Impact of Total Body Surface Area Burn Injuries on Clinical Outcomes and Comorbidities in Elderly Patients Aged Over 65

Abstract

Introduction: Burn injuries are associated with high mortality and morbidity, especially in the elderly population. Although burns are preventable, they account for the fourth most common cause of trauma worldwide. The majority of the mortality associated with burn victims is also seen in the elderly age group. Most mortality predictor scores focus on age and total body surface area (TBSA) burned. However, data focusing specifically on elderly populations with respect to TBSA, particularly within the Appalachian region, remain limited. This rough terrain is accompanied by multiple challenges and health care disparities with limited burn care access. The population was a significant portion of the elderly who have multiple comorbidities; the majority of the population are economically struggling, living in rural communities, and the state of West Virginia (WV) is considered to have the highest drug use/addiction in the country. It is not shocking that they have the worst health outcomes in the nation.

Aim: This study aims to evaluate the impact of TBSA burn on clinical outcomes and comorbidities in elderly burn patients within Appalachia.

Materials and methods: Cabell Huntington Hospital, the only burn intensive care unit (BICU) in WV, was investigated in this retrospective study. This cohort study analyzed data from 198 patients aged 65 and older admitted to the BICU between January 2017 and January 2023. Data included demographic variables, TBSA burned, comorbidities, and outcomes. Statistical analyses assessed relationships between TBSA and age, gender, length of hospital stay, discharge status, chronic obstructive pulmonary disease (COPD), smoking history, diabetes mellitus (DM), BMI, and inhalation injury. Different statistical analyses were used to analyze the relationship between TBSA and the variables of interest.

Results: Our result section indicated that the majority of the elderly patients with burns were males (65%); however, there was no statistical difference between genders and TBSA (p=0.86). The group with higher TBSA was more likely to have COPD (p<0.0001), use home oxygen (p<0.0001), and have inhalation injury on presentation (p=0.002). Older age was associated with higher TBSA burn (p=0.003), with each one-year increase in age, TBSA burned in our population increased by 0.46% (p=0.002). The group with higher TBSA had higher mortality with a significance (p<0.0001). The annual mortality rate for burn victims above the age of 65 in the Appalachia sole BICU is 14 patients per 100. Our study was not able to find any significance for hospital duration, source of burn, presence of DM, or BMI with TBSA burned.

Conclusion: This study in a unique population base will allow clinicians to understand the elderly burn victim in this underserved area of Appalachia, resource-limited and comorbidity-burdened population. This will allow for targeted interventions to improve outcomes in this vulnerable demographic.

Keywords: appalachia; burn injuries; burn outcomes; elderly patients; resource allocation; tbsa.