Pritzker School of Medicine, University of Chicago, Illinois, USA.
Department of Surgery, Section of Plastic & Reconstruction Surgery, University of Chicago, Illinois, USA.
J Burn Care Res. 2022 Jul 1;43(4):772-780. doi: 10.1093/jbcr/irac045.
Older adults with an acute burn experience a high frequency of in-hospital mortality. However, traditional burn mortality prediction models are less accurate for older adults likely because they do not account for geriatric specific factors, such as frailty. This study aims to investigate the impact of frailty on in-hospital mortality in older adult burn patients. Patients ≥50 years of age with an acute burn diagnosis in the National Inpatient Sample (2016-2018) were included in the cohort. Three multivariable logistic regression models to predict in-hospital mortality were generated and compared. The models were 1) age and percent total body surface area, 2) age, percent total body surface area and the Elixhauser Comorbidity Index, and 3) age, percent total body surface area, and Hospital Frailty Risk Score. A total of 60,515 weighted discharges were included in the cohort. In-hospital mortality increased with age, as 3.3% of 50- to 64-year-olds, 5.3% of 65- to 74-year-olds, 6.6% of 75- to 84-year-olds, and 9.9% of ≥85-year-olds died during the acute burn admission (P < .001). The multivariable model that included Hospital Frailty Risk Score had a higher area under the receiver operating characteristics curve than the model with age and percent total body surface area (0.84 vs 0.79; P < .001) and the model with Elixhauser Comorbidity Index (0.84 vs 0.83; P = .013). Frailty improved prediction of in-hospital mortality for older adult acute burn patients and burn specialists should consider implementing a frailty instrument to evaluate older adults with an acute burn injury.
老年急性烧伤患者住院病死率较高。然而，传统的烧伤病死率预测模型对老年人的预测准确性较低，可能是因为这些模型没有考虑到老年人特有的因素，如衰弱。本研究旨在探讨衰弱对老年烧伤患者住院病死率的影响。纳入国家住院患者样本（2016-2018 年）中年龄≥50 岁且有急性烧伤诊断的患者。共纳入了 60515 例加权出院患者。随着年龄的增长，住院病死率逐渐升高，50-64 岁患者的病死率为 3.3%，65-74 岁患者的病死率为 5.3%，75-84 岁患者的病死率为 6.6%，≥85 岁患者的病死率为 9.9%（P<0.001）。包含医院衰弱风险评分的多变量模型的受试者工作特征曲线下面积高于包含年龄和总体表百分比的模型（0.84 比 0.79；P<0.001）和包含 Elixhauser 合并症指数的模型（0.84 比 0.83；P=0.013）。衰弱改善了对老年急性烧伤患者住院病死率的预测，烧伤专家应考虑使用衰弱工具来评估急性烧伤的老年患者。
