Frailty

an independent predictor of burns mortality following in-patient admission

Joseph Ward, Georgina Phillips, Ishan Radotra, Sarah Smailes, Peter Dziewulski, Jufen Zhang, Niall Martin

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Introduction: Burn injury in the elderly is associated with increased morbidity and mortality. It is not uncommon for biological age, or frailty, to differ from chronological age in this patient group and thus predicting individual clinical outcomes remains challenging. It has been previously shown that Rockwood's Clinical Frailty Scale, a global clinical measure of fitness and frailty in older people, can be a useful adjunct for predicting outcomes for elderly patients with burns >10% TBSA. We refine our previous work to investigate the impact of frailty on mortality of elderly patients with thermal burns of any size admitted to a burns unit and explore its role as a meaningful adjunct to the modified Baux score. Methods: A retrospective analysis of case notes for all patients ≥65 years admitted to our burns centre as an in-patient during an 8-year period was performed with standard demographics, burn injury parameters, length of stay and mortality outcomes collected. Measures of frailty were reviewed and statistically analysed to assess the impact of biological aging on clinical outcome in order to assess how the modified Baux score may be developed for the elderly using Frailty Score. Results: 239 patients met the inclusion criteria. Mean age was 77 years (range: 65–99 years) and mean burn size was 14.46% TBSA (Range: 0.1–98% TBSA). The modified Baux and Frailty Score were both independent predictors of mortality (p < 0.0001). Increased premorbid Frailty Score was associated with increased in-hospital (OR: 2.33, 95% CI: 1.63–3.34) and one-year mortality (OR: 3.13, 95% CI: 2.22–4.41) independent of burn size compared to the modified Baux Score (IHM OR: 1.09; 95% CI: 1.07–1.13, 1yr M: OR 1.08; 95% CI: 1.05–1.11). The Frailty Score (>3) was a much more sensitive predictor of one-year mortality (Sensitivity: 83.9%; Specificity: 66.4%) than the modified Baux (>97) (Sensitivity: 59.8%; Specificity: 82.9%). A Frailty Score >3 when combined with the modified Baux score demonstrated increased area under ROC curve for both in-hospital (0.89 (95% CI: 0.85–0.94); p = 0.02) and one-year (0.88 (95% CI: 0.84–0.92); p = 0.02) mortality when compared to the modified Baux alone. Conclusion: We demonstrate that Frailty Score can be used to independently predict in-hospital and one-year mortality for thermal burns of any size in the elderly admitted as an in-patient to a burns unit. We also find that the Frailty Score can be employed in combination with the modified Baux score to improve mortality prediction. We recommend that Frailty Score is integrated into the modified Baux score and used to focus burn care resources appropriately.

Original languageEnglish (US)
Pages (from-to)1895-1902
Number of pages8
JournalBurns
Volume44
Issue number8
DOIs
StatePublished - Dec 1 2018
Externally publishedYes

Fingerprint

Patient Admission
Burns
Mortality
Burn Units
Hot Temperature
Wounds and Injuries
ROC Curve
Area Under Curve
Length of Stay
Demography
Morbidity

ASJC Scopus subject areas

  • Surgery
  • Emergency Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Ward, J., Phillips, G., Radotra, I., Smailes, S., Dziewulski, P., Zhang, J., & Martin, N. (2018). Frailty: an independent predictor of burns mortality following in-patient admission. Burns, 44(8), 1895-1902. https://doi.org/10.1016/j.burns.2018.09.022

Frailty : an independent predictor of burns mortality following in-patient admission. / Ward, Joseph; Phillips, Georgina; Radotra, Ishan; Smailes, Sarah; Dziewulski, Peter; Zhang, Jufen; Martin, Niall.

In: Burns, Vol. 44, No. 8, 01.12.2018, p. 1895-1902.

