TY - JOUR
T1 - The relationship between frailty and the subjective decision to conduct a goals of care discussion with burned elders
AU - Madni, Tarik D.
AU - Nakonezny, Paul A.
AU - Wolf, Steven E.
AU - Joseph, Bellal
AU - Jane Mohler, M.
AU - Imran, Jonathan B.
AU - Clark, Audra T.
AU - Arnoldo, Brett D.
AU - Phelan, Herb A.
N1 - Publisher Copyright:
© American Burn Association 2017. All rights reserved.
PY - 2018/1/1
Y1 - 2018/1/1
N2 - Best practices are to conduct an early discussion of goals of care (GoC) after injury in the elderly, but this intervention is inconsistently applied. We hypothesized that a frail appearance was a factor in the decision to conduct a GoC discussion after thermal injury. A retrospective review was performed of all burn survivors aged ≥ 65 years at our American Burn Association (ABA)-verified level 1 burn center between April 02, 2009, and December 30, 2014. Demographic information included age, gender, mechanism of injury, percentage TBSA burned, revised Baux score, patient/physician racial discordance, documented GoC discussion (as defined within the electronic medical record), length of stay (LOS), and disposition. One rater retrospectively assigned clinical frailty scores to patients using the Canadian Study of Health and Aging Criteria, which ranged from 1 (very fit) to 7 (severely frail). Ordinal logistic regression was performed. Demographics for the cohort of 126 subjects were (mean ± SD): age = 75.5±7.7 years, %TBSA burned = 11.9% ± 7.2, revised Baux = 87.8±10.2, hospital LOS (days) = 14.9±13.7, Intensive Care Unit (ICU) LOS (days) = 6.2±1.2, frailty score = 4.1±1.1. Overall, 72% of geriatric survivors had a favorable discharge disposition. GoC discussions occurred in 25% of patients. GoC discussion (OR, 3.42; 95% CI, 1.54-7.60) and an unfavorable disposition (OR, 9.01; 95% CI, 3.91-20.78) were associated with greater predicted odds of receiving a higher ordered frailty score. Our results suggest that, even in the absence of a formal diagnosis, a frail appearance may influence a provider's decision to perform GoC discussions after severe thermal injury.
AB - Best practices are to conduct an early discussion of goals of care (GoC) after injury in the elderly, but this intervention is inconsistently applied. We hypothesized that a frail appearance was a factor in the decision to conduct a GoC discussion after thermal injury. A retrospective review was performed of all burn survivors aged ≥ 65 years at our American Burn Association (ABA)-verified level 1 burn center between April 02, 2009, and December 30, 2014. Demographic information included age, gender, mechanism of injury, percentage TBSA burned, revised Baux score, patient/physician racial discordance, documented GoC discussion (as defined within the electronic medical record), length of stay (LOS), and disposition. One rater retrospectively assigned clinical frailty scores to patients using the Canadian Study of Health and Aging Criteria, which ranged from 1 (very fit) to 7 (severely frail). Ordinal logistic regression was performed. Demographics for the cohort of 126 subjects were (mean ± SD): age = 75.5±7.7 years, %TBSA burned = 11.9% ± 7.2, revised Baux = 87.8±10.2, hospital LOS (days) = 14.9±13.7, Intensive Care Unit (ICU) LOS (days) = 6.2±1.2, frailty score = 4.1±1.1. Overall, 72% of geriatric survivors had a favorable discharge disposition. GoC discussions occurred in 25% of patients. GoC discussion (OR, 3.42; 95% CI, 1.54-7.60) and an unfavorable disposition (OR, 9.01; 95% CI, 3.91-20.78) were associated with greater predicted odds of receiving a higher ordered frailty score. Our results suggest that, even in the absence of a formal diagnosis, a frail appearance may influence a provider's decision to perform GoC discussions after severe thermal injury.
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U2 - 10.1097/BCR.0000000000000594
DO - 10.1097/BCR.0000000000000594
M3 - Article
C2 - 28574881
AN - SCOPUS:85020223226
SN - 1559-047X
VL - 39
SP - 82
EP - 88
JO - Journal of Burn Care and Research
JF - Journal of Burn Care and Research
IS - 1
ER -