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Patient Characteristics

Patient Characteristics

Burn injuries do not affect all people equally. Certain conditions make it more or less likely that an individual will be able to recover from a burn injury and greatly impact the speed of any recovery. The physical condition of a patient has a significant impact on the body’s ability to fight off infection and heal itself. Burn injuries also take a toll on patients mentally and emotionally making the patient’s mental condition an important factor of recovery.

Physical Conditions

It shouldn’t come as a surprise that an individual’s physical condition can have an impact on the extent of a burn injury. Body changes over time as well as differences between people are bound to have an impact on the extent of burn injuries and the associated recovery times. Age, the existence of other medical conditions, and mobility are all factors that affect burn injuries.

Age

Numerous studies have evaluated the impact that age has on burn injuries. A general conclusion is that age affects burn injuries on a sliding scale. Children are most vulnerable at birth and reach their highest level of resilience in their teenage years. The effect of age plateaus until around the age of forty when the body’s ability to repair itself begins to decline.

Young

Children account for nearly a quarter of all burn victims worldwide with most of these injuries occurring in children under the age of five. The American Burn Association defines “young” as burn patients under the age of ten. While this age group accounts for a high percentage of burns, the burns suffered tend to be more minor than those experienced by older individuals. In a study of over 1400 burn patients, children under the age of ten had the lowest average Total Body Surface Area and lowest accompanying inhalation injury percentages out of any age group.

But even though the burn injuries may not be as severe, burns can still have long term consequences on children. Burn injuries can affect the way a child develops and lead to life-long physical deformity. Not only do scars leave lasting marks, burns received during early years increase a child’s risk of mental illness. As a result, children who experience burn injuries need immediate care to facilitate recovery as well as continual check-ups to ensure that the burn injury leaves as little physical and mental damage as possible.

Old

For the purposes of burn injuries, the American Burn Association defines “old” as burn patients over the age of fifty. Burn patients who fall into this category are at an increased risk for adverse outcomes following a burn injury. The two predominant ways in which this risk manifests is increased mortality rate and longer hospital stays.

Statistical evidence of burn patients admitted to burn care centers from 2002 to 2011 confirms the American Burn Associations age distinction. For burns covering between 0.1-40% of TBSA, mortality rates were twice as high for patient’s in the 50-59.9 age group than for those in the 40-49.9 age group demonstrating a sharp incline at the age of 50. Using the full sample, patients in the 50 plus age group had mortality rates over five times greater than those under the age of 50.

The reason for the increased mortality rates among older burn patients is two-fold. First, the body’s natural repairing abilities begin to decrease with age. The skin naturally thins with age as the body has a more difficult time in constantly refreshing the epidermis with new cells. Furthermore, the body produces fewer white blood cells (the primary infection fighting cells within the body) with age. The result is increased opportunities for infection with less infection fighting capacity. This problem is exacerbated in burn injuries.

Second, older individuals are at a higher risk of already having pre-existing medical conditions. As discussed more fully below, pre-existing medical conditions further decrease the body’s natural healing mechanisms and leave the burn patient vulnerable to serious complications.

Pre-existing Conditions

Burn injuries often cause damage that can aggravate or intensify pre-existing medical conditions. For example, flame burns are often accompanied by inhalation injuries which make breathing more difficult. For individuals with respiratory illness, inhalation injuries can cause an onset of the underlying condition.

Other conditions that are commonly complicated by burn injuries include heart conditions, kidney disease and diabetes. When it is already working to combat the pre-existing condition, the body has less capacity to protect itself and/or heal from burn injuries. Additionally, complications from burn injuries, such as blood loss or shock, are more likely to occur when the body is not functioning properly to begin.

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Physical Impairments

Burn injuries become more severe the longer the patient is exposed to the source of the burn. Often times, healthy individuals are able to completely avoid sustaining a burn injury by simply fleeing the area of potential danger. For example, healthy individuals often have little difficulty vacating a building that catches fire provided they are alerted early enough. The same is not always true for those who have physical impairments.

When an individual is bedridden, uses a wheelchair or other medical device for assistance (such as crutches), or cannot see or hear an alarm signaling danger; escaping the danger area takes longer and increases the individual’s risk of burn injury. Adding smoke and flames to the equation—as is often the case in fires—leads to disorientation and panic which make it even more difficult for the physically impaired to remove themselves from the situation.

