Abstract
Burn injuries pose a significant source of patient morbidity/mortality and reconstructive challenges for burn surgeons, especially in vulnerable populations such as geriatric patients. Our study aims to provide new insights into burn epidemiology by analyzing the largest national, multicenter sample of geriatric patients to date. Using the National Electronic Injury and Surveillance System (NEISS) database (2004-2022), individuals with a “burn” diagnosis were extracted and divided into 2 comparison age groups of 18-64 and 65+. Variables including sex, race, affected body part, incident location, burn etiology, and clinical outcomes were assessed between the 2 groups using 2 proportion z-tests. About 60,581 adult patients who sustained burns were identified from the NEISS database with 6630 of those patients categorized as geriatric (65+). Geriatric patients had a significantly greater frequency of scald burns (36.9% vs 35.4%; P < .01), and third-degree/full-thickness burns (10.4% vs 5.5%, P < .01) relative to nongeriatric adult patients with most of these burns occurring at home (75.9% vs 67.4%; P < .01). The top 5 burn sites for geriatric patients were the hand, face, foot, lower arm, and lower leg and the top 5 burn injury sources were hot water, cookware, oven/ranges, home fires, and gasoline. Geriatric patients had over 2 times greater risk of hospital admission (odds ratio [OR]: 2.32, 95% CI: 2.17-2.49, P < .01) and over 5 times greater risk of emergency department mortality (OR: 6.22, 95% CI: 4.00-9.66, P < .01) after incurring burn injuries. These results highlight the need for stronger awareness of preventative measures for geriatric burn injuries.
Keywords: geriatric, burns, elderly, burn injuries
INTRODUCTION
With the World Health Organization predicting that the worldwide population aged 60 years or older will increase from 12% to 22% between 2015 and 2050, it is clear that we are in an era dominated by an aging global population.1 Hence, it is paramount to understand and act on the unique healthcare challenges posed by geriatric patients in an effort to improve outcomes in this older demographic. Burn injuries represent a significant proportion of the variety of health concerns that affect the aging population—of the 400,000 patients treated annually for burn injuries in emergency departments (EDs) in the United States, roughly 20% are geriatric patients.2,3 The geriatric population has been shown to be the most susceptible demographic to burns, with the prevalence of these incidents continuing to rise.4,5 In addition to this, increasing age is considered to be one of the most significant predictors of burn-injury-related mortality.6,7
Due to this increased risk of mortality in the geriatric burn population, there is clear clinical need for both specialized burn care services and greater prevention efforts in this demographic. Obtaining a nuanced understanding of the sources and circumstances surrounding burns in geriatric patients will facilitate the development of targeted prevention strategies and effective healthcare interventions. To date, epidemiological studies of geriatric burn injury have predominantly been single-center studies with limited granularity.8,9 Our study, however, aims to provide new insights into sources, locations, and frequencies of burns by analysis of the largest national, multicenter sample of burn patients aged 65 years and above available to date. Through this, we hope to provide a panoramic view of burn injury in this older, more vulnerable adult demographic, and to better identify patterns that can inform preventative measures tailored to the specific needs of older individuals.
METHODS
Dataset and study cohort
Our sample population consisted of patients with burn injuries who were reported in the National Electronic Injury and Surveillance System (NEISS) database after being seen in an ED from January 1, 2004 to December 31, 2022. The NEISS database is maintained by the Consumer Product Safety Commission to track all injuries seen in the EDs of a representative sample of 100 US hospitals.10 This sample includes hospitals that provide care to children, rural populations, suburban populations, urban populations, and trauma victims, with each hospital providing 24-hour ED services and having at least 6 beds. The NEISS database collects information on patient sex, age, primary injury diagnosis and location, injury disposition, and a brief narrative detailing the circumstance of the injury.
