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21
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(ISSN
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ABSTRACT
The results of a survey of 522 elderly and senile patients with burn disease are presented. In victims of 60 years and
older, burn shock develops with an area of deep skin damage up to 5% of the div surface against the background
of concomitant diseases and is characterized by a significant severity of the course. Concomitant diseases were
detected in 98% (in 511 out of 522) of patients in whom diseases of the cardiovascular and pulmonary systems
predominated, and in a number of patients (33.9%) there was a combination of several concomitant diseases.
KEYWORDS
Burn disease, elderly and senile age.
INTRODUCTION
Thermal lesions in elderly and senile people is a
complex medical problem, where the leading role
belongs to age-related changes in the div and
associated disorders of the microcirculation process,
metabolic processes, pathological changes in internal
organs and systems [3, 5, 8].
Elderly and senile people are at risk for thermal injury.
Age, burn area, interval between injury and admission
to the burn center, comorbidities are the main factors
that determine the severity of the injury and affect the
prognosis and treatment tactics [1, 4, 6, 10].
Research Article
SOME ASPECTS AGGRESSING BURN DISEASE IN ELDERLY AND SENILE
PATIENTS
Submission Date:
June 01, 2023,
Accepted Date:
June 06, 2023,
Published Date:
June 11, 2023
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume03Issue06-05
Daminov Feruz Asadullaevich
Samarkand State Medical University, Samarkand, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 03 Issue 06-2023
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International Journal of Medical Sciences And Clinical Research
(ISSN
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03
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OCLC
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1121105677
Publisher:
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The current demographic situation in developed
countries is characterized by a decrease in the birth
rate and the aging of the population [2, 5, 7, 9].
The general aging of the population of the Republic of
Uzbekistan has a clear upward trend. This is reflected
by an increase in the number of elderly and senile
patients in burn centers, whose proportion reaches 1/3
or more of all hospitalized patients [1, 3, 6]. There is an
opinion that comorbidity in elderly and senile patients
reduces their resistance to operational stress [1].
Purpose of the study.
To study the epidemiological
features of burn disease in elderly and senile patients.
RESEARCH MATERIALS
In the burn department of the Samarkand branch of
the Republican scientific center for emergency medical
care in the period 2000-2022 522 elderly and senile
patients were treated with burn disease. The terms of
admission of patients from the moment of receiving a
burn varied from 6 hours to 25 days, which are
presented in table 1.
Table 1. Terms of admission of patients to the clinic after receiving a thermal injury
Time from the moment of receiving a burn to admission to
the clinic
Total
abs.
%
First 6 hours
101
19,3
From 6 to 12 hours
72
13,7
From 13 to 24 hours
51
9,8
From 25 to 48 hours
49
9,4
From 2 to 3 days
73
13,9
From 4 to 5 days
71
13,6
From 6 to 10 days
40
7,6
From 10 to 25 days
67
12,7
Total
522
100
When analyzing the data in Table. 1 it turned out that
for victims of elderly and senile age, late seeking
medical help is typical (345). During the first three days
after the injury, out of 522 patients, 346 (66.3%) victims
applied. Reasons for late admission: subjective
underestimation of the severity of the injury by the
victims (in 72 patients), decreased pain sensitivity in
the area of deep burns, unwillingness to be
hospitalized (in 32 patients), helplessness (among
single patients - 23 patients), etc. Late admission
Volume 03 Issue 06-2023
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VOLUME
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negatively affects both the general condition of such
patients , and during the course of the wound process,
and also significantly narrows the possibilities of early
surgical necrectomy and requires the use of other
methods of surgical treatment (398).
Approximately half of the patients with burns (42.9%)
were admitted within the first 24 hours after injury,
which made it possible to follow the dynamics of the
clinical course, determine the most optimal volumes of
infusion-transfusion therapy and evaluate its effect on
the condition of the victim, to carry out in dynamics,
starting from the first hours after injury, studies to
assess the degree of dysfunction of vital organs and
systems.
Patients aged 60 to 92 were treated. The mean age
was 73.3±0.41 years. According to the WHO
classification (1972), patients were distributed by age
as follows:
-
Elderly patients (60-74 years old) - 217;
-
Patients of senile age (75-89 years old) - 300;
-
Centenarians (90 and older) - 5 people.
The distribution of patients by age categories is shown
in Fig. 1. 1, it is shown that the frequency of adverse
outcome increases progressively with age. So, from
Fig.1 shows that the death rate in elderly patients (up
to 75 years) is 12.90% (28 deaths out of 217), and in
senile patients - 23.33% (70 out of 300). In the group of
centenarians, the lethality was 100%, which is probably
due to the small size of the group (5 people).
