Justiniano Carla F, Coffey Rebecca A, Evans David C, Jones Larry M, Jones Christian D, Bailey J Kevin, Miller Sidney F, Stawicki Stanislaw P
From the Division of Trauma, Critical Care, and Burn, Department of Surgery, The Ohio State University College of Medicine, Columbus.
J Burn Care Res. 2015 Jan-Feb;36(1):193-6. doi: 10.1097/BCR.0000000000000094.
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.
尽管烧伤面积较小，但年龄增长与死亡率增加相关。慢性病在老年人中很常见，导致用药种类繁多。合并症-用药种类评分（CPS）有助于定量评估合并症的严重程度或生理年龄。老年患者的烧伤与发病率和死亡率的增加相关，CPS可能预测死亡率、重症监护病房（ICU）和住院时间、并发症及最终出院情况等结局。我们的目标是评估CPS对老年烧伤人群结局的预测价值。对920例年龄≥45岁的急性烧伤患者（2006年1月1日至2012年12月31日）进行了一项回顾性研究。CPS通过将伤前合并症和用药种类相加来计算。根据CPS严重程度将受试者分为三组。收集的数据包括人口统计学资料、烧伤总面积（TBSA）、吸入性损伤情况、ICU/住院时间、并发症、出院情况及死亡率。进行了单因素和多因素分析。平均年龄为55.7岁；72.9%为男性；平均初始TBSA为6.93%；平均CPS为8.01。住院并发症风险与CPS独立相关（比值比[OR]为1.35）。CPS（OR为1.81）是转至护理机构的独立预测因素，但不是死亡率的独立预测因素。虽然CPS增加与TBSA降低相关，但死亡率保持不变。CPS是老年烧伤患者住院并发症及转至长期护理机构需求的独立预测因素，可在入院阶段确定，以帮助指导患者管理。
