Galet Colette, Lawrence Kevin, Lilienthal Drew, Hubbard Janice, Romanowski Kathleen S, Skeete Dionne A, Mashruwala Neil
Department of Surgery, Acute Care Surgery Division, University of Iowa, Iowa City, USA.
Carver College of Medicine, University of Iowa, Iowa City, USA.
J Burn Care Res. 2023 Jan 5;44(1):129-135. doi: 10.1093/jbcr/irac120.
Herein, we assessed the utility of the Canadian Study of Health and Aging Clinical Frailty Scale (CSHA-CFS) to predict burn-specific outcomes. We hypothesized that frail patients are at greater risk for burn-related complications and require increased healthcare support at discharge. Patients 50 years and older admitted to our institution for burn injuries between July 2009 and June 2019 were included. Demographics, comorbidities, pre-injury functional status, injury and hospitalization information, complications (graft loss, acute respiratory failure, and acute kidney disease [AKI]), mortality, and discharge disposition were collected. Multivariate analyses were performed to assess the association between admission frailty scored using the CSHA-CFS and outcomes. P < .05 was considered significant. Eight-hundred fifty-one patients were included, 697 were not frail and 154 were frail. Controlling for Baux scores, sex, race, mechanism of injury, 2nd and 3rd degree burn surface, and inhalation injury, frailty was associated with acute respiratory failure (OR = 2.599 [1.460-4.628], P = .001) and with mortality (OR = 6.080 [2.316-15.958]; P < .001). Frailty was also associated with discharge to skilled nursing facility, rehabilitation, or long-term acute care facilities (OR = 3.135 [1.784-5.508], P < .001), and to hospice (OR = 8.694 [1.646-45.938], P = .011) when compared to home without healthcare services. Frailty is associated with increased risk of acute respiratory failure, mortality, and requiring increased healthcare support post-discharge. Our data suggest that frailty can be used as a tool to predict morbidity and mortality and for goals of care discussions for the burn patient.
在此，我们评估了加拿大健康与衰老研究临床衰弱量表（CSHA - CFS）对预测烧伤特定结局的效用。我们假设衰弱患者发生烧伤相关并发症的风险更高，且出院时需要更多的医疗支持。纳入了2009年7月至2019年6月期间因烧伤入住我院的50岁及以上患者。收集了人口统计学资料、合并症、伤前功能状态、损伤和住院信息、并发症（植皮失败、急性呼吸衰竭和急性肾损伤[AKI]）、死亡率及出院处置情况。进行多因素分析以评估使用CSHA - CFS评定的入院时衰弱程度与结局之间的关联。P <.05被认为具有统计学意义。共纳入851例患者，其中697例不衰弱，154例衰弱。在控制了博克斯评分、性别、种族、损伤机制、二度和三度烧伤面积以及吸入性损伤后，衰弱与急性呼吸衰竭（OR = 2.599 [1.460 - 4.628]，P =.001）和死亡率（OR = 6.080 [2.316 - 15.958]；P <.001）相关。与无需医疗服务的居家出院相比，衰弱还与出院后入住专业护理机构、康复机构或长期急性护理机构（OR = 3.135 [1.784 - 5.508]，P <.001）以及临终关怀机构（OR = 8.694 [1.646 - 45.938]，P =.011）相关。衰弱与急性呼吸衰竭风险增加、死亡率增加以及出院后需要更多医疗支持相关。我们的数据表明，衰弱可作为预测烧伤患者发病率和死亡率以及用于护理目标讨论的工具。
