• Natalia S Partain, Madhu Subramanian, Erica I Hodgman, Claire L Isbell, Steve E Wolf, Brett D Arnoldo, Karen J Kowalske, and Herb A Phelan.
• 1 Division of Burns/Trauma/Critical Care, Parkland Memorial Hospital, University of Texas-Southwestern Medical Center , Dallas, Texas.
• J Palliat Med. 2016 Dec 1; 19 (12): 1275-1280.

BackgroundEnd-of-life (EoL) care after geriatric burns (geri-burns) is understudied.ObjectiveTo examine the practices of burn surgeons for initiating EoL discussions and the impact of decisions made on the courses of geri-burn patients who died after injury.MethodsThis retrospective cohort study examined all subjects ≥65 years who died on our Level I burn service from April 1, 2009, to December 31, 2014. Measurements obtained were timing of first EoL discussion (EARLY <24 hours post-admission; LATE ≥24 hours post-admission), decisions made, age, total body surface area burned, and calculated probability of death at admission.ResultsThe cohort consisted of 57 subjects, of whom 54 had at least one documented EoL care discussion between a burn physician and the patient/surrogate. No differences were seen between groups for the likelihood of an immediate decision for comfort care after the first discussion (p = 0.73) or the mean number of total discussions (p = 0.07). EARLY group subjects (n = 38) had significantly greater magnitudes of injury (p = 0.002), calculated probabilities of death at admission (p ≤ 0.001), shorter times to death (p ≤ 0.001), and fewer trips to the operating theater for burn excision and skin grafting (p ≤ 0.001) than LATE subjects (n = 16). LATE subjects' first discussion occurred at a mean of 9.3 ± 10.0 days.DiscussionThe vast majority of geri-burn deaths on our burn service occur after a discussion about EoL care. The timing of these discussions is driven by magnitude of injury, and it does not lead to higher proportions of an immediate decision for comfort care. The presence and timing of EoL discussions bears further study as a quality metric for geri-burn EoL care.

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