The Relationship Between Frailty and the Subjective Decision to Conduct a Goals of Care Discussion With Burned Elders

Tarik D. Madni, Paul A. Nakonezny, Steven Wolf, Bellal Joseph, Jane J. Mohler, Jonathan B. Imran, Audra Clark, Brett A. Arnoldo, Herb A. Phelan

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Best practices are to conduct an early discussion of goals of care (GoC) after injury in the elderly, but this intervention is inconsistently applied. We hypothesized that a frail appearance was a factor in the decision to conduct a GoC discussion after thermal injury. A retrospective review was performed of all burn survivors aged ≥ 65 years at our ABA-verified level 1 burn center between April 02, 2009, and December 30, 2014. Demographic information included age, gender, mechanism of injury, percentage TBSA burned, revised Baux score, patient/physician racial discordance, documented GoC discussion (as defined within the electronic medical record), length of stay (LOS), and disposition. One rater retrospectively assigned clinical frailty scores to patients using the Canadian Study of Health and Aging Criteria, which ranged from 1 (very fit) to 7 (severely frail). Ordinal logistic regression was performed. Demographics for the cohort of 126 subjects were (mean ± SD): age = 75.5 ± 7.7 years, %TBSA burned = 11.9% ± 7.2, revised Baux = 87.8 ± 10.2, hospital LOS (days) = 14.9 ± 13.7, ICU LOS (days) = 6.2 ± 1.2, frailty score = 4.1 ± 1.1. Overall, 72% of geriatric survivors had a favorable discharge disposition. GoC discussions occurred in 25% of patients. GoC discussion (OR, 3.42; 95% CI, 1.54–7.60) and an unfavorable disposition (OR, 9.01; 95% CI, 3.91–20.78) were associated with greater predicted odds of receiving a higher ordered frailty score. Our results suggest that, even in the absence of a formal diagnosis, a frail appearance may influence a provider’s decision to perform GoC discussions after severe thermal injury.

Original languageEnglish (US)
JournalJournal of Burn Care and Research
DOIs
StateAccepted/In press - May 31 2017
Externally publishedYes

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Patient Care Planning
Length of Stay
Wounds and Injuries
Survivors
Hot Temperature
Demography
Burn Units
Electronic Health Records
Practice Guidelines
Geriatrics
Logistic Models
Physicians
Health

ASJC Scopus subject areas

  • Surgery
  • Emergency Medicine
  • Rehabilitation

Cite this

The Relationship Between Frailty and the Subjective Decision to Conduct a Goals of Care Discussion With Burned Elders. / Madni, Tarik D.; Nakonezny, Paul A.; Wolf, Steven; Joseph, Bellal; Mohler, Jane J.; Imran, Jonathan B.; Clark, Audra; Arnoldo, Brett A.; Phelan, Herb A.

In: Journal of Burn Care and Research, 31.05.2017.

Research output: Contribution to journalArticle

Madni, Tarik D. ; Nakonezny, Paul A. ; Wolf, Steven ; Joseph, Bellal ; Mohler, Jane J. ; Imran, Jonathan B. ; Clark, Audra ; Arnoldo, Brett A. ; Phelan, Herb A. / The Relationship Between Frailty and the Subjective Decision to Conduct a Goals of Care Discussion With Burned Elders. In: Journal of Burn Care and Research. 2017.
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abstract = "Best practices are to conduct an early discussion of goals of care (GoC) after injury in the elderly, but this intervention is inconsistently applied. We hypothesized that a frail appearance was a factor in the decision to conduct a GoC discussion after thermal injury. A retrospective review was performed of all burn survivors aged ≥ 65 years at our ABA-verified level 1 burn center between April 02, 2009, and December 30, 2014. Demographic information included age, gender, mechanism of injury, percentage TBSA burned, revised Baux score, patient/physician racial discordance, documented GoC discussion (as defined within the electronic medical record), length of stay (LOS), and disposition. One rater retrospectively assigned clinical frailty scores to patients using the Canadian Study of Health and Aging Criteria, which ranged from 1 (very fit) to 7 (severely frail). Ordinal logistic regression was performed. Demographics for the cohort of 126 subjects were (mean ± SD): age = 75.5 ± 7.7 years, {\%}TBSA burned = 11.9{\%} ± 7.2, revised Baux = 87.8 ± 10.2, hospital LOS (days) = 14.9 ± 13.7, ICU LOS (days) = 6.2 ± 1.2, frailty score = 4.1 ± 1.1. Overall, 72{\%} of geriatric survivors had a favorable discharge disposition. GoC discussions occurred in 25{\%} of patients. GoC discussion (OR, 3.42; 95{\%} CI, 1.54–7.60) and an unfavorable disposition (OR, 9.01; 95{\%} CI, 3.91–20.78) were associated with greater predicted odds of receiving a higher ordered frailty score. Our results suggest that, even in the absence of a formal diagnosis, a frail appearance may influence a provider’s decision to perform GoC discussions after severe thermal injury.",
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