Outlook for Survival and Recovery - Burn Injury

Outlook for Survival and Recovery

Great strides in research have helped to increase the survival rate of burn victims. Mortality has fallen to levels never thought possi-ble. Hunt et al. (2000) reported that survival following large burns based on total body surface area (TBSA) appears to have leveled off. Persons older than 70 years are surviving burns of 30% TBSA; those 60 to 70 years of age, 50% TBSA; those 20 to 30 years of age, 80% TBSA; and those 2 to 5 years of age, 75% TBSA. Re-search in areas such as fluid resuscitation, emergent burn treat-ment, inhalation injury treatment, and changes in wound care practice with early débridement and excision have contributed greatly to the decrease in burn deaths. Additionally, a better under-standing of the importance of adequate nutritional support has contributed to increased survival rates. Very young and very old people have a high risk of death after burn injuries due to imma-ture and stressed immunologic systems and pre-existing medical conditions, respectively. Chances of survival are greater in children older than age 5 and in adults younger than age 40. Inhalation in-juries in combination with cutaneous burns worsen the prognosis. Outcome depends on the depth and extent of the burn as well as on the pre-injury health status and age of the patient. Acute care of patients with burn injuries has improved to the point at which survival is expected for most patients, and the burn team has shifted its focus to long-term outcomes for these patients.

Gerontologic Considerations

Reduced mobility, changes in vision, and decreased sensation in the feet and hands place elderly people at higher risk for burn in-jury; scalds and flames are the leading causes. These changes also place older people at risk for suffering a severe burn because they have difficulty in extinguishing the fire and removing themselves from the burn source.

Morbidity and mortality rates associated with burns are usu-ally greater in elderly patients than in younger patients. Thinningand loss of elasticity of the skin in the elderly predispose them to a deep injury from a thermal insult that might cause a less severe burn in a younger person. Moreover, chronic illnesses decrease the older person’s ability to withstand the multisystem stresses imposed by burn injury.

An important goal of nurses in community and home settings is preventing burn injury, especially among the elderly. Nurses need to assess an elderly patient’s ability to perform activities of daily living safely, assist elderly patients and families to modify the environment to ensure safety, and make referrals as needed.