Can we predict mortality, length of stay, and time taken to heal at the point of admission in burn patients?

BACKGROUND

Burn injuries may be complex, life-changing and life-threatening. Knowing the factors that contribute to unfavourable outcomes, particularly mortality, is crucial so that they can be assessed and addressed. Well-recognised contributors to adverse outcomes in burn patients include age, burn size, revised Baux score, and inhalation injury. Less well described, but increasingly reported, is frailty status. Here we aim to expand the current literature by adjusting for confounders not previously investigated. This is important particularly with an increasing emphasis on frailty assessment in acute care.

METHODS

A retrospective analysis of adult burn patients who required admission was conducted at a single burns unit in the United Kingdom from 2019 to 2024. The Rockwood Clinical Frailty Scale (CFS) was used to assess an individual's frailty on a scale of 1 (very fit) to 9 (terminally ill). Univariate and multi-variate linear and logistic regression analyses assessed associations between various predictors, including revised Baux score and frailty (as a potential prognostic factor), and hospital mortality, length of stay, and time taken to heal.

RESULTS

Our study included 1451 adult patients. Adjusting for age, sex, burn size, inhalation injury, and revised Baux score, frailty was significantly associated with increased mortality (OR 3, CI 1.84 - 4.88, p < 0.001), length of hospital stay (LOS, b 2.03, 95 % CI 1.27 - 2.78, p < 0.001), and time taken to heal (b 4.5, 95 % CI 1.75 - 7.3, p = 0.001). Other significant predictors of mortality were %TBSA (OR per % increase 1.06, 95 % CI 1.03-1.1, p < 0.001) and revised Baux (OR per 1 point increase 1.06, 95 % CI 1.03 - 1.1, p = 0.001). Burn %TBSA was also predictive of LOS (β per 1 % increase 0.35, 95 % CI 0.24 - 0.47, p < 0.001).

CONCLUSIONS

Our findings suggest that 1) age, %TBSA, revised Baux score, and frailty are independently associated with mortality in burn injured patients; 2) frailty score and the % TBSA are independent predictors of increased length of hospital stay; and 3) frailty is an independent predictor of prolonged burn wound healing time. Further validation in more severe burn cohorts and multi-centre populations is needed before strong clinical recommendations can be made.