Research output: Contribution to journalArticle

Ward, J, Phillips, G, Radotra, I, Smailes, S, Dziewulski, P, Zhang, J & Martin, N 2018, 'Frailty: an independent predictor of burns mortality following in-patient admission', Burns, vol. 44, no. 8, pp. 1895-1902. https://doi.org/10.1016/j.burns.2018.09.022
Ward, Joseph ; Phillips, Georgina ; Radotra, Ishan ; Smailes, Sarah ; Dziewulski, Peter ; Zhang, Jufen ; Martin, Niall. / Frailty : an independent predictor of burns mortality following in-patient admission. In: Burns. 2018 ; Vol. 44, No. 8. pp. 1895-1902.
@article{d5841b709f9645a9b08bc9f9d961f644,
title = "Frailty: an independent predictor of burns mortality following in-patient admission",
abstract = "Introduction: Burn injury in the elderly is associated with increased morbidity and mortality. It is not uncommon for biological age, or frailty, to differ from chronological age in this patient group and thus predicting individual clinical outcomes remains challenging. It has been previously shown that Rockwood's Clinical Frailty Scale, a global clinical measure of fitness and frailty in older people, can be a useful adjunct for predicting outcomes for elderly patients with burns >10{\%} TBSA. We refine our previous work to investigate the impact of frailty on mortality of elderly patients with thermal burns of any size admitted to a burns unit and explore its role as a meaningful adjunct to the modified Baux score. Methods: A retrospective analysis of case notes for all patients ≥65 years admitted to our burns centre as an in-patient during an 8-year period was performed with standard demographics, burn injury parameters, length of stay and mortality outcomes collected. Measures of frailty were reviewed and statistically analysed to assess the impact of biological aging on clinical outcome in order to assess how the modified Baux score may be developed for the elderly using Frailty Score. Results: 239 patients met the inclusion criteria. Mean age was 77 years (range: 65–99 years) and mean burn size was 14.46{\%} TBSA (Range: 0.1–98{\%} TBSA). The modified Baux and Frailty Score were both independent predictors of mortality (p < 0.0001). Increased premorbid Frailty Score was associated with increased in-hospital (OR: 2.33, 95{\%} CI: 1.63–3.34) and one-year mortality (OR: 3.13, 95{\%} CI: 2.22–4.41) independent of burn size compared to the modified Baux Score (IHM OR: 1.09; 95{\%} CI: 1.07–1.13, 1yr M: OR 1.08; 95{\%} CI: 1.05–1.11). The Frailty Score (>3) was a much more sensitive predictor of one-year mortality (Sensitivity: 83.9{\%}; Specificity: 66.4{\%}) than the modified Baux (>97) (Sensitivity: 59.8{\%}; Specificity: 82.9{\%}). A Frailty Score >3 when combined with the modified Baux score demonstrated increased area under ROC curve for both in-hospital (0.89 (95{\%} CI: 0.85–0.94); p = 0.02) and one-year (0.88 (95{\%} CI: 0.84–0.92); p = 0.02) mortality when compared to the modified Baux alone. Conclusion: We demonstrate that Frailty Score can be used to independently predict in-hospital and one-year mortality for thermal burns of any size in the elderly admitted as an in-patient to a burns unit. We also find that the Frailty Score can be employed in combination with the modified Baux score to improve mortality prediction. We recommend that Frailty Score is integrated into the modified Baux score and used to focus burn care resources appropriately.",
author = "Joseph Ward and Georgina Phillips and Ishan Radotra and Sarah Smailes and Peter Dziewulski and Jufen Zhang and Niall Martin",
year = "2018",
month = "12",
day = "1",
doi = "10.1016/j.burns.2018.09.022",
language = "English (US)",
volume = "44",
pages = "1895--1902",
journal = "Burns",
issn = "0305-4179",
publisher = "Elsevier Limited",
number = "8",

