85 Elderly Respond Differently than Adults to the Initial Burn Injury, but are Treated the Same
Bibliographic record
Abstract
Survival of elderly burn patients remains unacceptably poor despite modern and protocolized burn care. The acute phase, defined as the first 96 hours after burn, includes the resuscitation period and influences subsequent outcomes and survival. As the acute phase response of elderly burn patients is essentially unknown, the aim of this study was to determine if the acute phase post-injury is significantly different in elderly patients compared to adult burn patients. We included all patients admitted with an acute burn injury with a total body surface area (TBSA) ≥ 20% burn to our burn centre from 2010–2016. Clinical and laboratory measures during the acute phase, defined as 96 hours post-injury, were compared between adult (aged <65 years) and elderly (aged ≥65 years) patients. Outcomes included clinical hemodynamic measurements, biomarkers, volume of fluid resuscitation, cardiac agents, and the inflammatory response, determined in plasma by cytokine profiling. Data were analyzed using the Student’s t-test, Mann-Whitney U test, and Fisher’s exact test. A total of 149 patients were included, with 126 adults and 23 elderly. Inhalation injury and % TBSA burn were not significantly different among adult and elderly patients. Despite similar amounts and composition of resuscitation and fluid output, elderly had significantly lower heart rates (p<0.05), cardiac index (p<0.05), MAP (p<0.05), PaO2/FiO2 (p<0.05), and pH, along with higher lactate (p<0.05). Organ biomarkers, particularly creatinine and BUN showed distinct differences between adults and elderly (p<0.05). Elderly had significantly lower levels of IL-6, MCP-1, MCP-3, MIP-1α and MIP-1β during the acute phase (p<0.05). Elderly patients were hypometabolic relative to adult patients, with greater glucose and lipid variability (p<0.05). Overall mortality was significantly higher in elderly patients (5% vs. 52%, p<0.0001). Injury severity was similar between adult and elderly burn patients, but the response to the burn injury during the acute phase after injury is distinctly different. The acute phase in elderly is characterized by cardiac depression, hypoperfusion, and hypo-inflammation. The attenuated acute phase response in elderly burn patients might contribute to subsequent increased organ failure and mortality. While elderly might be predisposed to worse outcomes, further work on the cellular level is warranted to identify potential novel approaches to treat elderly burn patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".