 1900 hours. Scalds accounted for 45.23% (502) of the 1110 patients, and flame burns accounted for 42.33% (471). Only 29% of all patients received proper first aid with cool water or burn cream. The average length of hospital stay was 22 days. Children under 10 years and adults between 20 and 30 years of age are the most susceptible populations, and first aid is performed poorly in Shandong Province. Burn prevention and first aid education campaigns should be launched to encourage safe lifestyle and work habits.

Aetiology and outcome of burns in the elderly

INTRODUCTION

This retrospective study, analyses aetiology and factors affecting the outcome of burns in patients over 65 years of age.

METHODS

Sixty-three consecutive patients, over 65 years of age, were admitted to a Burns Unit over a period of 3 years. Retrospective data was analyzed, taking into account aetiology, burn thickness and area, co-morbid factors. Also, surgery as a factor-affecting outcome was examined.

RESULTS

There was a significant difference of total body surface area burn (TBSA), Abbreviated Burn Severity Index (ABSI), Baux score and the number of pre-existing co-morbid factors between survivors and non-survivors. Age and surgery were not significant to the outcome. Patients undergoing surgery had increased hospital stay without any difference in mortality. The timing of surgery did not have any impact on hospital stay or survival.

CONCLUSION

This study shows a positive correlation between the number of co-morbid conditions and mortality. Early surgery after careful patient selection does not have any negative impact on patient survival.

Predictors of survival and length of stay in burn patients older than 80 years of age: does age really matter?

Predictors of survival and length of stay (LOS) in the advanced elderly with burn injuries is not well studied. Because of progress in burn wound and critical care, we hypothesized that a contemporary analysis would show improved outcomes. Clinical data were collected on 45 consecutive patients older than 80 years of age that were treated for burn injury at our institution during the past 10 years. Regression analysis was used to identify predictors of LOS and survival. Overall rate of mortality was 29%, and no patient survived a burn more than 60% TBSA. The strongest predictor of survival was percent TBSA burn. LOS of survivors was dependent on presence of inhalation injury and total number of operations. The survival of patients older than 80 years of age with burn injury is better than reported. Modern burn care allows survival in many patients over 80 with less than 60% TBSA burns without significant other co-morbidities.

Prevention oriented epidemiologic study of accidental burns in rural areas of Ardabil, Iran

PURPOSE OF STUDY

Burns are one of the leading causes of injury-related deaths in Iran. We conducted a study to investigate features of burns in rural areas of Ardabil Province from October 2004 through March 2005, with an aim to providing content for effective prevention programs.

BASIC PROCEDURES

This study employed longitudinal prospective methodology. The study population included all patients presenting with burns to local health care facilities during the study period.

MAIN FINDINGS

A total of 1179 cases were studied. Most of the cases (59.4%) were females. Mean of age of victims was 22.3+/-19 years in females and 13.6+/-17 years in males. The vast majority (91.2%) of burns occurred at home. More than two-thirds of burns were because of hot liquids or steam. The majority of scald burns resulted during use of heating devices such as samovars, gas stoves, valors and picnic gas stoves. Overturning and spilling of hot liquids were the most common injury mechanisms.

PRINCIPLE CONCLUSIONS

Prevention programs should focus on children and adult women. Prevention efforts should target home environments and focus on prevention of scalding burns.

Behandlungskonzepte bei Verbrennungen

The best treatment for burns and scalds depends on the depth of the skin necrosis. Epidermal and superficial dermal burn injuries (IIa) can heal spontaneously with conservative treatment without scar development, but deep dermal or full-thickness burns constitute an absolute indication for surgery. Full-thickness or split-thickness skin grafts are used for wound closure. In the case of extensive burn injuries allografts are used for temporary wound closure. In certain licensed laboratories autologous keratinocytes can be cultured for transplantation. In circumferential burn injuries affecting the extremities or the trunk the rigid eschar has to be incised to relieve the pressure behind it. Following a debridement conservative treatment of superficial dermal burns involving wound coverage with biosynthetic dressings or nanocristalline silver gauze dressings or use of special disinfecting ointments can be implemented.

Elderly patients discharged home from the emergency department with minor burns

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.

Effectiveness of a Burn Prevention Campaign for Older Adults

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.

Advanced age negatively influences mesenteric lymph node T cell responses after burn injury

While the pathophysiology of burn injury is well established in young adults, the factors that contribute to pathogenesis and increased death in elderly burn patients are not defined. The purpose of this study is to determine the effects of burn injury on mesenteric lymph node (MLN) T cell responses in young and aged mice. MLN is a cluster of lymph nodes that drains various parts of the intestine and is known to play role in clearance bacteria originating from the intestinal lumen. Results presented here suggest a significant suppression in Con A-induced MLN cell proliferation and IL-2 production in uninjured aged mice compared with uninjured young mice. Following 24 h after injury, although, a significant decrease in lymph node cell proliferation and IL-2 production was observed in both young and aged mice compared with their respective sham-injured animals, the suppression was more in aged mice. In addition we found a reduction in IFN-gamma, a Th-1 cytokine by MLN T cells from aged burned mice relative to young burn (P<0.05) or sham-injured mice (P<0.01). The Th-2 cytokine IL-4, on the other hand, was significantly increased in both young and aged burn-injured mice MLN T cells compared with their respective sham-injured mice. These results show that burn injury causes a greater suppression in MLN T cells ability to proliferate and a more pronounced shift to Th-2 phenotype in aged mice as compared with young mice. Such decreases in T cell functions may impair MLN's ability to clear the bacterial pathogens originating from intestine and thereby contribute to increased pathogenesis in injured host.