LOUISVILLE, KY. — The high rate of serious burns among adults older than 65 years suggests a need for greater patient education and prevention programs for this age group, Dr. Palmer Q. Bessey reported at the annual meeting of the Central Surgical Association.
Physicians and parents know that children are at risk for burns, several members of the audience said. But older adults appear to be equally vulnerable to burn injuries requiring hospitalization.
Dr. Bessey gathered discharge diagnoses reported by all hospitals in California, Florida, New Jersey, and New York for patients with ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification) diagnostic codes for burns during 2000–2004. The number of burns requiring hospitalization by state were as follows: 24,925 (California), 18,872 (New York), 12,445 (Florida), and 5,742 (New Jersey).
Except for the very young, the hospitalization rate for burns increased with age. This situation is different from other forms of trauma, in which the peak rate of hospitalization is in the late teens and early 20s, said Dr. Bessey, professor of surgery at Weill Cornell Medical College, New York.
Serious burns occurred in children aged 0–4 years at an incidence of more than 350 per million people. Adults aged 85 years or older also had an incidence of serious burns of more than 350 per million, while those aged 75–84 years had an incidence of just under 250 per million.
Burns comprise no more than 4% of emergency department visits. But the case fatality rate rivals that of motor vehicle crashes and consumes large amounts of health care resources, because burn patients require the longest hospital length of stay of all injuries reported in the National Trauma Data Bank, Dr. Bessey noted.
In the subset of patients for whom data on the type and extent of burn injury were available, more than half of the discharge diagnoses were for scalding burns and one-third were for flame burns, he reported.
Most burns occupied a small fraction of total body surface area: About 75% of burns occupied 0%–9% of total body surface area, while 15% of burns cover 10%–19% of total body surface area and 10% cover 20% or greater total body surface area.
Scalding burns occurred in significantly more children under age 15 than adults aged 65 or older (63% vs. 38%). But flame or inhalation burns were nearly three times as likely to occur in older adults as in children. Older adults also had more than twice the risk of receiving large burns, compared with children.
Older adults could be at high risk for burns because of their failure to respond to a fire or burn hazard. They may be less able to move out of the way quickly if water suddenly becomes very hot in the shower or if hot water is spilled, Dr. Bessey said.
Prevention programs could target potential hazards such as old hot-water heaters, which may be present in the homes of older adults who have lived in one place for a long time, he said.
Although burn prevention has usually been the domain of pediatricians, an education campaign among physicians such as internists or geriatricians would be worthwhile, Dr. Bessey said.
Prevention efforts and educational programs directed toward physicians and the public are needed, in order to reduce serious burn injuries in elderly persons. Craig Reinaker