{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T03:13:53Z","timestamp":1789182833949,"version":"build-2803163510"},"reference-count":37,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2020,10,22]],"date-time":"2020-10-22T00:00:00Z","timestamp":1603324800000},"content-version":"vor","delay-in-days":295,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003503","name":"Dutch Burns Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003503","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>In modern-day burn care, advanced age remains an important predictor for mortality among burn victims. In this study, we compared the complete treatment trajectory (including pre-hospital and surgical treatment) and the outcomes between an elderly burn population and a younger adult burn population.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In this nationwide study, data from the Dutch Burn Repository were used. This is a uniform national registration for Dutch specialized burn care. All adult patients that were admitted to one of the three Dutch burn centres from the period 2009 to 2015 were included in the analysis. Burn patients were considered as elderly when \u226565\u00a0years of age, and were then further subdivided into three age categories: 65\u201374, 75\u201385 and 85+ years. Younger adults in the age category 18\u201364\u00a0years were used as the reference group.<\/jats:p>\n                  <jats:p>Surgical management was studied comprehensively and included timing of surgery, the number of procedures and details on the surgical technique, especially the technique used for debridement and the grafting technique that was applied.<\/jats:p>\n                  <jats:p>For the comparison of clinical outcome, the following parameters were included: mortality, wound infections, length of stay\/TBSA (total body surface area) burned, discharge disposition and secondary reconstructions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>During the study period, 3155 adult patients were included (elderly, n\u00a0=\u2009505). Burn severity, reflected by the median TBSA, varied between 3.2\u20134.0% and was comparable, but aetiology and pre-hospital care were different between elderly and the younger adult reference group.<\/jats:p>\n                  <jats:p>Surgical treatment was initiated significantly faster in elderly burn patients (p\u2009&amp;lt;\u20090.001). Less selective techniques for surgical debridement were used in the elderly burns patients (hydrosurgery, 42.0% vs 23.5\u201322.6%), and on the other hand more avulsion (5.3% vs 7.3\u201317.6%) and primary wound closure (6.7% vs 24.5%). The most frequently used grafting technique was meshed skin grafts (79.2\u201388.6%); this was not related to age.<\/jats:p>\n                  <jats:p>Mortality increased rapidly with a higher age and showed a high peak in the 85+ category (23.8%). Furthermore, considerable differences were found in hospital discharge disposition between the elderly and the reference group.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In conclusion, elderly burn patients who require specialized burn care are vulnerable and medically challenging. Differences in aetiology, comorbidity, physiology and the management prior to admission possibly affect the initial surgical management and result in significantly worse outcomes in elderly. Elderly patients need optimal, timely and specialized burn care to enhance survival after burn injuries.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/burnst\/tkaa027","type":"journal-article","created":{"date-parts":[[2020,6,16]],"date-time":"2020-06-16T11:09:32Z","timestamp":1592305772000},"source":"Crossref","is-referenced-by-count":49,"title":["Burns in the elderly: a nationwide study on management and clinical outcomes"],"prefix":"10.1093","volume":"8","author":[{"given":"Harold","family":"Goei","sequence":"first","affiliation":[{"name":"Association of Dutch Burn Centres, Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands"},{"name":"Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, VU University Medical Centre, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margriet E","family":"van Baar","sequence":"additional","affiliation":[{"name":"Association of Dutch Burn Centres, Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Dokter","sequence":"additional","affiliation":[{"name":"Burn Centre Maasstad Hospital, Rotterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Vloemans","sequence":"additional","affiliation":[{"name":"Burn Centre Red Cross Hospital, Beverwijk, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerard I J M","family":"Beerthuizen","sequence":"additional","affiliation":[{"name":"Burn Centre, Martini Hospital, Groningen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther","family":"Middelkoop","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, VU University Medical Centre, Amsterdam, the Netherlands"},{"name":"Association of Dutch Burn Centres, Burn Centre Red Cross Hospital, Beverwijk, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kees H","family":"van der Vlies","sequence":"additional","affiliation":[{"name":"Burn Centre Maasstad Hospital, Rotterdam, the Netherlands"},{"name":"Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Dutch Burn Repository group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,10,22]]},"reference":[{"key":"2020102205145785700_ref1","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1016\/j.burns.2015.04.008","article-title":"Outcomes of burns in the elderly: revised estimates from the Birmingham burn Centre","volume":"41","author":"Wearn","year":"2015","journal-title":"Burns."},{"key":"2020102205145785700_ref2","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1016\/j.burns.2005.06.006","article-title":"A three decade analysis of factors affecting burn mortality in the elderly","volume":"31","author":"Lionelli","year":"2005","journal-title":"Burns."},{"key":"2020102205145785700_ref3","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1016\/j.burns.2007.06.010","article-title":"A three-decade review of thermal injuries among the elderly at a regional burn Centre","volume":"34","author":"Macrino","year":"2008","journal-title":"Burns."},{"key":"2020102205145785700_ref4","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1097\/BCR.0B013E318093E45E","article-title":"Burns at the extremes of age","volume":"28","author":"Sheridan","year":"2007","journal-title":"J Burn Care Res."