SAN ANTONIO – Geriatric burn patients have less than a 50% chance of returning home with a Baux score of about 85, and the risk of death begins to climb steadily after a score 93, approaching 50% at 110 points and almost 100% at 130 points, according to a review of 8,001 elderly patients in the National Burn Repository.
The investigators are developing the findings into a decision-making tool to help counsel families and caregivers about their options when elderly loved ones are seriously burned.
Dr. Erica Hodgman
“There’s just not a lot of data out there on prognosis after burn injury in the geriatric population. We thought a simple decision aid for discussion with key stakeholders would provide significant assistance,” said investigator Dr. Erica Hodgman, a surgery research resident at the University of Texas Southwestern Medical Center, Dallas.
The hope is that families and caregivers will be able to better judge if the patient would want to press on with treatment given the odds of returning home, being discharged to a skilled nursing or rehab facility, or dying. “I think it will help people” feel less guilty if they decide to withdraw care or not send patients far away to a burn center, she said at the Eastern Association for the Surgery of Trauma scientific assembly.
The Baux score, a well-known metric in the burn community, adds the patient’s age to the percentage of surface area burned, so a 70 year old patient burned over 23% of their body, for instance, would have a score of 93. A modified Baux score adds points for inhalation injuries, but because the data didn’t include inhalation injury severity, the investigators found it more useful to stick with the original formula.
They queried the repository for patients 65 years or older with second- or third-degree burns from 2002-2011. They excluded patients with a length of stay of a day or less, along with elective admissions, non-burn injuries, and transfers to other burn centers. Next, they calculated Baux scores for each of their 8,001 subjects and noted if the patients were discharged home or to an alternate facility, or if he or she died.
Most patients had moderate scores of 70-100, and almost half were sent home. Of the 1,509 that died in hospital, 264 (17.5%) had care withdraw at a median of 3 days, but a range of 0-231 days. Flames were the most common cause of injury, followed by scalding.
A receiver operating curve analysis found that a Baux score at or below 86.15 predicted discharge home (AUC 0.698, 75.28% sensitivity, 54.64% specificity); a score above 77.12 predicted discharge to an alternate setting (AUC 0.539, 74.91% sensitivity, 34.38% specificity); and a score above 93.3 predicted mortality (AUC 0.779, 57.46% sensitivity, 87.08% specificity).
Dr. Hodgman said she thinks the cut-points will remain useful even as burn care improves with new grafting techniques that require smaller donor sites. Such innovation will apply mostly to moderately injured patients; for the more severely injured, the predictive power of the findings should still hold.
The investigators have no disclosures.