The use of a frailty scoring system for burns in the elderly

Masud, D.; Norton, SA; Smailes, Sarah; Shelley, Odhran; Philp, Bruce; Dziewulski, Peter

doi:10.1016/j.burns.2012.03.002

Cited by 63 publications

(33 citation statements)

References 13 publications

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“…Masud et al [36] assigned a frailty score (between 1 and 7) [37] to each patient over 65 years old and with TBSA greater than 10% admitted to an intensive care unit during a 4 years period.…”

Section: Discussionmentioning

confidence: 99%

Inclusion of coexisting morbidity in a TBSA% and age based model for the prediction of mortality after burns does not increase its predictive power

Pompermaier

Steinvall

Fredrikson

et al. 2015

Burns

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Introduction: Several models for predicting mortality have been developed for patients with burns, and the most commonly used are based on age and total body surface area (TBSA%). They often show good predictive precision as depicted by high values for area under the receiver operating characteristic curves (AUC). However the effect of coexisting morbidity on such prediction models has not to our knowledge been thoroughly examined. We hypothesised that adding it to a previously published model (based on age, TBSA%, full thickness burns, gender, and need for mechanical ventilation) would further improve its predictive power. Methods: We studied 772 patients admitted during the period 1997-2008 to the Linkoping University Hospital, National Burn Centre with any type of burns. We defined coexisting morbidity as any of the medical conditions listed in the Charlson list, as well as psychiatric disorders or drug or alcohol misuse. We added coexisting medical conditions to the model for predicting mortality (age, TBSA%, and need for mechanical ventilation) to determine whether it improved the model as assessed by changes in deviances between the models. Results: Mean (SD) age and TBSA% was 35 (26) years and 13 (17) %, respectively. Among 725 patients who survived, 105 (14%) had one or more coexisting condition, compared with 28 (60%) among those 47 who died. The presence of coexisting conditions increased with age (p < 0.001) among patients with burns. The AUC of the mortality prediction model in this study, based on the variables age, TBSA%, and need for mechanical ventilation was 0.980 (n = 772); after inclusion of coexisting morbidity in the model, the AUC improved only marginally, to 0.986. The model was not significantly better either. Conclusion: Adding coexisting morbidity to a model for prediction of mortality after a burn based on age, TBSA%, and the need for mechanical ventilation did not significantly improve its predictive value. This is probably because coexisting morbidity is automatically adjusted for by age in the original model. (C) 2015 Elsevier Ltd and ISBI. All rights reserved

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Section: Discussionmentioning

confidence: 99%

Inclusion of coexisting morbidity in a TBSA% and age based model for the prediction of mortality after burns does not increase its predictive power

Pompermaier

Steinvall

Fredrikson

et al. 2015

Burns

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“…Despite the more developed resuscitation principles, wound care and surgical techniques in recent years, burns trauma in the elderly is still an important cause for morbidity and mortality [1,9,10]. Due to declining ability in motor functions and reflexes, elderly patients are exposed to burns more often.…”

Section: Discussionmentioning

confidence: 99%

“…Burns are serious cases that create serious physical and mental problems that can cause death or disabilities. Despite medical and technological progress, burns are serious problems that still threaten lives [1]. Therefore, the cheapest and the most effective method is preventing the burns with precautions taken beforehand [2].…”