To study burn trends in geriatric patients and how they compare with burn trends of nongeriatric adult patients, only individuals with a “burn” diagnosis (NEISS diagnosis codes 46, 47, 48, 49, and 51) were examined. This isolated “burns” dataset was then categorized into 2 subsets: geriatric patients (65-120 years old) and nongeriatric adult patients (18-64 years old). Children (<18 years of age) were excluded from the dataset.
Study variables and data analysis
The variables studied in this analysis were age, sex, race, diagnosis (type of burn), affected body part, incident location, product involved, drug/alcohol involvement (limited only to years 2019-2022 for which data were available), and ED outcome. The studied variables were recorded with NEISS codes and mapped to their respective word descriptions using NEISS coding guidelines. Additional information regarding severity of burn (degree/thickness level) was screened and extracted from a subset of the brief case narratives for which this information was available.
All statistical analysis was performed using Python Jupyter Notebook. To compare frequencies of different events, 2 proportion z-tests were used. In addition, a Welch 2-sample t-test was performed to compare the average age of patients admitted and not admitted to the hospital. Odds ratio (OR) for geriatric hospital admission, ED mortality, and burn risk from drug/alcohol use were calculated. P-values less than .05 were considered statistically significant.
RESULTS
Study cohort/demographics
In total, 60,581 adult patients who sustained burns were identified from the NEISS dataset from 2004 to 2022. This sample size was extrapolated to a weighted national estimate of 2,404,086 patients, as determined by the sampling weights assigned by the NEISS database which are dependent on the geographic location of the injury. Out of the 60,581 adult patients identified, 6630 of those patients were categorized as over the age of 65 (accounting for a weighted total of 279,630 patients over the age of 65). Figure 1 provides a proportion of the number of burn cases from the NEISS dataset per year between the 2 demographic populations. Age, sex, and race demographics of the study population are presented in Table 1. About 48.9% of the geriatric burn population was male and 51.1% was female. The racial/ethnic makeup consisted predominantly of White (49.8%), Hispanic (19.1%), and Black/African American (14.9%) individuals. The median age of the geriatric population was 72.0 (IQR: 11.0), and the median age of the nongeriatric adult population was 37.0 (IQR: 22.0).
Figure 1.
Proportion of Burns in Geriatric and Nongeriatric Adult Patients Per Year Presenting to the ED
Table 1.
Patient Sex and Race/Ethnicity Demographics for Nongeriatric and Geriatric Patients
| Non-geriatric (n = 53,951) |
Geriatric (n = 6,630) |
|
|---|---|---|
| Sex | ||
| Female | 26,573 (49.3%) | 3,391 (51.1%) |
| Male | 27,376 (50.7%) | 3,239 (48.9%) |
| Unknown | 2 (0.003%) | 0 (0.0%) |
| Race/ethnicity | ||
| White | 25,263 (46.8%) | 3,303 (49.8%) |
| Black/African American | 8,847 (16.4%) | 986 (14.9%) |
| Hispanic/Latino | 11,619 (21.5%) | 1,268 (19.1%) |
| Asian | 681 (1.3%) | 129 (1.9%) |
| American Indian / Alaska Native | 150 (0.3%) | 15 (0.2%) |
| Native Hawaiian / Pacific Islander | 41 (0.1%) | 10 (0.2%) |
| Other | 2,668 (4.9%) | 166 (2.5%) |
| Unknown | 4,682 (8.7%) | 753 (11.4%) |
Trends in types of burns
The types of burns obtained by geriatric compared to nongeriatric patients were compared. Geriatric patients were more likely to be injured by scald burns than nongeriatric adults (36.9% vs 35.4%, P < .01), while nongeriatric patients were more likely to have electrical burns than geriatric patients (1.2% vs .6%, P < .01), as shown in Figure 2. There was no significant difference in the frequency of thermal (P = .19) and chemical (P = .17) burns identified between geriatric patients and nongeriatric patients. In addition, male geriatric patients were found to incur a higher frequency of thermal (54.9% vs 45.1%, P < .01), chemical (58.2% vs 41.8%, P < .01), and electrical burns (69.8% vs 30.2%, P < .01) compared to female geriatric patients, while female geriatric patients were found to incur a higher frequency of scald burns (62.9% vs 37.1%, P < .01), as shown in Table 2. Supplementary Table S1 provides a further descriptive breakdown of the most common types of burns incurred in geriatric patients by race/ethnicity.
