E. Graetz1, S.M. Miller2, E.B. Schneider1, K. Gibbs3, A. Savetamal3 1Yale University School Of Medicine, Department Of Surgery Center For Health Services And Outcomes Research, New Haven, CT, USA 2Yale University School Of Medicine, Department Of Surgery, New Haven, CT, USA 3Bridgeport Hospital/Yale New Haven Health, Department Of Surgery, Bridgeport, CT, USA
Introduction: While the vast majority of burn injuries are survivable, patients with larger burns and advancing age are at higher risk for mortality. Advances in burn care have reduced mortality in younger patients, but reduction in mortality in older patients has been less pronounced. Older patients will often succumb to burn injury that is survivable in a younger patient. We have noted that many patients who succumb to burns do not receive specialized palliative care (PC). We set out to better understand how burn severity and age affect which patients receive PC.
Methods: We identified adults age ≥18 who were admitted with a primary diagnosis of burn injury in the National Inpatient Sample (2016-2021). We compared demographic and clinical characteristics between patients aged less than 65 and greater than or equal to 65. We further analyzed the characteristics of the subset of deceased patients with the same age grouping who received a palliative care consultation (PC). The proportion of patients receiving PC by percentage of total body surface area (TBSA) burned was calculated among all patients and among deceased patients.
Results: Of the 125,935 patients hospitalized with a primary burn diagnosis, 80.1% were under age 65 and 19.9% were over the age of 65. Between age groups, the proportional difference in TBSA group was similar (p=0.298, Table 1). Overall, 1.3% of patients under 65 received PC, while 7.2% of patients over 65 received PC. Among patients greater than 65 years of age, around half of patients with 60-79% TBSA and >80% TBSA received PC. In contrast, among patients under age 65, only 16.2% of patients with 60-79% TBSA and 34.8% of patients with TBSA >80% received PC (Table 1). Among deceased patients, proportion of patients under 65 receiving PC ranged from 32.9% to 51.7% in TBSA categories, whereas the proportion of patients over 65 receiving PC ranged from 49.3% to 59.1% (Table 1).
Conclusion: Severity of burns was comparably distributed between the two age groups. The proportion of patients receiving palliative care was substantially higher for those over 65 in all TBSA categories. Among deceased patients, the proportion of older patients receiving PC was higher in all TBSA categories except those with the lowest TBSA. Interestingly, the proportion of older patients with significant burns (>40% TBSA) who received PC did not increase dramatically compared to 20-39% TBSA burns, despite the enhanced risk of mortality from burn injury in the >65 age group. This suggests that palliative care is under-utilized in this elder population, and that the underlying sources of this discrepancy merit further investigation.