Development of the Burn Frailty Index: A prognostication index for elderly patients sustaining burn injuries

Maxwell, Daniel W.; Rhee, Peter; Drake, Mack; Hodge, Juvonda; Ingram, Walter L.; Williams, Robbie

doi:10.1016/j.amjsurg.2018.11.012

Cited by 23 publications

(13 citation statements)

References 32 publications

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“…Previous literature suggests that frailty assessment on admission could realize a complete overview of the elderly burn patient that could lead to appropriate interventions during hospital stay [ 26 ]. Examples of frailty assessment used in burn care include The Clinical Frailty Scale (CFS) and Burn Frailty Index (BFI) [ 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

Short-term and long-term increased mortality in elderly patients with burn injury: a national longitudinal cohort study

et al. 2023

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Background The population of elderly patients with burn injuries is growing. Insight into long-term mortality rates of elderly after burn injury and predictors affecting outcome is limited. This study aimed to provide this information. Methods A multicentre observational retrospective cohort study was conducted in all three Dutch burn centres. Patients aged ≥65 years, admitted with burn injuries between 2009 and 2018, were included. Data were retrieved from electronic patient records and the Dutch Burn Repository R3. Mortality rates and standardized mortality ratios (SMRs) were calculated. Multivariable logistic regression was used to assess predictors for in-hospital mortality and mortality after discharge at 1 year and five-year. Survival analysis was used to assess predictors of five-year mortality. Results In total, 682/771 admitted patients were discharged. One-year and five-year mortality rates were 8.1 and 23.4%. The SMRs were 1.9(95%CI 1.5–2.5) and 1.4(95%CI 1.2–1.6), respectively. The SMRs were highest in patients aged 75–80 years at 1 year (SMRs 2.7, 95%CI 1.82–3.87) and five-year in patients aged 65–74 years (SMRs 10.1, 95%CI 7.7–13.0). Independent predictors for mortality at 1 year after discharge were higher age (OR 1.1, 95%CI 1.0–1.1), severe comorbidity, (ASA-score ≥ 3) (OR 4.8, 95%CI 2.3–9.7), and a non-home discharge location (OR 2.0, 95%CI 1.1–3.8). The relative risk of dying up to five-year was increased by age (HR 1.1, 95%CI 1.0–1.1), severe comorbidity (HR 2.3, 95%CI 1.6–3.5), and non-home discharge location (HR 2.1, 95%CI 1.4–3.2). Conclusion Long-term mortality until five-year after burn injury was higher than the age and sex-matched general Dutch population, and predicted by higher age, severe comorbidity, and a non-home discharge destination. Next to pre-injury characteristics, potential long-lasting systemic consequences on biological mechanisms following burn injuries probably play a role in increased mortality. Decreased health status makes patients more prone to burn injuries, leading to early death.

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Section: Discussionmentioning

confidence: 99%

Short-term and long-term increased mortality in elderly patients with burn injury: a national longitudinal cohort study

et al. 2023

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“…For example, on a retrospective analysis of elderly burn patients, Maxwell et al developed a Burn Frailty Index that predicted frailty and associated outcomes in an elderly burn-injured population. 24 A review of the ACS-TQIP database examined over 34,000 patients for frailty using a modified frailty index (mFI) derived from the CSHA that assesses 11 variables comprising of 10 comorbidities and one functional status measure to predict complications and mortality. 25 Despite this, studies examining the validity of these scoring systems remain limited.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Comparison of Frailty Scores and Fall Prediction in Acutely Injured Older Adults

