The frailty tipping point: Determining which patients are targets for intervention in a burn population

Objective: Elderly burn patients vary in physiologic age and frailty. While previous evidence suggests that frailty on admission is associated with poor outcomes, changes in frailty during hospitalization for a burn injury have not been reported. Methods: We performed a two-year retrospective review of all elderly (≥65 years)burn-patients admitted to our burn center. Patients who died during admission were excluded. Data collected include: demographics, injury characteristics, outcomes, and discharge disposition. Canadian Study on Health and Aging Clinical Frailty Scores (CFS)were calculated on admission and at discharge. Change in frailty was calculated for each patient. Mean values are represented as mean ± standard deviation, median values are represented as median (IQR). Results: Seventy-nine patients, mean age of 75 ± 8 years, with a mean admission CFS was 4.3 ± 1.2 and discharge CFS was 5.1 ± 1.2 were included in the study. The mean change in CFS was −0.55 ± 0.93. Forty-six patients (59%)had no change or an improvement in frailty during hospitalization while 32 (41%)had worsened CFS at discharge. Patients whose CFS was worse at discharge had larger burns (12.8 ± 10.7% vs. 6.28 ± 5.7%), lower admission CFS (3.88 ± 1.5 vs. 4.93 ± 1.0), and longer ICU stays (15.6 ± 18.9 vs. 7.64 ± 10.6 days)than patients without change in CFS. On multivariate regression analysis TBSA (OR 1.2 (1.07–1.3))and admission CFS of 1–4 (OR 7.9 (2.2–28))were significant predictors of worsened CFS at discharge. Conclusions: In our study population, patients with low admission frailty scores are at greatest risk for worsened frailty at discharge and should be targeted for the development of future frailty prevention programs.