ABSTRACT
Aging is an important factor contributing decisively to the clinical outcome of burn patients. The aim of this study was to assess the characteristics of patients admitted to a Burn Unit and determine the impact of aging on mortality. A retrospective analysis of patients successively admitted to a major burn centre in Portugal from 1/1/2012 to 31/12/2016 was conducted. They were divided into 2 groups: "elderly" (≥65 years) and "non-elderly" (<65 years). A total of 736 patients were included, 324 of them classified as elderly with a mean age of 78.12±7.14 years. Most of the patients in the elderly group were female (59.6%), in contrast to the non-elderly group (35%; p<0.001). The elderly patients had a higher mean length of hospital stay (20.14±18.46 days; p=0.011). Most of the burns were caused by fire (58.3%) and scalding (36.1%) and mainly after home accidents. Elderly patients showed a higher mean of burn severity index (7.26; p<0.001) and 6.8% needed an amputation. Mortality rate was significantly higher in the elderly group (11.7%; p=0.001). Age (p<0.001; OR=1.169), a higher total burn surface area (p<0.001; OR=1.081), full-thickness burns (p=0.005; OR=11.985) and the need for mechanical ventilation (p<0.001; OR=16.856) were associated with a higher mortality risk and reached statistical significance after multivariate analysis. The functional and vital prognosis of patients admitted to a burn centre is affected by multiple factors. This study showed that age, higher TBSA, full-thickness burns and need for mechanical ventilation seem to increase the risk of mortality.
L'âge avancé est un facteur déterminant du devenir d'un patient brûlé. Le but de cette étude rétrospective était d'évaluer les caractéristiques des patients admis dans notre CTB entre le 1/1/2012 et le 31/12/2016 et de déterminer les conséquences de l'âge sur la mortalité. Il étaient divisé en groupe "senior", S ((≥65 ans) et "non senior", NS (< 65 ans). Trois cent vingt quatre des 736 patients étaient S. Dans ce groupe, l'âge moyen était de 78,12 +/- 18 ans. Dans le groupe S, les femmes étaient surreprésentées (59,6%) comparativement au groupe NS (35%, p < 0,001). Les patients S restaient plus longtemps à l'hôpital (20,14 +/- 18,46 j ; p = 0,011). Les brûlures par flamme (58,3%) étaient plus fréquentes que les ébouillantements (36,1%). Elles provenaient le plus souvent d'un accident domestique. L'ABSI (7,26) était plus élevé dans le groupe S (p < 0,001). L'âge (OR 1,169 ; p < 0,001), l'augmentation de la SB (OR 1,081 ; p < 0,001), la présence de brûlures profondes (OR 11,985 ; p = 0,005) et la nécessité de ventilation mécanique (OR 16,856 ; p < 0,001) étaient, en analyse multivariées, associés à la mortalité. Les pronostics vital et fonctionnel des patients admis en CTB sont associés à de multiples paramètres. Cette étude montre que l'âge, la surface brûlée, la présence de brûlures profondes et la nécessité de recours à la ventilation mécanique augmentent le risque létal.
Subject(s)
Physical and Rehabilitation Medicine/organization & administration , Rehabilitation/organization & administration , Accreditation , Advisory Committees/organization & administration , Clinical Competence , European Union , Humans , Interinstitutional Relations , International Cooperation , Interprofessional Relations , Organizational Objectives , Physical and Rehabilitation Medicine/standards , Quality Assurance, Health Care/methods , Quality Assurance, Health Care/organization & administration , Rehabilitation/standards , Societies, Medical/organization & administrationABSTRACT
AIM: Partial body weight support (PBWS) is an accepted treatment for hemiplegic patients. The aim of this study is to compare the efficiency of gait trainer with conventional treatment on the gait management after stroke. METHODS: Forty chronic post-stroke hemiplegics were part of a prospective research. Inclusion criteria were: first ever stroke in a chronic stage with stabilised motor deficits; age >18 and <80 years; cognitive and communication skills to understand the treatment; absence of cardiac, psychological and orthopedic contraindications. Patients were randomised into two groups: the control group (CG) that used the Bobath method in 40 minutes sessions, 5 times a week, for 5 weeks, and the experimental group (EG) that used the gait trainer, for the same period of time and frequency. Assessment tools: Motricity Index (MI); Toulouse Motor Scale (TMS); modified Ashworth Spasticity Scale (mASS); Berg Balance Scale (BBS); Rivermead Mobility Index (RMI); Fugl-Meyer Stroke Scale (F-MSS); Functional Ambulation Category (FAC); Barthel Index (BI); 10 meters, time up and go (TUG), 6 minutes, and step tests. EG and CG did the assessments before treatment (T(0)), right after treatment (T(1)), and on follow-up, 3 months later (T(2)). RESULTS: CG and EG were homogenous in all the variables at T(0). CG and EG showed improvement in almost all the assessment scales after treatment, although only some with relevant differences. EG showed statistically relevant improvement on T(1) and on T(2) in several of the assessment tools, whereas CG only showed statistically significant improvement after T(1) and only in some of the assessment tools. CONCLUSIONS: Both groups of chronic hemiplegic patients improved after either PBWS with gait trainer or Bobath treatment. Only subjects undergoing PBWS with gait trainer maintained functional gain after 3 months.
