Frailty score on admission predicts outcomes in elderly burn injury

Kathleen Romanowski, Alura Barsun, Tina L. Pamlieri, David G Greenhalgh, Soman Sen

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

With longer life expectancy, the number of burn injuries in the elderly continues to increase. Prediction of outcomes for the elderly is complicated by preinjury physical fitness and comorbid illness. The authors hypothesize that admission frailty assessment would be predictive of outcomes in the elderly burn population. Our primary aim was to determine if higher frailty scores were associated with higher risk of mortality for elderly burn patients. The secondary aims were to assess if higher frailty scores were associated with increased length of stay, increased needs for mechanical ventilation and poor discharge disposition. A 2-year retrospective chart review was performed of all admitted acute burn patients 65 years or older. Data collected included: age, gender, %TBSA of burn injury, presence of inhalation injury, in hospital mortality, hospital length of stay, ventilator days, ICU length of stay, surgical procedures, insurance status, and discharge disposition. Frailty scores were assessed from admission data and calculated using the Canadian Study of Health and Aging clinical frailty scale. A total of 89 patients met entry criteria. Mean age was 75.3 ± 8.1 years and consisted of 62 men and 27 women. Mean %TBSA was 9.6 ± 9.1% and mean frailty score (FS) was 4.5 ± 1.2. Eighty patients survived to discharge and nine died. Nonsurvivors had significantly higher FS compared to survivors (5.2 ± 1.2 vs 4.4 ± 1.2). FS were also significantly higher in patients discharged to skilled nursing facilities (SNF) (5.34 ± 0.9) compared to those who were discharged home (4.1 ± 1.2) or to physical rehabilitation facilities (4 ± 1.5). Multivariate linear regression analysis revealed that age (B = 0.04) and discharge to SNF (B = 1.2) are independently associated with higher FS. However, survivors were independently associated with a significantly lower FS (B = -1.3). Multivariate logistic regression analysis revealed high admission FS independently increased the risk of discharge to SNF (odds ratio of 2.5 [1.3-4.8, 95% confidence interval]) and increased the risk of mortality (odds ratio of 1.67 [1.01-2.7, 95% confidence interval]). Frailty scores on admission allow for a more complete assessment of elderly patients and can be used to establish benchmark models for burn injury outcomes. In addition FS can be used as a research tool to improve outcomes for elderly burn injured patients.

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalJournal of Burn Care and Research
Volume36
Issue number1
DOIs
StatePublished - Jan 21 2015

Fingerprint

Skilled Nursing Facilities
Wounds and Injuries
Length of Stay
Surgical Insurance
Survivors
Odds Ratio
Regression Analysis
Confidence Intervals
Benchmarking
Insurance Coverage
Physical Fitness
Mortality
Mechanical Ventilators
Hospital Mortality
Life Expectancy
Artificial Respiration
Inhalation
Linear Models
Rehabilitation
Logistic Models

ASJC Scopus subject areas

  • Emergency Medicine
  • Rehabilitation
  • Surgery

Cite this

Frailty score on admission predicts outcomes in elderly burn injury. / Romanowski, Kathleen; Barsun, Alura; Pamlieri, Tina L.; Greenhalgh, David G; Sen, Soman.

In: Journal of Burn Care and Research, Vol. 36, No. 1, 21.01.2015, p. 1-6.

Research output: Contribution to journalArticle

@article{cf0463aed3c54bd8b0cdd52179b261ce,
title = "Frailty score on admission predicts outcomes in elderly burn injury",
abstract = "With longer life expectancy, the number of burn injuries in the elderly continues to increase. Prediction of outcomes for the elderly is complicated by preinjury physical fitness and comorbid illness. The authors hypothesize that admission frailty assessment would be predictive of outcomes in the elderly burn population. Our primary aim was to determine if higher frailty scores were associated with higher risk of mortality for elderly burn patients. The secondary aims were to assess if higher frailty scores were associated with increased length of stay, increased needs for mechanical ventilation and poor discharge disposition. A 2-year retrospective chart review was performed of all admitted acute burn patients 65 years or older. Data collected included: age, gender, {\%}TBSA of burn injury, presence of inhalation injury, in hospital mortality, hospital length of stay, ventilator days, ICU length of stay, surgical procedures, insurance status, and discharge disposition. Frailty scores were assessed from admission data and calculated using the Canadian Study of Health and Aging clinical frailty scale. A total of 89 patients met entry criteria. Mean age was 75.3 ± 8.1 years and consisted of 62 men and 27 women. Mean {\%}TBSA was 9.6 ± 9.1{\%} and mean frailty score (FS) was 4.5 ± 1.2. Eighty patients survived to discharge and nine died. Nonsurvivors had significantly higher FS compared to survivors (5.2 ± 1.2 vs 4.4 ± 1.2). FS were also significantly higher in patients discharged to skilled nursing facilities (SNF) (5.34 ± 0.9) compared to those who were discharged home (4.1 ± 1.2) or to physical rehabilitation facilities (4 ± 1.5). Multivariate linear regression analysis revealed that age (B = 0.04) and discharge to SNF (B = 1.2) are independently associated with higher FS. However, survivors were independently associated with a significantly lower FS (B = -1.3). Multivariate logistic regression analysis revealed high admission FS independently increased the risk of discharge to SNF (odds ratio of 2.5 [1.3-4.8, 95{\%} confidence interval]) and increased the risk of mortality (odds ratio of 1.67 [1.01-2.7, 95{\%} confidence interval]). Frailty scores on admission allow for a more complete assessment of elderly patients and can be used to establish benchmark models for burn injury outcomes. In addition FS can be used as a research tool to improve outcomes for elderly burn injured patients.",
author = "Kathleen Romanowski and Alura Barsun and Pamlieri, {Tina L.} and Greenhalgh, {David G} and Soman Sen",
year = "2015",
month = "1",
day = "21",
doi = "10.1097/BCR.0000000000000190",
language = "English (US)",
volume = "36",
pages = "1--6",
journal = "Journal of Burn Care and Research",
issn = "1559-047X",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Frailty score on admission predicts outcomes in elderly burn injury

AU - Romanowski, Kathleen

AU - Barsun, Alura

AU - Pamlieri, Tina L.

