Re-evaluating Resuscitation Thresholds in Elderly Burn Patients

Abstract Introduction Elderly burn patients are at increased risk of adverse outcomes at a lower total body surface area (TBSA) than their younger counterparts due to a higher burden of comorbidities and decreased physiologic reserve. Standard of care is to activate nurse-driven resuscitation protocols (NDRP) for burns involving ≥20% TBSA. After observing a concerning trend of adverse events in patients aged ≥60 with 15-19.9% TBSA burns, our burn center revised its protocol to initiate NDRP in patients with ≥15% TBSA. Methods This is a retrospective cohort study of 47 adult burn patients (≥18 years) presenting with 15-19.9% TBSA burns admitted to our burn center between January 2020 through April 2025. Patients were grouped by age ≥ 60 (n = 16) and age 60 (n = 31). The primary outcomes were mortality and incidence of acute kidney injury (AKI) in the first 48 hours of admission. A Fisher’s exact test was utilized due to the small sample size of this study. Results Patients in the age ≥ 60 group experienced significantly higher mortality compared to the age 60 group (3/16 vs. 0/31 deaths; p=.033). Although the incidence of AKI within 48 hours of admission was greater in the age ≥ 60 group (4/16 vs. 1/31), the difference was not statistically significant (p=.138) likely due to the small sample size. However, the relative risk of AKI in patients age ≥ 60 was 7.75, indicating a clinically meaningful trend toward increased AKI risk in this population. Conclusions Burn patients aged ≥60 years with TBSA 15-19.9% demonstrate higher risk of mortality and a trend towards increased AKI rates compared to their younger counterparts. These results support the adoption of a lower threshold for initiating NDRP to 15% TBSA in patients aged ≥60, extending protocol indications to this vulnerable population. Applicability of Research to Practice These results support the adoption of a lower threshold for initiating NDRP to 15% TBSA in patients aged ≥60. Funding for the study N/A.