Figure 2.
Frequency of Burns by Type for Nongeriatric and Geriatric Patients
Table 2.
Sex Distribution for Geriatric Patients by Type of Burn
| Geriatric males (n = 3,239) |
Geriatric females (n = 3,391) |
P-value | |
|---|---|---|---|
| Thermal | 1,913 (54.9%) | 1,569 (45.1%) | <.01 |
| Scald | 907 (37.1%) | 1,538 (62.9%) | <.01 |
| Chemical | 340 (58.2%) | 244 (41.8%) | <.01 |
| Electrical | 30 (69.8%) | 13 (30.2%) | <.01 |
P-values <0.05 presented in bold text.
Trends in body parts of burns for older vs younger patients
The top 5 body parts affected by burns in geriatric patients were the hand (18.1%), face (12.8%), foot (10.1%), lower arm (9.2%), and lower leg (7.8%), in descending order (Table 3). In addition, geriatric patients were more likely than nongeriatric patients to burn their shoulder (0.9% vs 0.7%, P = .03), lower leg (7.8% vs 6.0%, P < .01), upper leg (6.0% vs 5.1%, P < .01), head (1.2% vs 0.5%, P < .01), foot (10.1% vs 7.3%, P < .01), knee (2.5% vs 0.5%, P < .01), toe (0.7% vs 0.5%, P < .01), upper trunk (6.9% vs 4.8%, P < .01), and lower trunk (6.9% vs 5.1%, P < .01), while nongeriatric adults were more likely than geriatric adults to burn their hand (26.4% vs 18.1%, P < .01), lower arm (11.6% vs 9.2%, P < .01), wrist (1.7% vs 1.4%, P = .04), neck (0.8% vs 0.5%, P < .01), and finger (7.1% vs 5.3%, P < .01), among other body parts. It is notable that as a whole, upper extremity burns were more common among nongeriatric patients (49.1% vs 36.7%, P < .01), while lower extremity (26.4% vs 20.2%, P < .01), head and neck (20.0% vs 19.0%, P = .03), and thoracic (14.1% vs 10.3%, P < .01) burns were more common among geriatric patients.
Table 3.
Distribution of Burns by Body Part for Nongeriatric and Geriatric Adults
| Non-geriatric (n = 53,951) |
Geriatric (n = 6,630) |
P-value | |
|---|---|---|---|
| Upper extremity | 26,496 (49.1%) | 2,430 (36.7%) | <.01 |
| Hand | 14,250 (26.4%) | 1,202 (18.1%) | <.01 |
| Lower arm | 6,235 (11.6%) | 610 (9.2%) | <.01 |
| Finger | 3,835 (7.1%) | 350 (5.3%) | <.01 |
| Wrist | 910 (1.7%) | 93 (1.4%) | .04 |
| Upper arm | 711 (1.3%) | 93 (1.4%) | .28 |
| Shoulder | 355 (0.7%) | 57 (0.9%) | .03 |
| Elbow | 200 (0.4%) | 25 (0.4%) | .47 |
| Lower extremity | 10,917 (20.2%) | 1,749 (26.4%) | <.01 |
| Foot | 3,919 (7.3%) | 669 (10.1%) | <.01 |
| Lower leg | 3,251 (6.0%) | 517 (7.8%) | <.01 |
| Upper leg | 2,740 (5.1%) | 395 (6.0%) | <.01 |
| Ankle | 453 (0.8%) | 58 (0.9%) | .3 |
| Knee | 283 (0.5%) | 164 (2.5%) | <.01 |
| Toe | 271 (0.5%) | 48 (0.7%) | <.01 |
| Head and neck | 10,273 (19.0%) | 1,324 (20.0%) | .03 |
| Head | 261 (0.5%) | 82 (1.2%) | <.01 |
| Face | 6,657 (12.3%) | 850 (12.8%) | .13 |
| Eyeball | 2,593 (4.8%) | 325 (4.9%) | .37 |
| Neck | 427 (0.8%) | 34 (0.5%) | <.01 |
| Mouth | 180 (0.3%) | 21 (0.3%) | .41 |
| Ear | 155 (0.3%) | 12 (0.2%) | .06 |
| Thoracic | 5,557 (10.3%) | 935 (14.1%) | <.01 |
| Upper trunk | 2,580 (4.8%) | 457 (6.9%) | <.01 |
| Lower trunk | 2,737 (5.1%) | 457 (6.9%) | <.01 |
| Pubic region | 240 (0.4%) | 21 (0.3%) | .07 |
P-values <0.05 presented in bold text.