To combat this issue, the American Disabilities Act (ADA) sets standards to assist during emergencies. One example is the area of rescue assistance (ARA) requirement within multistory buildings. ARAs are designated safe areas where individuals with impairments (physical or mental) can wait for help and are required generally required on each floor, other than the ground floor, of a multistory building. Another example is the requirement that there be both audible and visual alarms when emergency warning systems are provided.

Mental Impairment

In addition to providing guidelines to assist physically impaired individuals, the ADA guidelines apply to those with mental impairment as well. This is important as mental impairments can make individuals particularly susceptible to disorientation or panic in emergency situations.

Individuals with mental impairment are also more prone to accidental burns. The ADA sets guidelines for accommodations in public areas to help prevent accidental burns. For example, insulating pipes under sinks to prevent burns. The precautions recommended in public facilities are equally as effective when used in the home.

Mental and Emotional Conditions

More than 50 million Americans suffer from some sort of mental or emotional conditions, but only 36% are receiving treatment. This suggests that there is still a stigmatism attached to these types of conditions that prevents victims from seeking treatment. Not only does this not solve the issue, but it can further isolate the individual and worsen the problem.

Burn injuries commonly lead to the development of mental or emotional conditions in burn victims regardless of the victims’ previous condition. Mood and anxiety disorders make up over 25% of diagnosed mental conditions and are the most common conditions developed by burn victims.

Additionally, burn victims often suffer from Post-Traumatic Stress Disorder (PTSD), depending on the severity of the burn injury. It is normal for traumatic events to cause stress reactions; the body and mind need time to adjust. But stress reactions should heal with time. The U.S. Department of Veteran’s Affairs warns that symptoms lasting longer than four weeks indicate a high probability of PTSD. If symptoms last longer than four weeks, cause significant mental or physical distress, or disrupt home or work life, it’s time to seek professional assistance.

Mental conditions are often the result of too much or too little of certain chemicals in the brain. For example, too little serotonin can lead to depression and too much adrenaline can cause anxiety. Burn injuries can cause fluctuations in brain chemistry just as easily as they can cause tissue damage. Treatment for burn injuries should account for both of these effects.

Below is a list of common symptoms that burn patients may exhibit. If you are experiencing these symptoms or know of a burn victim who exhibits these symptoms, seek professional assistance.

  • Alcohol or drug abuse
  • Avoidance (people, places, or things associated with the burn injury)
  • Detachment (social withdrawal and isolation)
  • Difficulty sleeping (restlessness or night terrors)
  • Flashbacks
  • Suppression (inability to recall the traumatic event)

Burn Severity

The American Burn Association measures burn severity using burn classification, TBSA, and patient characteristics. Burn severity is broken into three categories: minor, moderate, and major. While there is certainly an increasing risk of mortality and complications associated with higher burn severity levels, it would be a mistake to assume that minor burns are risk free. A minor burn does not mean no professional medical assistance is necessary. Rather, burn severity helps medical professionals determine if specialized burn center treatment is warranted. Moderate and major burns are directed to burn centers while minor burns are often treated in regular hospitals.

Minor Moderate Major
Adults: < 10% TBSA Adults: 10–20% TBSA Adults: >20% TBSA
Children or seniors: < 5% TBSA Children or seniors: 5-10% TBSA Children or seniors: >10% TBSA
<2% second degree burns 2–5% second degree burns >5% second degree burns
Possible inhalation injury Known inhalation injury
Pre-existing health problems Injuries associated with burn
Burns to face, feet, hands or joints
Third – sixth degree burns

Sources

American Burn Association 2012 Annual Report

International Journal of Critical Illness and Injury Science

Journal of Investigative Dermatology

Journal of Neurology, Neurosurgery & Psychiatry

National Center for Biotechnology Information (1994 and 2011 studies)

Patient UK

Phoenix Society for Burn Survivors

Scientific American

WebMD

Our Attorneys

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Kirk Morgan

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Billy Walker

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Will Walker

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Chuck Slaughter

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Types of Burns

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Degrees of Burns

First , second , and third degree burns

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Burn Injuries

There are many types of burn injuries

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Scald Burn Injury

Caused when very hot liquids come into contact with skin

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Electrical Burns

Electricity can burn the skin and is capable of causing internal damage

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Chemical Burns

Caused when a strong acid or base comes into direct contact with skin

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Car/Boating Accidents

Thermal burns can occur if the car catches fire or explodes

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Gas Explosions

Caused when a gas leak combines with an ignition source

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Worker’s Compensation

If you've been burned on the job, you may need legal guidance

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E-Cigarette Burns

Can be caused by defective batteries or overheated vapor

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