Thermal injury in the elderly: When is comfort care the right choice?

The factors contributing to a higher mortality rate in elderly thermal inju ry victims are not well delineated, The purpose of this study is to determi ne the impact of the initial injury, medical comorbidities, and burn size o n patient outcome and to determine a level of injury in this population whe n comfort care is an appropriate first choice. Individual medical records o f patients over 65 years of age admitted to our burn center over a 10-year interval were reviewed for patient demographics, mechanism of injury, total body surface area (TBSA) burned, medical comorbidities, use of Swan-Ganz c atheters, evidence of inhalation injury, level of support, and patient outc ome. The mechanisms of thermal injury were flame (68%), scald (21%) and ele ctrical or chemical contact (11%). Twenty-six preventable bathing, cooking, and smoking-related injuries were seen (33%). The average TBSA was 25 per cent. Average length of stay varied depending on outcome. The overall morta lity rate for this group was 45 per cent. Patients older than 80 years with 40 per cent or greater TBSA burned had a 100 per cent mortality rate despi te aggressive treatment. Burn wound size correlated better with probability of poor outcome than age. Thermal injuries in the elderly are becoming mor e important with the aging of our population. Underlying medical problems-s pecifically chronic obstructive pulmonary disease-do play a role in increas ed patient morbidity and mortality. This study shows that age greater than 80 years in combination with bums greater than 40 per cent TBSA are uniform ly fatal despite aggressive therapy. We believe that delaying the start of comfort-only measures in this situation only prolongs the pain and sufferin g for the patient, the family, and the physician.