Comorbidity-Polypharmacy Score Predicts In-Hospital Complications and the Need for Discharge to Extended Care Facility in Older Burn Patients

Abstract

Advancing age is associated with increased mortality despite smaller burn size. Chronic conditions are common in the elderly with resulting polypharmacy. The Comorbidity-Polypharmacy Score (CPS) facilitates quantitative assessment of the severity of comorbid conditions, or physiologic age. Burn injury in older patients is associated with increasing morbidity and mortality and the CPS may be predictive of outcomes such as mortality, ICU and hospital LOS, complications, and final hospital disposition. Our goal was to evaluate the predictive value of CPS for outcomes in the elderly burn population. A retrospective study was undertaken of 920 burn patients with age ≥45 admitted with acute burn injuries (January 1, 2006 to December 31, 2012). CPS was calculated by adding preinjury comorbidities and medications. Subjects were stratified into three groups according to CPS severity. Data collected included demographics, total body surface area burned (TBSA), presence of inhalation injury, ICU/hospital length of stay, complications, discharge disposition, and mortality. Univariate and multivariate analyses were performed. The mean age was 55.7; 72.9% were males; the mean initial TBSA was 6.93%; and mean CPS was 8.01. The risk of in-hospital complications is independently associated with CPS (OR 1.35). CPS (OR 1.81) was an independent predictor of discharge to a facility CPS but not of mortality. While increasing CPS was associated with lower TBSA, mortality remained unchanged. CPS is an independent predictor of in-hospital complications and need for transfer to extended care facilities in older burn patients, which can be determined at the stage of admission to help direct patient management.

Comorbidity-polypharmacy score predicts readmission in older trauma patients

“…These are unsurprising and consistent with prior studies. However, the failure of patient age to have significant association with readmission risk agrees with studies by Morris et al [15,17] while being at odds with a large study by Moore et al [16] None of these studies were limited to older patients, however. Somewhat more surprising is the inverse association apparent between ICU LOS and readmission risk, especially as an independent variable not further confounded by comorbidities (CPS) and injury severity.…”

“…Although a patient's number of medical comorbidities (or the presence of specific comorbidities) has previously been described as only a partial contributor to the patient's overall frailty, we hypothesized that the combination of comorbidities with the patient's level of polypharmacy could function as an effective measure of patient frailty. Prior evaluations have demonstrated CPS accuracy in predicting discharge destination [15] and in estimating risk of undertriage from the emergency department [8], outcomes commonly measured by other frailty indices.…”

Age and preexisting conditions as risk factors for severe adverse events and failure to rescue after injury

“…The fact that age was associated with higher odds of FTR than was injury mechanism or any PEC aside from renal disease highlights the vulnerability of geriatric trauma patients and suggests that there may be factors unique to increased age that puts elder patients at higher risk. Previously suggested theories linking increased age and increased mortality in trauma patients include decreased physiologic reserve (18, 49), polypharmacy (50), and overall frailty (51, 52). …”

Chronic conditions and multimorbidity in a primary care population: a study in the Swiss Sentinel Surveillance Network (Sentinella)

“…The former index was developed to predict cost in insurance collectives (Fischer et al 2007). The latter has shown to correlate with survival in trauma patients (Evans et al 2012; Holmes et al 2014), in-hospital complications and the need for extended care facilities (Justiniano et al 2015), and re-admissions (Housley et al 2015). When coding TMI, the same condition can have different impacts depending on whether the condition is active or inactive, stable or unstable, or socially sensitive or non-sensitive.…”