Tejiram

Cartwright

Taylor

et al. 2021

Journal of Surgical Research

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Background: Elderly (65 and older) fall-related injuries are a significant cause of morbidity and mortality. Although frailty predicts poor outcomes in geriatric trauma, literature comparing frailty scoring systems remains limited. Herein, we evaluated which frailty scoring system best predicts falls over time in the elderly. Materials and methods: Acute surgical patients 65 y and older were enrolled and prospectively observed. Demographics and frailty, assessed using the FRAIL Scale, Trauma Specific Frailty Index (TSFI), and Canadian Frailty Scale (CSHA-CFS), were collected at enrollment and 3 mo intervals following discharge for 1 y. Surveys queried the total number and timing of falls. Changes in frailty over time were assessed by logistic regression and area under the curve (AUC). Results: Fifty-eight patients were enrolled. FRAIL Scale and CSHA-CFS scores did not change over time, but TSFI scores did (P 0.01). Worsening frailty was observed using TSFI at 6 (P 0.01) and 12 mo (P 0.01) relative to baseline. Mortality did not differ based on frailty using any frailty score. Increasing frailty scores and time postdischarge was associated with increased odds of a fall. AUC estimates with 95% CI were 0.72 [0.64, 0.80], 0.81 [0.74, 0.88], and 0.76 [0.68, 0.84] for the FRAIL Scale, TSFI, and CSHA-CFS, respectively. Conclusions: The risk of falls postdischarge were associated with increased age, time postdischarge, and frailty in our population. No scale appeared to significantly outperform the other by AUC estimation. Further study on the longitudinal effects of frailty is warranted.

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“…Avariety of assessment tools evaluating frailty in trauma patients have been developed. 9,11,18,19,[22][23][24] However, an important barrier to implement routine frailty assessment in daily trauma care is the lack of consensus on what tool to use. 2 A few earlier systematic reviews on the measurement properties of frailty assessment tools in acute care have been published.…”

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confidence: 99%

“…6,7 Frailty has been shown to be a strong predictor of in-hospital complications, discharge to institutional care, morbidity, and mortality. [8][9][10][11][12] Tailored interventions including a patient's frailty can contribute to better outcomes in acute care. 5,[13][14][15][16] Multiple interventions are available to prevent frailty from arising, to screen frailty in high-risk groups, to promote early detection, and finally, to limit the consequences of frailty in patients where frailty has been detecte.…”

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confidence: 99%

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The feasibility and reliability of frailty assessment tools applicable in acute in-hospital trauma patients: A systematic review

Cords

Spronk

Mattace-Raso

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:Assessing frailty in patients with an acute trauma can be challenging. To provide trustworthy results, tools should be feasible and reliable. This systematic review evaluated existing evidence on the feasibility and reliability of frailty assessment tools applied in acute in-hospital trauma patients. METHODS:A systematic search was conducted in relevant databases until February 2020. Studies evaluating the feasibility and/or reliability of a multidimensional frailty assessment tool used to identify frail trauma patients were identified. The feasibility and reliability results and the risk of bias of included studies were assessed. This study was conducted and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and registered in Prospective Register of Systematic Reviews (ID: CRD42020175003). RESULTS:Nineteen studies evaluating 12 frailty assessment tools were included. The risk of bias of the included studies was fair to good. The most frequently evaluated tool was the Clinical Frailty Scale (CFS) (n = 5). All studies evaluated feasibility in terms of the percentage of patients for whom frailty could be assessed; feasibility was high (median, 97%; range, 49-100%). Other feasibility aspects, including time needed for completion, tool availability and costs, availability of instructions, and necessity of training for users, were hardly reported. Reliability was only assessed in three studies, all evaluating the CFS. The interrater reliability varied between 42% and >90% agreement, with a Krippendorff α of 0.27 to 0.41. CONCLUSION:Feasibility of most instruments was generally high. Other aspects were hardly reported. Reliability was only evaluated for the CFS with results varying from poor to good. The reliability of frailty assessment tools for acute trauma patients needs further critical evaluation to conclude whether assessment leads to trustworthy results that are useful in clinical practice.

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Development of the Burn Frailty Index: A prognostication index for elderly patients sustaining burn injuries

Cited by 23 publications

References 32 publications

Short-term and long-term increased mortality in elderly patients with burn injury: a national longitudinal cohort study

Short-term and long-term increased mortality in elderly patients with burn injury: a national longitudinal cohort study

A Prospective Comparison of Frailty Scores and Fall Prediction in Acutely Injured Older Adults

The feasibility and reliability of frailty assessment tools applicable in acute in-hospital trauma patients: A systematic review

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