593 Mortality of Burn patients over two decades: Improving outcomes in the elderly

Abstract

\n \n \n Shifting paradigms in the care of burn patients over the past two decades have led to the improved survival of adult and pediatric patients, but the same trend has not been manifested in the elderly population. We aimed to review our patient population, particularly the elderly, for the last twenty years and examine the relationship of age to the TBSA (total burn surface area) LD50 (lethal dose, 50%).\n \n \n \n This IRB approved study retrospectively analyzed acute burn patients admitted at two academic regional burn centers from January 1, 1999 to August 1, 2019. Data collected included age, gender, TBSA, mortality, mechanism of burn, inhalation injury, and presence of full-thickness burn. The relationship between mortality and TBSA and age was assessed using logistic regression. The TBSA LD50 was calculated conditional on age and confidence intervals were constructed based on 1000 bootstrap samples.\n \n \n \n A total of 9,721 patients were admitted for treatment of acute burn injury between the two institutions. In our population, flame was the most common cause of burn injury (51%), full-thickness burns were present 47% of the time, and mean TBSA was 13%. The average patient age was 28, although there were 789 patients over the age of 65. The TBSA LD50 relationship to age best fit a cubic regression model with a peak of 81% TBSA LD50 at 17 years of age, rapid decrease early in the 5th decade and a general leveling out at the nadir of 27% TBSA (Figure). The LD50 did not reach 30% until 78 years of age.\n \n \n \n Over the past two decades, elderly patients treated at our hospitals appear to have improved survival in comparison to the outcomes reported nationally. Due the ongoing rapid aging of the population, it is important that we continue to focus on both improving survival and delivering the best care to this vulnerable part of the population. Moreover, this continuous model could be used to track improvements in care within our institution and serve as a template for a national model.\n \n