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Published on: August 23, 2022
Development of the Burn Frailty Index: A prognostication index for elderly patients sustaining burn injuries
Daniel Maxwell1, Peter Rhee2, Mack Drake3
1Burn Center, Grady Memorial Hospital, 80 Jesse Hill Jr Dr SE, Atlanta, GA, 30303, USA; Department of Surgery, Emory University Hospital, 1364 Clifton Rd NE, Atlanta, GA, 30322, USA.
Background:
Frailty has demonstrated enhanced prognostic ability for elderly patient morbidity. The aim was to create a burn-specific frailty index for elderly patients and compare it to commonly used scoring systems in burn management.
Methods:
From 2013 to 2017, we prospectively surveyed a randomized cohort of patients ≥65-years-old previously admitted to our burn unit. Prognostic comparisons with 6 commonly used indices and multivariate risk analyses were performed.
Results:
Of 100 included patients, n = 32 were classified as frail. The mean patient age was 73.0 ± 6.8-years with a median follow up of 20.9 months. There were 13 moralities in total, 12 occurred in the frail group including 5 in-house mortalities. Patients classified as frail had significantly more complications (p < 0.001), non-home discharges (p < 0.001), ICU admissions, and longer hospital and ICU lengths of stay (p < 0.001), decreased 1 and 3-year survival (p = 0.001). The BFI was identified as an independent predictor of mortality (p = 0.001) and course-altering diagnoses including sepsis/septic shock, ARDS/ALI, and AKI.
Conclusions:
The Burn Frailty Index accurately predicts morbidity and mortality in elderly frail patients suffering burn injuries.
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