Abstract
Older adults with an acute burn experience a high frequency of in-hospital mortality. However, traditional burn mortality prediction models are less accurate for older adults likely because they do not account for geriatric specific factors, such as frailty. This study aims to investigate the impact of frailty on in-hospital mortality in older adult burn patients. Patients ≥50 years of age with an acute burn diagnosis in the National Inpatient Sample (2016-2018) were included in the cohort. Three multivariable logistic regression models to predict in-hospital mortality were generated and compared. The models were 1) age and percent total body surface area, 2) age, percent total body surface area and the Elixhauser Comorbidity Index, and 3) age, percent total body surface area, and Hospital Frailty Risk Score. A total of 60,515 weighted discharges were included in the cohort. In-hospital mortality increased with age, as 3.3% of 50- to 64-year-olds, 5.3% of 65- to 74-year-olds, 6.6% of 75- to 84-year-olds, and 9.9% of ≥85-year-olds died during the acute burn admission (P < .001). The multivariable model that included Hospital Frailty Risk Score had a higher area under the receiver operating characteristics curve than the model with age and percent total body surface area (0.84 vs 0.79; P < .001) and the model with Elixhauser Comorbidity Index (0.84 vs 0.83; P = .013). Frailty improved prediction of in-hospital mortality for older adult acute burn patients and burn specialists should consider implementing a frailty instrument to evaluate older adults with an acute burn injury.