Although thermal injuries are less common than others, and their frequency remains the same, their after-effects – such as mortality, permanent damage and long, painful and expensive treatment – are among the worst of all injuries. Therefore it is very important to concentrate not only on treatment but also on prevention and the provision of adequate first aid.
MATERIAL AND METHODS
Every year about 1% of the population is treated for some kind of burn injury. 97% of them are outpatients, while about 3% have to be admitted to hospital. Over the last five years senior citizens over the age of 65 have constituted more than 12% of all patients admitted to the Prague Burn Centre. There were about a third more females than males. The demographic situation in Czech Republic suggests that the number of senior citizens has been growing each year since 2002. According to the STEM Agency (Centre of Empiric Research), from 2006 our population has been defined as regressive, with elderly women over-represented. The proportion of elderly people above 60 is now constant at 18%, but according to the demographical prognosis it will start to grow. We can assume that this group represents a very important sector of the population, which will grow bigger and whose needs are specific.
The average age of senior citizens admitted for treatment from 2005 to 2008 has increased (Graph 1).
Prague Burn Centre is the oldest and biggest burn superconsultant workplace in the Czech Republic, with a catchment area comprising the whole of Bohemia, home to approximately seven million people.
The age structure of the senior citizens hospitalized in the Prague Burn Centre between 2005 and 2008 is indicated in Graph 2. People from 65 to 85 are the largest group. The lower number of people over 85 years of age corresponds to the smaller lower number of elderly people above that age. 291 senior citizens were hospitalized in the Prague Burn Centre from 2005 to 2008; the female to male ratio was 1:0.77.
The specific causal factors of burns to senior citizens are the physical (immobility, locomotive dyscoordination), the psychological (anxiety, involutional depression, resignation, dementia) and health anamnesis (cardiovascular, respiratory, metabolic, neurological co-morbidities) (1, 2). Graph 3 shows the occurrence of cardiovascular diseases (ischemic heart disease, hypertension), diabetes mellitus, the most frequent neurological diseases (cerebrovascular dementia, morbus Alzheimer, epilepsy) chronic corticotherapy in our patients. The most frequent causes of mortality are prolonged burn shock, heart failure, pulmonary embolism, sepsis – multiple organ dysfunction – failure (Table 1). It is apparent that the most common comorbidity factors in our patients were diseases of the cardiovascular system. Prolonged burn shock, heart failure and lung embolism are the most frequent causes of death.
The most common mechanism of burn injuries in seniors are the scorches and scalds (Fig. 1–3), while other relatively frequent causes are the non-thermal (trophic defects, skin tumors or general skin bullate affections such as exfoliative epidermolysis) – Table 2, Graph 4.
Severity of burn injuries is determined by the location. The locations with the highest risk are the head, neck, genitals and inhalatory trauma (Graph 5).
The most consequential prognostic factors determining the severity of burn injuries are the extent (Table 3, Graph 6) and the depth of burns (Graph 7).
The most common injuries are up to 5% of the body surface area (TBSA). However, we should note that injuries above 15% of TBSA comprise about 30% of cases. The most frequent depth is IIb.
The most common therapy is necrectomy with autotransplantation. Xenotransplantation was used till 2005 (Table 4, Graph 8). Average time before arrival for special treatment was 1.15 days. The average length of hospital stay during 2005–2008 was 27.66 days (Graph 9).
According to demographic research, the population is getting older. Because the subpopulation of seniors will grow in the coming years, it is crucial to create and put into practice systematic methods of prevention of thermal injuries. The senior population is a specific group characterized by polymorbidity and impaired course of healing. One very frequent problem is to establish whether the injury is the cause or result of another disease. About 20 % of thermal injuries result from inadequate safety provisions in the home. The kitchen, bathroom and garden are the most high-risk places. The prevention of injuries of this sort, in the home, entails a complex of structural changes, the usage of protective instruments and procedures, and the education of family members. Procedures to reduce the dangers of post-traumatic effects need not be overly complex: cooling and timely transport to a facility offering special treatment is sufficient. As many of 65% of senior citizens who suffer such injuries are capable of resuming an independent lifestyle afterwards.
291 senior citizens were hospitalized in the Prague Burn Centre from 2005 to 2008; the female to male ratio was 1:0.77. The average age of people who were admitted increased from 70 to 75 without an increase in mortality. The etiology of burns, their localizations and depth, TBSA distribution, the occurrence of associated diseases and average hospital stay did not show any significant variation throughout the period of 2005 to 2008. We can observe a significant increase in the use of radical surgery methods (p > 0.10), necrectomy and auto-transplantation in comparison with conservative methods. This correlates with a mild rise in III degree burns.
Address for correspondence:
Monika Tokarik, M.D.
Prague Burn Centre, Third Faculty of Medicine,
Charles University Prague
Faculty Hospital Královské Vinohrady
100 34 Prague 10
1. Brož L. Popáleniny u seniorů, Česká geriatrická revue, 1/2008, p. 48–51.
2. Wong P. Elderly burn prevention: A novel epidemiological approach, Burns, 33, 2007, p. 995–1000.