Trends in consumer products involved and locations of burns for older vs younger patients
The top 5 consumer products involved for burns in geriatric patients were hot water (21.1%), cookware (6.8%), ranges/ovens (6.0%), home fires (3.7%), and gasoline (3.7%), in descending order (Table 4). From those products identified, geriatric patients were more likely than nongeriatric patients to be burned by hot water (21.1% vs 19.6%, P < .01) and home fires (3.7% vs 2.2%, P < .01), while nongeriatric adults were more likely than geriatric patients to be burned by cookware (10.3% vs 6.8%, P < .01) and gasoline (5.1% vs 3.7%, P < .01). In addition, geriatric patients were more likely than nongeriatric patients to get burned at home (75.9% vs 67.4%, P < .01), while nongeriatric patients were more likely than geriatric patients to get burned in other settings such as through sports (1.3% vs 0.5%, P = .02), at school (0.5% vs 0.01%, P < .01), and on the street (0.6% vs 0.4%, P < .01) (Table 4). From 2019 to 2022, data regarding drug and/or alcohol involvement were available which identified 40 geriatric burn injuries that incurred under the influence of these substances. The majority of these burns were thermal in nature (80%) mostly caused by general home or room involvement fires. Relative to nongeriatric adults, geriatric patients under the influence of drugs/alcohol had a significantly greater risk of thermal burn injuries involving fires (OR: 17.12, 95% CI: 9.13-32.09, P < .01) (Table 5).
Table 4.
Distribution of Burns by ED Outcome, Consumer Product Involved, and Location for Nongeriatric and Geriatric Adults
| Nongeriatric (n = 53,951) |
Geriatric (n = 6,630) |
P-value | |
|---|---|---|---|
| ED outcome | |||
| Treated/examined and released | 45,701 (84.7%) | 4,819 (72.7%) | <.01 |
| Treated and admitted/hospitalized | 4,852 (9.0%) | 1,237 (18.7%) | <.01 |
| Treated and transferred | 2,200 (4.1%) | 439 (6.6%) | <.01 |
| Left without being seen | 981 (1.8%) | 63 (1.0%) | <.01 |
| Held for observation | 166 (0.3%) | 37 (0.6%) | <.01 |
| Died | 46 (0.1%) | 35 (0.5%) | <.01 |
| Unknown | 5 (0.0%) | 0 (0.0%) | .22 |
| Top 5 products involved | |||
| Hot water | 10,601 (19.6%) | 1,398 (21.1%) | <.01 |
| Cookware | 5,571 (10.3%) | 453 (6.8%) | <.01 |
| Ranges/ovens | 3,032 (5.6%) | 401 (6.0%) | .08 |
| Gasoline | 2,772 (5.1%) | 244 (3.7%) | <.01 |
| Home fires | 1,172 (2.2%) | 248 (3.7%) | <.01 |
| Location | |||
| Home | 36,344 (67.4%) | 5,034 (75.9%) | <.01 |
| Unknown | 14,499 (26.9%) | 1,319 (19.9%) | <.01 |
| Public | 1,688 (3.1%) | 192 (2.9%) | .15 |
| Sports | 728 (1.3%) | 30 (0.5%) | .02 |
| Street | 332 (0.6%) | 27 (0.4%) | <.01 |
| School | 258 (0.5%) | 1 (0.01%) | <.01 |
| Mobile | 77 (0.1%) | 23 (0.3%) | .02 |
| Farm | 15 (0.03%) | 4 (0.1%) | .08 |
| Industrial area | 10 (0.01%) | 0 (0.0%) | .13 |
P-values <0.05 presented in bold text.
