title: The use of a frailty scoring system for burns in the elderly.
abstract: BACKGROUND
  Burn in the elderly has a high mortality. Scoring systems incorporating age, and/or co-morbidities have been developed to assist in predicting outcomes in this high risk group. Life expectancy has increased in the general population and within the elderly age group medical co morbidity, physiological response to injury and socioeconomic factors give rise to the concept of biological versus chronological age. For a given age, baseline pre morbid state can vary. It is more valid to consider biological rather than chronological age when calculating risk. The Canadian Study of Health and Aging (CSHA) clinical frailty scale, incorporating fitness, co-morbidities and level of dependence was used to analyse our elderly burn patients admitted to Burns ITU, their surgical management and one-year survival.
  
  
  METHODS
  Data from patients with burns greater than 10% and aged over 65 years managed on the Burns ITU between 2005 and 2009 were obtained. A frailty score (1-7) was assigned to each patient based on the records of their admission assessment. 42 patients met the study criteria for analysis. 18 (42.9%) patients, with mean age 74.9 years (range 65-95 years) survived (S) their ITU stay and of these, 83.3% survived at 1 year. 24 (57.2%) patients, mean age 78.4 years (range 66-95 years) died (D) whilst on ITU. There was no significant difference between the two groups with regard to age, percentage burn (30% TBSA range 10-85%) (P>0.05 using T Test) or inhalational injury (p>0.05 using Z test). Using Mann-Whitney U test analysis, the frailty score between the two groups showed a significant difference at p=0.0001 (Mann-Whitney U test=78), median=3 (S) and median=5 (D). This suggests patients with better pre-morbid capacity, as evaluated by the frailty scoring system, were more likely to survive their burn insult and treatment. Significantly, more patients in the group that survived underwent surgical debridement (Mann-Whitney U test=111, p=0.02).
  
  
  CONCLUSIONS
  Frailty scoring system appears to be a useful adjunct in predicting outcome in burns requiring admission to HDU/ITU in the senior population. The frailty score may predict which patients will benefit from surgery which also continues to be an important determinant of outcome in these patients.
authors.affiliation: St Andrews Centre for Plastic Surgery and Burns, Chelmsford, Essex, UK. dhalia.masud@doctors.org.uk
authors.forename: D
authors.initials: D
authors.lastname: Masud
authors.forename: S
authors.initials: S
authors.lastname: Norton
authors.forename: S
authors.initials: S
authors.lastname: Smailes
authors.forename: O
authors.initials: O
authors.lastname: Shelley
authors.forename: B
authors.initials: B
authors.lastname: Philp
authors.forename: P
authors.initials: P
authors.lastname: Dziewulski
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002056:Burns / Q000401:mortality / Q000601:surgery; D003646:Debridement / Q000401:mortality; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D012189:Retrospective Studies; D016019:Survival Analysis; D006113:United Kingdom