Frailty as a predictor of discharge destination and long-term function in older adults with burn injury

Elderly patients are at increased risk of burn injury due to the biological, psychological, and social changes associated with aging. This population experiences higher rates of morbidity, mortality, and an increased length of stay compared to younger patients. This study examines frailty as a predictor of discharge disposition and long-term functional outcomes after burn injury.

A prospective study was performed at a single U.S. ABA-verified burn center. Patients > 55 years old admitted from September 2019 to 2021 were screened for enrollment. Patient demographics, the pre-morbid Clinical Frailty Scale (CFS), Barthel Index (BI), and discharge disposition were recorded. Long-term functional status was assessed using the follow up Barthel Index and a functional questionnaire completed at 6 months to 1.5 years post-discharge.

Fifty patients were enrolled, with an average age of 71 (SD 10.4) years and a median percentage Total Body Surface Area of Burn Injury (TBSA) of 4 (IQR 5). The mean CFS score was 3.4 (SD 1.7). Patients discharged to a Skilled Nursing Facility (SNF) had significantly higher mean CFS scores (5.0, SD 0.9) compared to those discharged home (2.2, SD 1.2) or to an Inpatient Rehabilitation Facility (IRF) (3.0, SD 1.3), with a statistically significant difference across groups (F = 15.97; P < 0.0001). At follow-up, 50% (n = 25) of patients reported a return to baseline.

Frailty score as assessed by the CFS is associated with disposition destination after burn injury. A higher CFS was associated with discharge to a higher level of care. The CFS may be useful after burn injury in predicting disposition and assisting with early conversations with patients and their families related to longitudinal care.