Table 5.
Odds Ratio for Hospital Admission, ED Mortality, and Drug/Alcohol Involvement Following Burn Injury for Geriatric Patients
| Odds ratio | 95% confidence interval | P-value | |
|---|---|---|---|
| Burn injury hospital admission—geriatric total | 2.32 | 2.17–2.49 | <.01 |
| Burn injury hospital admission—geriatric males | 2.08 | 1.9–2.28 | <.01 |
| Burn injury hospital admission—geriatric females | 2.89 | 2.60–3.22 | <.01 |
| Burn injury ED mortality—geriatric total | 6.22 | 4.00–9.66 | <.01 |
| Burn injury ED mortality—geriatric males | 7.29 | 4.22–12.59 | <.01 |
| Burn injury ED mortality—geriatric females | 4.80 | 2.27–10.17 | <.01 |
| Thermal (fire) burn injury involving drugs/alcohol—geriatric total | 17.1 | 9.13–32.09 | <.01 |
P-values <0.05 presented in bold text.
Trends in ED outcome and hospital admission rate for older vs younger patients
Patients who were admitted to the hospital after being burned were significantly older than patients who were released from the hospital after treatment or examination (48.6 ± 18.3 years old vs 40.9 ± 16.4 years old, P < .01). The majority of geriatric patients who sustained burn injuries were released after being treated or examined (72.7%), while a minority were admitted to the hospital or transferred for admission (25.3%) (Table 4). Despite the low admission proportion, geriatric patients had a significantly higher hospital admission frequency (18.7% vs 9.0%, P < .01) and ED mortality (0.5% vs 0.1%, P < .01) than nongeriatric adults. Specifically, when determining the OR, geriatric patients had a significantly greater risk of hospital admission following burn injury (OR: 2.32, 95% CI: 2.17-2.49, P < .01) and this risk was greater in female geriatric patients (OR: 2.89, 95% CI: 2.60-3.22, P < .01) than male geriatric patients (OR: 2.08, 95% CI: 1.90-2.28, P < .01) (Table 5). In addition, geriatric patients had a significantly greater risk of mortality in the ED following burn injury (OR: 6.22, 95% CI: 4.00-9.66, P < .01) and this risk was also greater in male geriatric patients (OR: 7.29, 95% CI: 4.22-12.592, P < .01) than female geriatric patients (OR: 4.80, 95% CI: 2.27-10.17, P < .01). Geriatric patients were more likely than nongeriatric patients to be transferred elsewhere for treatment (6.6% vs 4.1%, P<.01) or be held for observation after getting burned (0.6% vs 0.3%, P<.01), while nongeriatric patients were more likely than older adults to be released after being treated/examined (84.7% vs 72.7%, P<.01) (Table 4).
Trends in severity of burns
The severity of burn injuries was noted in approximately a fourth of the patient cohort for which the information was available (1613 geriatric patients and 14,065 nongeriatric patients). Geriatric patients incurred a significantly greater frequency of third-degree/full-thickness burns (10.4% vs 5.5%, P < .01) and a significantly lesser frequency of first-degree/superficial burns (16.8% vs 21.1%, P < .01) relative to nongeriatric adults (Table 6).