AU - Greenhalgh, David G

AU - Sen, Soman

PY - 2015/1/21

Y1 - 2015/1/21

N2 - With longer life expectancy, the number of burn injuries in the elderly continues to increase. Prediction of outcomes for the elderly is complicated by preinjury physical fitness and comorbid illness. The authors hypothesize that admission frailty assessment would be predictive of outcomes in the elderly burn population. Our primary aim was to determine if higher frailty scores were associated with higher risk of mortality for elderly burn patients. The secondary aims were to assess if higher frailty scores were associated with increased length of stay, increased needs for mechanical ventilation and poor discharge disposition. A 2-year retrospective chart review was performed of all admitted acute burn patients 65 years or older. Data collected included: age, gender, %TBSA of burn injury, presence of inhalation injury, in hospital mortality, hospital length of stay, ventilator days, ICU length of stay, surgical procedures, insurance status, and discharge disposition. Frailty scores were assessed from admission data and calculated using the Canadian Study of Health and Aging clinical frailty scale. A total of 89 patients met entry criteria. Mean age was 75.3 ± 8.1 years and consisted of 62 men and 27 women. Mean %TBSA was 9.6 ± 9.1% and mean frailty score (FS) was 4.5 ± 1.2. Eighty patients survived to discharge and nine died. Nonsurvivors had significantly higher FS compared to survivors (5.2 ± 1.2 vs 4.4 ± 1.2). FS were also significantly higher in patients discharged to skilled nursing facilities (SNF) (5.34 ± 0.9) compared to those who were discharged home (4.1 ± 1.2) or to physical rehabilitation facilities (4 ± 1.5). Multivariate linear regression analysis revealed that age (B = 0.04) and discharge to SNF (B = 1.2) are independently associated with higher FS. However, survivors were independently associated with a significantly lower FS (B = -1.3). Multivariate logistic regression analysis revealed high admission FS independently increased the risk of discharge to SNF (odds ratio of 2.5 [1.3-4.8, 95% confidence interval]) and increased the risk of mortality (odds ratio of 1.67 [1.01-2.7, 95% confidence interval]). Frailty scores on admission allow for a more complete assessment of elderly patients and can be used to establish benchmark models for burn injury outcomes. In addition FS can be used as a research tool to improve outcomes for elderly burn injured patients.

AB - With longer life expectancy, the number of burn injuries in the elderly continues to increase. Prediction of outcomes for the elderly is complicated by preinjury physical fitness and comorbid illness. The authors hypothesize that admission frailty assessment would be predictive of outcomes in the elderly burn population. Our primary aim was to determine if higher frailty scores were associated with higher risk of mortality for elderly burn patients. The secondary aims were to assess if higher frailty scores were associated with increased length of stay, increased needs for mechanical ventilation and poor discharge disposition. A 2-year retrospective chart review was performed of all admitted acute burn patients 65 years or older. Data collected included: age, gender, %TBSA of burn injury, presence of inhalation injury, in hospital mortality, hospital length of stay, ventilator days, ICU length of stay, surgical procedures, insurance status, and discharge disposition. Frailty scores were assessed from admission data and calculated using the Canadian Study of Health and Aging clinical frailty scale. A total of 89 patients met entry criteria. Mean age was 75.3 ± 8.1 years and consisted of 62 men and 27 women. Mean %TBSA was 9.6 ± 9.1% and mean frailty score (FS) was 4.5 ± 1.2. Eighty patients survived to discharge and nine died. Nonsurvivors had significantly higher FS compared to survivors (5.2 ± 1.2 vs 4.4 ± 1.2). FS were also significantly higher in patients discharged to skilled nursing facilities (SNF) (5.34 ± 0.9) compared to those who were discharged home (4.1 ± 1.2) or to physical rehabilitation facilities (4 ± 1.5). Multivariate linear regression analysis revealed that age (B = 0.04) and discharge to SNF (B = 1.2) are independently associated with higher FS. However, survivors were independently associated with a significantly lower FS (B = -1.3). Multivariate logistic regression analysis revealed high admission FS independently increased the risk of discharge to SNF (odds ratio of 2.5 [1.3-4.8, 95% confidence interval]) and increased the risk of mortality (odds ratio of 1.67 [1.01-2.7, 95% confidence interval]). Frailty scores on admission allow for a more complete assessment of elderly patients and can be used to establish benchmark models for burn injury outcomes. In addition FS can be used as a research tool to improve outcomes for elderly burn injured patients.

UR - http://www.scopus.com/inward/record.url?scp=84921610057&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84921610057&partnerID=8YFLogxK

U2 - 10.1097/BCR.0000000000000190

DO - 10.1097/BCR.0000000000000190

M3 - Article

C2 - 25383979

AN - SCOPUS:84921610057

VL - 36

SP - 1

EP - 6

JO - Journal of Burn Care and Research

JF - Journal of Burn Care and Research

SN - 1559-047X

IS - 1

ER -