Frailty Score on Admission Predicts Outcomes in Elderly Burn Injury

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.