Table 6.
Distribution of Burns by Severity for Nongeriatric and Geriatric Adults
| Nongeriatric (n = 13,782) |
Geriatric (n = 1,574) |
P-value | |
|---|---|---|---|
| 1st-degree (superficial) | 2,912 (21.1%) | 265 (16.8%) | <.01 |
| 2nd-degree (partial thickness) | 10,109 (73.3%) | 1,145 (72.7%) | .61 |
| 3rd-degree (full thickness) | 757 (5.5%) | 164 (10.4%) | <.01 |
| 4th degree | 4 (0.03%) | 0 (0.0%) | .50 |
P-values <0.05 presented in bold text.
DISCUSSION
This study, representing the largest national, multicenter analysis of burns in the geriatric population across nearly 2 decades, aimed to unravel the landscape of burn injuries within this vulnerable demographic. The goal of this research has been to inform targeted preventive measures as well as tailored interventions for the specific needs of older individuals. This is imperative considering our study revealed a gradual increase in the proportion of geriatric burn injuries presenting to the ED in the last decade (Figure 1), paralleling the aging US population.1
Geriatric patients were found to have a significantly greater incidence of scald burn injuries but a lower incidence of electrical burns when compared to the nongeriatric adult population. This finding reaffirms data from existing single-center studies, many of which have observed that cooking-related activities, followed by hot water baths/taps, were the most common cause of scald burns among older adults.11–18 Mechanistically, these types of scald injuries could be attributed to reduced thermal sensitivity, visual impairments, and slower reaction time that occurs in tandem with physiological aging as a result of reduced thermoreceptor density and superficial skin blood flow.19–21 Especially in the context of cookstove-related burns (eg boiling/steaming water), this notion is additionally supported by the fact that the most common locations of burns in the geriatric population were identified to be the hand, followed by the face, foot, lower arm, and lower leg-body parts either in direct vicinity of cooking sources of scald injury (hand, face, and lower arm) or from spillage of scalding material onto lower portions (foot and lower leg).
Our study also revealed that geriatric patients were seen to experience significantly greater incidence of burns to the lower extremity, head and neck, and trunk when compared to nongeriatric patients. This finding can additionally be ascribed to cooking-related activities being one of the most common causes of burn injuries in older adults, as typically kitchen equipment such as cookstoves are located at the level of the thoracic region/trunk.22 This pattern has been previously described and referred to as “granny gown burns,” when clothing catches fire while cooking—resulting in large burns that include the trunk and thoracic region.22,23 Congruently, it has been shown that aging results in a decline in fine motor skills, predisposing older adults to being more likely to drop hot cooking items, resulting in lower extremity burns.24 The decline in fine motor skills is also mirrored by a similar reduction in physical reaction time.25 This notion coupled with the more atrophic and less resilient quality of skin with age, explains why geriatric patients also incurred a significantly greater frequency of more severe third-degree/full-thickness burns relative to nongeriatric adults.26 The inability to react rapidly and reach safety when put in contact with a thermal agent, increases the contact time of the burn injury and thus the depth of tissue that is lost or damaged. In order to mitigate the incidence of these injuries, increased provision of geriatric physical rehabilitation activities through physiotherapy could improve fine motor skills as well as muscular coordination and reaction in order to reduce the risk of burn injury in this patient population.27
Our results also highlighted that within the geriatric group, males were found to have a higher incidence of the majority of burn types including thermal, chemical, and electrical while female geriatric patients had a higher incidence of scald burn injuries. Sex variation within the etiology of burn injuries has been noted in previous studies.28–30 For instance, our finding identifying the higher incidence of scald burns in older female patients has been ascribed in part to cultural and gender informed practices surrounding engagement with cooking activities.30–32 Other studies have shown that when combining all age groups, male patients typically dominate the total caseload in specialized burn injury services.11,33 This is hypothesized to be due to a higher prevalence of men than women occupying jobs and performing tasks such as repairs and maintenance of appliances which are associated with a higher risk of chemical, flash, and electrical injury trends concurrent