Redefining the concept of the elderly burn patient: Analysis of a multicentre international dataset
Bibliographic record
Abstract
BACKGROUND: The elderly are highly vulnerable to major burn injuries. Typically, 'elderly' is accepted as ≥ 65 years of age. This cut-off is arbitrary, lacks a robust evidence base and is potentially damaging from a clinical-decision-making perspective. The study objective was to utilise a large international dataset of major burns to stratify mortality risk by age and objectively define 'elderly' patients with significantly higher risk of poor outcome. METHODS: We performed a sub-analysis of the RE-ENERGIZE clinical trial dataset. RE-ENERGIZE included 1200 patients admitted to 54 burn centres worldwide with 2nd and/or 3rd degree burns, who were expected to require skin grafting. In a first-of-its-kind age stratification study, we stratified major burns patients by five-year age intervals. Logistic regression and Cox proportional hazards analyses were performed with three-month mortality and time-to-discharge-alive (TTDA) as the primary and secondary outcomes. RESULTS: Three-month mortality was 15.41 %. Age was associated with three-month mortality upon multivariable logistic regression analysis (p = 0.000, OR=1.06, CI=1.05-1.08), independently of total burn surface area burned (TBSA%), Acute Physiology and Chronic Health Evaluation II (APACHE II) and Charlson Comorbidity Index (CCI). Age 80 + was independently associated with increased mortality and TTDA, when compared to all referent 5-year age groups (p ≤ 0.000-0.043). The Lethal Dose 50 (LD50) for the 80 + group was 20.5 %. CONCLUSIONS: We present a new threshold of risk stratification in patients with major burns; Patients ≥ 80 years have a significantly poorer outcome, irrespective of injury severity, resultant critical illness severity, and variables including comorbidities, which has implications for prognostication and management decisions.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| 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) | 0.000 | 0.000 |
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 teacher head, 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".