Fig 1. Distribution of patients by age group and outcome
189
230
28
70
5
0
50
100
150
200
250
300
60-74 лет
75-89 лет
90-92 года
умершие
выжившие
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According to the nature of the impact of the damaging
factor, burns with boiling water (33.7%), hot food
(26.8%) and flame (15.5%) prevailed. Among the elderly,
burns were mainly of a domestic nature (in 515-98%).
According to our observations, helplessness and poor
coordination were important factors contributing to
the high incidence of burns in the elderly, especially
those over the age of 75 years (62.6%) from 55.4 to
62.7%. The etiology of burns and the age of patients are
presented in Table 2.
Table 2. Causes of burns and age of patients
Causes of burns
Age of patients
Total
60-74 years
75-89
90 years and
older
Аbs.
%
Аbs.
%
Аbs.
%
Аbs.
%
Boiling water
29
5,5
147
28,2
176
33,7
Hot food
76
14,5
59
11,3
5
0,96
140
26,8
Flame
60
11,5
21
4,0
81
15,5
Hot items
22
4,2
41
7,8
63
12,1
Steam
29
5,5
26
4,9
55
10,5
Chemical substances
4
0,8
4
0,8
Electric trauma
1
0,2
2
0,4
3
0,6
Total
217
41,6
300
57,5
5
0,96
522
100
Among the burned elderly and senile age, there were
from 59 to 60.3% of women and from 39.7 to 41% of
men. The age of the majority (58.4%) of the victims is
from 75 to 92 years. Urban residents accounted for 308
(59%), and rural residents - 214 (41%) patients.
In accordance with the recommendations of the
National Burn information Exchange - NBIE (Feller I.
1976), two age levels (60-74 and 75-92 years), five levels
of deep burn area (up to 5%, 6-10%, 11- 20%, 21-30% and
more than 30% b.t.).
To determine the burn area at which 50% death of
patients is observed (lethal area, LA50), probit analysis
was used, which is based on a two-dimensional linear
regression equation by the least squares method (Bull
J. P., Squire J. R., 1949; Pruitt B. Jr. et al ., 1964).
The total number of chronic diseases and pathological
conditions per patient in the group was calculated
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Publisher:
Oscar Publishing Services
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(based on the conclusions of a general practitioner,
neuropathologist, urologist, psychiatrist, etc.).
To characterize the severity of lesions, several
indicators are used: the total area of the burn, the area
of deep lesions and the assessment in arbitrary units
according to the Frank coefficient (G. Frank, 1960).
The area of the burn was determined by the method
of "nine" (A.B. Wallace, 1951). Burns up to 30% of the
div surface were in 370 (71%) patients, 30% or more in
152 (29%) patients (Table 3).
Table 3. The total area of the lesion and the age of the victims (group I)
Total affected
area
Age of patients
Total
60-74 years
75-89 years
90 years and
older
Аbs.
%
Аbs.
%
Аbs.
%
Аbs.
%
Up to 10
92
17,6
93
17,8
185
35,4
11-20
42
8,0
68
13,0
110
21,1
21 -30
27
5,2
48
9,2
75
14,4
31-40
26
4,9
38
7,3
64
12,3
41-50
8
1,5
22
4,2
30
5,7
51-60
13
2,5
11
2,1
1
0,2
25
4,8
61-70
7
1,3
14
2,7
3
0,6
24
4,6
More than 70
2
0,4
6
1,1
1
0,2
9
1,7
Total
217
41,6
300
57,5
5
0,96
522
100
The depth of skin lesions was determined by a four-degree classification adopted at the XXVII All-Union Congress of
Surgeons (A.A. Vishnevsky et al., 1960). The area of a deep burn and the age of the burnt are shown in Table 4.
Table 4. Deep burn area and age of patients
Deep burn
area, %
Age of patients
Total
60-74 years
75-89 years
90 years and
older
Аbs.
%
Аbs.
%
Аbs.
%
Abs.
%
Up to 5
55
10,5
163
31,2
218
41,8
6-10
70
13,4
68
13,0
138
26,4
11-15
44
8,4
34
6,5
78
14,9
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16-20
21
4,0
18
3,4
39
7,5
21-30
16
3,1
11
2,1
2
0,4
29
5,5
31-40
7
1,3
6
1,1
13
2,5
More than 40
4
0,8
3
0,6
7
1,3
Total
217
41,6
300
57,5
5
0,96
522
100
90.6% of patients had deep burns up to 20% of the div
surface (in 473 out of 522). In a state of burn shock of
varying severity, 324 (62.1%) out of 522 elderly and
senile patients with burns II-IIIAB-IV degree 10-55% b.t.
were admitted. (IIIB-IV degree from 5 to 40% b.t.),
admission time - the first day after the injury.