with our study findings.11,34 In addition, from Supplementary Table S1, we found that overall thermal burn injuries were the most common for all races within geriatric patients, except for Asians where a higher incidence of scald burn over thermal injuries was observed. This is an unexpected finding, however, prior studies have identified that unique cultural and environmental risk factors do exist. For example, specific cooking practices may predispose certain ethnic groups to different types of burn injury.35,36 Ultimately, this reinforces the need for more effort in the field of culturally competent burn prevention research, which is tailored to offering information in multiple languages and involving representatives from diverse backgrounds.36
The top 5 causative products involved in geriatric burn injuries were hot water, cookware, ranges/ovens, home fires, and gasoline respectively, in order of occurrence with burns from hot water and home fires occurring at a significantly higher incidence in geriatric patients compared to nongeriatric patients. Hot water as a leading, significant source of burns in geriatric patients, is consistent with the higher incidence of scald burns highlighted previously in this demographic. In a similar vein, the higher frequency of burns from home fires in geriatric patients is largely corroborated by reports from the US Fire Administration, which identified individuals age 65 years or older as twice as likely to be killed or injured by fires in the home.37 In fact, our study identified that this thermal burn injury risk is exponentially amplified for geriatric patients intoxicated by drugs and/or alcohol, likely a result of the additive effect of these substances on the age-dependent impairments in cognition and motor functioning of older individuals.38,39 An additional risk factor for geriatric individuals is an aging housing stock, as these patients are more likely to inhabit older homes, which have been shown to be associated with home fire injuries due to outdated electrical designs.40 Our findings also revealed that geriatric adults were found to burn themselves in their home significantly more frequently than the adult population, and less frequently in the external environment, a finding corroborated by other studies and largely congruent with the limited mobility and greater time spent at home seen with older adults.26,30,31,41 Collectively, these findings highlight the need for greater surveillance, care, and education for geriatric adults on appropriate safety precautions in the home such as the implementation of fire safety home visit programs that have demonstrated significant benefit in this regard.42–44
In terms of immediate outcomes following burn injury, geriatric patients were found to have over 2 times greater risk of being admitted to the hospital and over 5 times greater risk of mortality in the ED following burn injuries when compared to the nongeriatric adult population. This finding was supported by Van Yperen et al. who conducted a national survey of patients with burn trauma admissions in the Netherlands and noted a clear incidence peak for patients over 80 years of age.45 This finding can be attributed to the challenges posed by geriatric patients. Geriatric patients have thinner, atrophic skin, making them more vulnerable to deeper and more severe burn injuries that take longer to heal. Healing is further prolonged by the increased frequency of comorbidities in the geriatric population, such as diabetes, hypertension, and dementia.46–49 Our finding of increased risk of burn-associated mortality with age is largely congruent with the formulaic paradigm underlying the Baux score (predicting burn mortality risk with age as a dependent factor) and additionally has been validated by a recent study across 3 Dutch burn centers, which observed that admitted patients aged 75-80 years had the highest standardized mortality ratios after 1-year while admitted patients aged 65-74 had the highest standardized mortality ratio after 5 years.50,51 Age-related deficits have been shown to contribute to the inability of the older immune systems to overcome postburn infections with an appropriate inflammatory response, ultimately resulting in an increased risk of mortality.49 In addition to this, increased frailty and severe comorbidities observed in the geriatric population can also compound to result in an increased risk of complications during hospitalizations and mortality as well.52,53 Thus, the significantly increased risk of burn hospitalization of the geriatric population and associated mortality highlighted by our study ultimately underscores the vulnerability of the demographic and emphasizes the need for heightened care not only in support of preventative measures but in the postburn injury period as well.