}

TY - JOUR

T1 - Frailty

T2 - an independent predictor of burns mortality following in-patient admission

AU - Ward, Joseph

AU - Phillips, Georgina

AU - Radotra, Ishan

AU - Smailes, Sarah

AU - Dziewulski, Peter

AU - Zhang, Jufen

AU - Martin, Niall

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Introduction: Burn injury in the elderly is associated with increased morbidity and mortality. It is not uncommon for biological age, or frailty, to differ from chronological age in this patient group and thus predicting individual clinical outcomes remains challenging. It has been previously shown that Rockwood's Clinical Frailty Scale, a global clinical measure of fitness and frailty in older people, can be a useful adjunct for predicting outcomes for elderly patients with burns >10% TBSA. We refine our previous work to investigate the impact of frailty on mortality of elderly patients with thermal burns of any size admitted to a burns unit and explore its role as a meaningful adjunct to the modified Baux score. Methods: A retrospective analysis of case notes for all patients ≥65 years admitted to our burns centre as an in-patient during an 8-year period was performed with standard demographics, burn injury parameters, length of stay and mortality outcomes collected. Measures of frailty were reviewed and statistically analysed to assess the impact of biological aging on clinical outcome in order to assess how the modified Baux score may be developed for the elderly using Frailty Score. Results: 239 patients met the inclusion criteria. Mean age was 77 years (range: 65–99 years) and mean burn size was 14.46% TBSA (Range: 0.1–98% TBSA). The modified Baux and Frailty Score were both independent predictors of mortality (p < 0.0001). Increased premorbid Frailty Score was associated with increased in-hospital (OR: 2.33, 95% CI: 1.63–3.34) and one-year mortality (OR: 3.13, 95% CI: 2.22–4.41) independent of burn size compared to the modified Baux Score (IHM OR: 1.09; 95% CI: 1.07–1.13, 1yr M: OR 1.08; 95% CI: 1.05–1.11). The Frailty Score (>3) was a much more sensitive predictor of one-year mortality (Sensitivity: 83.9%; Specificity: 66.4%) than the modified Baux (>97) (Sensitivity: 59.8%; Specificity: 82.9%). A Frailty Score >3 when combined with the modified Baux score demonstrated increased area under ROC curve for both in-hospital (0.89 (95% CI: 0.85–0.94); p = 0.02) and one-year (0.88 (95% CI: 0.84–0.92); p = 0.02) mortality when compared to the modified Baux alone. Conclusion: We demonstrate that Frailty Score can be used to independently predict in-hospital and one-year mortality for thermal burns of any size in the elderly admitted as an in-patient to a burns unit. We also find that the Frailty Score can be employed in combination with the modified Baux score to improve mortality prediction. We recommend that Frailty Score is integrated into the modified Baux score and used to focus burn care resources appropriately.

AB - Introduction: Burn injury in the elderly is associated with increased morbidity and mortality. It is not uncommon for biological age, or frailty, to differ from chronological age in this patient group and thus predicting individual clinical outcomes remains challenging. It has been previously shown that Rockwood's Clinical Frailty Scale, a global clinical measure of fitness and frailty in older people, can be a useful adjunct for predicting outcomes for elderly patients with burns >10% TBSA. We refine our previous work to investigate the impact of frailty on mortality of elderly patients with thermal burns of any size admitted to a burns unit and explore its role as a meaningful adjunct to the modified Baux score. Methods: A retrospective analysis of case notes for all patients ≥65 years admitted to our burns centre as an in-patient during an 8-year period was performed with standard demographics, burn injury parameters, length of stay and mortality outcomes collected. Measures of frailty were reviewed and statistically analysed to assess the impact of biological aging on clinical outcome in order to assess how the modified Baux score may be developed for the elderly using Frailty Score. Results: 239 patients met the inclusion criteria. Mean age was 77 years (range: 65–99 years) and mean burn size was 14.46% TBSA (Range: 0.1–98% TBSA). The modified Baux and Frailty Score were both independent predictors of mortality (p < 0.0001). Increased premorbid Frailty Score was associated with increased in-hospital (OR: 2.33, 95% CI: 1.63–3.34) and one-year mortality (OR: 3.13, 95% CI: 2.22–4.41) independent of burn size compared to the modified Baux Score (IHM OR: 1.09; 95% CI: 1.07–1.13, 1yr M: OR 1.08; 95% CI: 1.05–1.11). The Frailty Score (>3) was a much more sensitive predictor of one-year mortality (Sensitivity: 83.9%; Specificity: 66.4%) than the modified Baux (>97) (Sensitivity: 59.8%; Specificity: 82.9%). A Frailty Score >3 when combined with the modified Baux score demonstrated increased area under ROC curve for both in-hospital (0.89 (95% CI: 0.85–0.94); p = 0.02) and one-year (0.88 (95% CI: 0.84–0.92); p = 0.02) mortality when compared to the modified Baux alone. Conclusion: We demonstrate that Frailty Score can be used to independently predict in-hospital and one-year mortality for thermal burns of any size in the elderly admitted as an in-patient to a burns unit. We also find that the Frailty Score can be employed in combination with the modified Baux score to improve mortality prediction. We recommend that Frailty Score is integrated into the modified Baux score and used to focus burn care resources appropriately.

UR - http://www.scopus.com/inward/record.url?scp=85055094762&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85055094762&partnerID=8YFLogxK

U2 - 10.1016/j.burns.2018.09.022

DO - 10.1016/j.burns.2018.09.022

M3 - Article

VL - 44

SP - 1895

EP - 1902

JO - Burns

JF - Burns

SN - 0305-4179

IS - 8

ER -