Redefining the concept of the elderly burn patient: Analysis of a multicentre international dataset.

Authors

Nina C Dempsey, Kayvan Shokrollahi, Laura Cappuyns, Ascanio Tridente, Daren K Heyland

Published in

Burns : journal of the International Society for Burn Injuries. Volume 51. Issue 5. Pages 107468. Mar 28, 2025. Epub Mar 28, 2025.

Abstract

The elderly are highly vulnerable to major burn injuries. Typically, 'elderly' is accepted as ≥ 65 years of age. This cut-off is arbitrary, lacks a robust evidence base and is potentially damaging from a clinical-decision-making perspective. The study objective was to utilise a large international dataset of major burns to stratify mortality risk by age and objectively define 'elderly' patients with significantly higher risk of poor outcome.
We performed a sub-analysis of the RE-ENERGIZE clinical trial dataset. RE-ENERGIZE included 1200 patients admitted to 54 burn centres worldwide with 2nd and/or 3rd degree burns, who were expected to require skin grafting. In a first-of-its-kind age stratification study, we stratified major burns patients by five-year age intervals. Logistic regression and Cox proportional hazards analyses were performed with three-month mortality and time-to-discharge-alive (TTDA) as the primary and secondary outcomes.
Three-month mortality was 15.41 %. Age was associated with three-month mortality upon multivariable logistic regression analysis (p = 0.000, OR=1.06, CI=1.05-1.08), independently of total burn surface area burned (TBSA%), Acute Physiology and Chronic Health Evaluation II (APACHE II) and Charlson Comorbidity Index (CCI). Age 80 + was independently associated with increased mortality and TTDA, when compared to all referent 5-year age groups (p ≤ 0.000-0.043). The Lethal Dose 50 (LD50) for the 80 + group was 20.5 %.
We present a new threshold of risk stratification in patients with major burns; Patients ≥ 80 years have a significantly poorer outcome, irrespective of injury severity, resultant critical illness severity, and variables including comorbidities, which has implications for prognostication and management decisions.

PMID:
40288004
Bibliographic data and abstract were imported from PubMed on 28 Apr 2025.

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