Section: Introductionmentioning

confidence: 99%

Factors affecting mortality in patients with burns

Erbiş

Aliosmanoglu²,

Öztürk³

et al. 2015

J Clin Exp Invest

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ÖZETAmaç: Yaşam kalitesi ve tıbbi tedavi imkanlarının artması, yaşlı hasta nüfusunda bir artışa neden olmuştur. Yanık tedavisindeki gelişmeler çocuklarda ve genç erişkinlerde yanığa bağlı mortalitede azalmaya neden olmuştur, ancak yaşlılardaki yanıklar, diğer yaş gruplarından farklı şekilde ele alınması gereken önemli bir travmadır. Bu çalışmanın amacı 45 yaşın üzerindeki yanıklı hastalarda mortalite üzerine etkili faktörleri değerlendirmektir.Yöntemler: Son 3 yıl içerisinde yanık ünitemizde tedavi edilen 45 yaş üzerindeki 58 hasta çalışmaya dahil edildi. Hastaların yaşları, yanık oranları ve yanıklarının derinliği, eşlik eden hastalıklar ve mortalite oranları retrospektif olarak değerlendirildi. Bulgular:Mortalite gelişmeyen hastaların ortalama yaşı 57,4 yıl iken, mortalite gelişenlerinki 70 yıl idi (p=0,002). Ortalama yanık genişliği mortalite gelişmeyenlerde % 21,1 iken, mortalite gelişenlerde % 50 idi (p<0,01). Yanık-lı hastalarda eşlik eden hastalık bulunmasının mortalite üzerine anlamlı etkisi olduğu saptandı (p=0,001). Mortalitenin en önemli nedeni sepsis ve konjestif kalp yetmezliği idi.Sonuç: Çalışmamızın sonuçları yanık alanının yüzdesi-nin ve eşlik eden hastalıkların varlığının tedavi başarısı ve mortalite üzerine olumsuz etkileri olduğunu gösterdi. Bu hastalarda multidisipliner yaklaşım ve yakın takip ile mortalite oranlarının düşeceğini düşünmekteyiz.Anahtar kelimeler: Yanıklar, eşlik eden hastalıklar, mortalite, yaşlı hastalar ABSTRACT Objective: The increase in life quality and expectancy causes an increase in the elderly population. Improvements in burn treatment resulted in decreased mortality in children and young adults but in elderly patients burns are still an important trauma that should be handed differently than other age groups. The aim of this study was to evaluate the factors effecting mortality in patients with burns over 45 years old.Methods: Fifty-eight patients over 45 years of age, who were treated in our burns unit in the last 3 years were included in our study. Their age, burn percentage and depth, coexisting diseases and mortality rates were examined retrospectively.Results: The average age of surviving patients was 57.4 years while it was 70 years for nonsurviving patients (p=0.002). The width of burn area was 21.1 % in surviving and 50 % in nonsurviving patients (p<0.01). The effect of additional coexistent diseases on mortality was significant (p=0.001). The most common reasons of mortality were sepsis and congestive heart failure. Conclusion:We found out that the age, percentage of burns and coexistent diseases had a negative effect on success of treatment and mortality. Mortality rates will decrease in these cases with careful follow-up and a multidisciplinary approach. J Clin Exp Invest 2015; 6 (3): 240-243

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“…Experienced geriatricians show good inter-rater agreement in the estimation of patients' biological age [37] and these subjective measures have strong construct validity. The Clinical Frailty Scale [36] can predict outcomes from severe burns in older people [38]. However, inter-rater agreement, and therefore utility, decreases when frailty scales are used by clinicians not trained in geriatric medicine, particularly as an accurate assessment of functional status underpins many frailty scales.…”

Section: Subjective Opinionmentioning

confidence: 99%

Patient frailty: the elephant in the operating room

2013

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SummaryFor most surgeons and many anaesthetists, patient frailty is currently the 'elephant in the (operating) room': it is easy to spot, but is often ignored. In this paper, we discuss different approaches to the measurement of frailty and review the evidence regarding the effect of frailty on peri-operative outcomes. We explore the limitations of 'eyeballing' patients to quantify frailty, and consider why the frail older patient, challenged by seemingly minor insults in the postoperative period, may suffer falls or delirium. Frailty represents a state of increased vulnerability to stressors, and older inpatients are exposed to multiple stressors in the peri-operative setting. Quantifying frailty is likely to increase the precision of peri-operative risk assessment. The Frailty Index derived from Comprehensive Geriatric Assessment is a simple and robust way to quantify frailty, but is yet to be systematically investigated in the preoperative setting. Furthermore, the optimal care for frail patients and the reversibility of frailty with prehabilitation are fertile areas for future research. (While I can't define it)…I know it when I see it.-Justice Potter Stewart, US Supreme Court Clinicians usually recognise a frail patient, who is often, but not always, elderly. However, at best, we usually quantify frailty in a largely subjective 'end-of-the-bed' or 'eyeball' way [1]. Furthermore, although studies have examined patient factors such as age and ASA physical status and their association with peri-operative complications and mortality [2-4], until very recently, few have examined frailty [5]. Frailty increases vulnerability to stressors, which, in the peri-operative setting, can include the procedure(s), complications and medical care administered.The aims of this paper are to review the emerging science around defining and quantifying frailty, and to examine its associated peri-operative risks. Current evidence suggests that quantifying frailty improves the precision of risk assessment [5]. However, we think that, for most surgeons and many anaesthetists, frailty and its associated risks represent an 'elephant in the (operating) room': it is easy to spot, but is often ignored.

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The use of a frailty scoring system for burns in the elderly

Cited by 63 publications

References 13 publications

Inclusion of coexisting morbidity in a TBSA% and age based model for the prediction of mortality after burns does not increase its predictive power

Inclusion of coexisting morbidity in a TBSA% and age based model for the prediction of mortality after burns does not increase its predictive power

Factors affecting mortality in patients with burns

Patient frailty: the elephant in the operating room

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