},{"key":"2020102205145785700_ref5","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/j.burns.2015.12.008","article-title":"Threshold age and burn size associated with poor outcomes in the elderly after burn injury","volume":"42","author":"Jeschke","year":"2016","journal-title":"Burns."},{"key":"2020102205145785700_ref6","author":"World Health Organisation"},{"key":"2020102205145785700_ref7","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1016\/j.burns.2007.03.017","article-title":"Elderly burn prevention: a novel epidemiological approach","volume":"33","author":"Wong","year":"2007","journal-title":"Burns."},{"key":"2020102205145785700_ref8","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1016\/j.burns.2011.06.005","article-title":"Epidemiology of burns throughout the world. Part I: distribution and risk factors","author":"Peck","year":"2011","journal-title":"Burns."},{"key":"2020102205145785700_ref9","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1016\/j.surg.2006.07.029","article-title":"The vulnerabilities of age: burns in children and older adults","volume":"140","author":"Bessey","year":"2006","journal-title":"Surgery."},{"key":"2020102205145785700_ref10","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1016\/j.burns.2006.03.024","article-title":"Aetiology and outcome of burns in the elderly","volume":"32","author":"Rao","year":"2006","journal-title":"Burns."},{"key":"2020102205145785700_ref11","doi-asserted-by":"crossref","first-page":"1617","DOI":"10.1016\/j.burns.2015.08.029","article-title":"Burns in the elderly: mortality is still a relevant outcome","volume":"41","author":"Wearn","year":"2015","journal-title":"Burns."},{"key":"2020102205145785700_ref12","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1097\/BCR.0000000000000094","article-title":"Comorbidity-polypharmacy score predicts in-hospital complications and the need for discharge to extended care facility in older burn patients","volume":"36","author":"Justiniano","year":"2015","journal-title":"J Burn Care Res."},{"key":"2020102205145785700_ref13","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1097\/BCR.0b013e31825aeaac","article-title":"Long-term functional outcomes in the elderly after burn injury","volume":"33","author":"Palmieri","year":"2012","journal-title":"J Burn Care Res."},{"key":"2020102205145785700_ref14","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1097\/BCR.0000000000000216","article-title":"Predictors of discharge disposition in older adults with Burns: a study of the burn model systems","volume":"36","author":"Pham","year":"2015","journal-title":"J Burn Care Res."},{"key":"2020102205145785700_ref15","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/BCR.0000000000000190","article-title":"Frailty score on admission predicts outcomes in elderly burn injury","volume":"36","author":"Romanowski","year":"2015","journal-title":"J Burn Care Res."},{"key":"2020102205145785700_ref16","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1097\/00005373-199004000-00011","article-title":"An early surgical approach to burns in the elderly","volume":"4","author":"Kara","year":"1990","journal-title":"J Trauma"},{"key":"2020102205145785700_ref17","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/0305-4179(85)90036-1","article-title":"A policy of early excision and grafting in elderly burn patients shortens the hospital stay and improves survival","volume":"2","author":"Deitch","year":"1985","journal-title":"Burns Incl Therm Inj."},{"key":"2020102205145785700_ref18","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1097\/00006534-199809020-00013","article-title":"Early excision and grafting versus conservative management of burns in the elderly","author":"Kirn","year":"1998","journal-title":"Plast Reconstr Surg."},{"key":"2020102205145785700_ref19","doi-asserted-by":"crossref","first-page":"2879","DOI":"10.1364\/OL.31.002879","article-title":"In vivo assessment of human skin aging by multiphoton laser scanning tomography","volume":"31","author":"Koehler","year":"2006","journal-title":"Opt Lett."},{"key":"2020102205145785700_ref20","doi-asserted-by":"crossref","first-page":"1058","DOI":"10.1016\/j.burns.2011.03.006","article-title":"Burns are more aggressive in the elderly: proportion of deep burn area\/total burn area might have a role in mortality","volume":"37","author":"Albornoz","year":"2011","journal-title":"Burns."},{"key":"2020102205145785700_ref21","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1016\/j.jamcollsurg.2005.11.002","article-title":"Age-dependent differences in survival after severe burns: a unicentric review of 1,674 patients and 179 autopsies over 15 years","volume":"202","author":"Pereira","year":"2006","journal-title":"J Am Coll Surg."},{"key":"2020102205145785700_ref22","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1097\/TA.0000000000000124","article-title":"External validation of the revised Baux score for the prediction of mortality in patients with acute burn injury","volume":"76","author":"Dokter","year":"2014","journal-title":"J Trauma Acute Care Surg."},{"key":"2020102205145785700_ref23","author":"The Netherlands Institute for Social Research"},{"key":"2020102205145785700_ref24","first-page":"76","volume-title":"Hoogewerf CJ. 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A meta-analysis and meta-regression of over 190,000 patients","volume":"7","author":"Moja","year":"2012","journal-title":"PLoS One."},{"key":"2020102205145785700_ref37","doi-asserted-by":"crossref","first-page":"1609","DOI":"10.1503\/cmaj.092220","article-title":"Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis","volume":"182","author":"Simunovic","year":"2010","journal-title":"CMAJ."}],"container-title":["Burns &amp; Trauma"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/burnstrauma\/article-pdf\/doi\/10.1093\/burnst\/tkaa027\/33981474\/tkaa027.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/burnstrauma\/article-pdf\/doi\/10.1093\/burnst\/tkaa027\/33981474\/tkaa027.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,10,22]],"date-time":"2020-10-22T09:15:10Z","timestamp":1603358110000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/burnstrauma\/article\/doi\/10.1093\/burnst\/tkaa027\/5934908"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1,1]]},"references-count":37,"URL":"https:\/\/doi.org\/10.1093\/burnst\/tkaa027","relation":{},"ISSN":["2321-3876"],"issn-type":[{"value":"2321-3876","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020]]},"published":{"date-parts":[[2020,1,1]]},"article-number":"tkaa027"}}