The stage of acute burn toxemia (AOT) was diagnosed
in 169 patients (77.9%) who survived the stages of
shock (70) and were admitted on days 3-8 after injury
with burns II-IIIAB-IV degree 5-50% b.t., IIIB- IV degree -
5-40% b.t. Septicotoxemia was noted in 21 patients
(40.4%) of all patients with burns.
The severity of burn disease is determined mainly by
the area and depth of the lesion. Both indicators are
reflected by us using the Frank index. At the same
time, burns with a Frank index of up to 30 were in 186
(35.6%) patients, from 31 to 60 - in 150 (28.7%) victims,
from 61 to 90 - in 118 (22.6%) patients, from 91 to 120 -
in 22 (4.2%), from 121 to 150 - in 35 (6.8%) victims and
over 150 in 11 (2.1%) patients (Fig. 2). Burned patients
with a favorable prognosis (FI up to 60 units)
accounted for 64.3%, doubtful and unfavorable (FI over
60 units) - 35.7%.
1 group, IF <30
ed, 186, 36%
2 group, IF 31-
60 ed, 150, 29%
3 group IF 61-
90 ed, 118, 22%
4 group, IF
more 90 еd, 68,
13%
1 group, IF <30 ed
2 group, IF 31-60 ed
3 group IF 61-90 ed
4 group, IF more 90 еd
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Fig. 2. Distribution of patients into groups in accordance with the Frank index
The distribution of victims according to the location of burns for which they were treated is presented in Table 5. In
the observed patients, burns of the torso prevailed (73.3%), which is probably due to impaired coordination of
movements in elderly patients.
Table 5. Localization of burns and age of patients
Localization of burns
Age of patients
Total
60-74 years
75-89 years
90 years and
older
Аbs.
%
Аbs.
%
Аbs.
%
Аbs.
%
Head and neck
8
1,5
30
5,7
38
7,3
Chest
39
7,5
79
15,1
3
0,6
121
23,2
Belly
68
13,0
72
13,8
2
0,4
142
27,2
Back
61
11,7
59
11,3
120
22,9
Upper limbs
19
3,6
30
5,7
49
9,4
Lower limbs
15
2,9
23
4,4
38
7,3
Buttock
7
1,3
7
1,3
14
2,7
Total
217
41,6
300
57,5
5
0,96
522
100
No less important influence on the nature of the treatment of burn disease and its outcomes is exerted by concomitant
diseases identified in 98% (in 511 out of 522) of elderly and senile patients (Table 6).
The study took into account only serious diseases that could in one way or another affect the outcome and treatment
tactics.
Table 6. Comorbidities identified in patients with thermal injury*
Premorbid background
Age of patients
Total
60-74
years
75-90
years
90 years and
older
abs.
%
General atherosclerosis, coronary-cardiosclerosis,
coronary artery disease
128
279
2
409 42,9
Hypertension
88
87
3
178 18,7
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Chronic bronchitis, emphysema,
pneumosclerosis, pulmonary tuberculosis
12
73
85
8,9
Diabetes mellitus
25
34
59
6,2
Disease of the nervous system
3
9
12
1,2
Chronic hepatitis, liver cirrhosis, hron.
alcoholism
16
13
29
3,0
Benign prostatic hyperplasia, kidney disease
52
16
68
7,1
Peptic ulcer of the stomach and duodenum
52
48
100 10,5
Malignant neoplasms
7
6
13
1,4
Total
383
565
5
953 100
* - The amount exceeds the total number of patients, because 21.5% of patients suffered from 2 diseases, and 33.9% -
from three or more diseases.
As can be seen from the presented table 6, diseases of
the cardiovascular and pulmonary systems prevailed in
patients, and a number of patients had a combination
of several concomitant diseases.
CONCLUSIONS
1. For victims of elderly and senile age, late seeking
medical help is typical (66.1%). Late admission
negatively affects both the general condition of such
patients and the course of the wound process, and also
significantly reduces the possibility of early surgical
necrectomy and requires the use of other methods of
surgical treatment (76.2%).
2. Burn shock in victims aged 60 years and older
develops with an area of deep skin damage up to 5%
of the div surface against the background of
concomitant diseases and is characterized by a
significant severity of the course, which is
characterized by severe disorders of cardiac activity,
external respiration function, liver, kidneys and other
vital organs and systems.
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1121105677
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Oscar Publishing Services
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