title: Comorbidity-polypharmacy score predicts in-hospital complications and the need for discharge to extended care facility in older burn patients.
abstract: 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.
authors.affiliation: From the Division of Trauma, Critical Care, and Burn, Department of Surgery, The Ohio State University College of Medicine, Columbus.
authors.forename: Carla F
authors.initials: CF
authors.lastname: Justiniano
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Coffey
authors.forename: David C
authors.initials: DC
authors.lastname: Evans
authors.forename: Larry M
authors.initials: LM
authors.lastname: Jones
authors.forename: Christian D
authors.initials: CD
authors.lastname: Jones
authors.forename: J Kevin
authors.initials: JK
authors.lastname: Bailey
authors.forename: Sidney F
authors.initials: SF
authors.lastname: Miller
authors.forename: Stanislaw P
authors.initials: SP
authors.lastname: Stawicki
mesh_terms: D000367:Age Factors; D000368:Aged; D002056:Burns / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D003422:Critical Care; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D019338:Polypharmacy; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012866:Skilled Nursing Facilities