LIMITATIONS
There are a few limitations of this study that should be acknowledged. The data organized by the NEISS are gathered from various hospitals and healthcare systems across the country, thus potentiating the opportunity to introduce inconsistencies and biases in the data provided as a result of intra- and inter-institutional variance in data reporting. In addition, certain details regarding each geriatric ED admission for burn injury that could have provided greater context to the findings reported in this study were not provided by the NEISS database including the extent of the burn (total body surface area percentage calculation), any treatment received for the burn injury, as well as any nonburn concomitant injuries present. We must also recognize that because the NEISS strictly collects data from ED visits only, this study cannot characterize the true incidence and prevalence of all burn injuries in geriatric patients if they did not present to the ED (ie were left untreated or treated in an outpatient clinic). This is especially important to consider for this patient demographic as at least 6.5% of older adults (65+) live in nursing homes or assisted living facilities that provide their own medical facilities and staff on site which may remove the need for an ED visit for more minor burns and injuries.54 Despite these limitations, however, it is important to reaffirm that the US Consumer Product Safety Commission and CDC have supported the NEISS’s capacity to provide nationally representative data on all nonfatal injuries treated in EDs within the United States.55
CONCLUSION
In this study, based on nearly 2 decades of multi-institutional data, we were able to provide an epidemiological overview of burn injury trends in geriatric patients. Geriatric patients incurred a significantly higher frequency of scald burns relative to nongeriatric patients, with the majority of these burn injuries occurring on the hand, face, and foot, and more frequently being of greater severity (third-degree/full-thickness burns). The most common location of these injuries was the home, and the most common sources of these burn injuries were cooking-related (hot water, cookware, and ranges/ovens), suggesting that interventions related to cooking safety would be most profoundly impactful in this patient population. Most prominently, this study identified that burn injuries incurred by geriatric adults had over 2 times greater risk of resulting in hospital admission, and over 5 times greater risk of ED. These findings emphasize the need for both preventative and postinjury measures in geriatric patients for mitigating burn injury incidence and mortality.
SUPPLEMENTARY MATERIAL
Supplementary material is available at Journal of Burn Care & Research online.
Contributor Information
Sam Boroumand, Division of Plastic & Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06519, USA.
Beatrice Katsnelson, Division of Plastic & Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06519, USA.
Alna Dony, Division of Plastic & Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06519, USA; School of Medicine, University of Leeds, Leeds LS2 9JT, UK.
Viola A Stögner, Division of Plastic & Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06519, USA; Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Burn Center, Hannover Medical School, Hannover 30625, Germany.
Lioba Huelsboemer, Division of Plastic & Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06519, USA.
Neil Parikh, Division of Plastic & Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06519, USA.
SeungJu Jackie Oh, Division of Plastic & Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06519, USA.
Martin Kauke-Navarro, Division of Plastic & Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06519, USA.
Alisa Savetamal, Department of Surgery, Connecticut Burn Center, Bridgeport Hospital, Bridgeport, CT 06610, USA.
Bohdan Pomahac, Division of Plastic & Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06519, USA.
Author Contributions: Sam Boroumand (Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Writing—original draft, Writing—review & editing [lead]), Beatrice Katsnelson (Formal analysis, Methodology, Software, Writing—original draft [supporting]), Alna Dony (Methodology, Writing—original draft [supporting]), Viola A. Stögner (Investigation, Writing—review & editing [supporting]), Lioba Huelsboemer (Investigation, Writing—review & editing [supporting]), Neil Parikh (Investigation, Methodology, Writing—review & editing [supporting]), SeungJu Jackie Oh (Methodology, Supervision, Writing—review & editing [supporting]), Martin Kauke-Navarro (Investigation, Supervision, Writing—review & editing [supporting]), Alisa Savetamal (Investigation, Methodology, Supervision, Writing—review & editing [supporting]), and Bohdan Pomahac (Investigation, Supervision, Writing—review & editing [supporting])
Funding: The authors received no funding for data collection or preparation of the manuscript.
Conflict of Interest Statement: The authors declare no conflicts of interest.
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