Higher Admission Frailty Scores Predict Increased Mortality, Morbidity, and Healthcare Utilization in the Elderly Burn Population

2021 ◽  
Author(s):  
Kathleen A Iles ◽  
Emilie Duchesneau ◽  
Paula D Strassle ◽  
Lori Chrisco ◽  
T Clark Howell ◽  
...  
Keyword(s):  
Healthcare Utilization ◽  
Physiological State ◽  
Tertiary Care ◽  
Care Facility ◽  
The Elderly ◽  
Cox Proportional Hazards ◽  
Clinical Frailty Scale ◽  
Frailty Phenotype ◽  
Risk Of Death ◽  
Increased Risk

Abstract The Rockwood Clinical Frailty Scale is a validated rapid assessment of frailty phenotype and predictor of mortality in the geriatric population. Using data from a large tertiary care burn center, we assessed the association between admission frailty in an elderly burn population and inpatient outcomes. This was a retrospective analysis of burn patients ≥ 65 years from 2015-2019. Patients were assigned to frailty subgroups based on comprehensive medical, social work, and therapy assessments. Cox proportional hazards regression was used to estimate associations between admission frailty and 30-day inpatient mortality. Our study included 644 patients (low frailty: 262, moderate frailty: 345, and high frailty: 37). Frailty was associated with higher median TBSA and age at admission. The 30-day cumulative incidence of mortality was 2.3%, 7.0%, and 24.3% among the low, moderate, and high frailty strata, respectively. After adjustment for age, TBSA, and inhalation injury, high frailty was associated with increased 30-day mortality, compared to low (HR 5.73; 95% CI 1.86, 17.62). Moderate frailty also appeared to increase 30-day mortality, although estimates were imprecise (HR 2.19; 95% CI 0.87-5.50). High frailty was associated with increased morbidity and healthcare utilization, including need for intensive care stay (68% vs 37% and 21%, p<0.001) and rehab or care facility at discharge (41% vs 25% and 6%, p<0.001), compared to moderate and low frailty subgroups. Our findings emphasize the need to consider pre-injury physiological state and the increased risk of death and morbidity in the elderly burn population.

48 Higher Admission Frailty Scores Predict Increased Mortality, Morbidity and Healthcare Utilization in the Elderly Burn Population

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S35-S36
Author(s):  
Kathleen A Iles ◽  
Emilie D Duchesneau ◽  
Paula Strassle ◽  
Lori Chrisco ◽  
Thomas Howell ◽  
...  
Keyword(s):  
Healthcare Utilization ◽  
Proportional Hazards ◽  
Tertiary Care ◽  
Rapid Assessment ◽  
Cox Proportional Hazards ◽  
Clinical Frailty Scale ◽  
Frailty Phenotype ◽  
Geriatric Population ◽  
Term Care ◽  
Burn Center

Abstract Introduction The Rockwood Clinical Frailty Scale is a validated rapid assessment of frailty phenotype, predictor of mortality and other clinical outcomes in the geriatric population, even when applied retrospectively. Using data from a large tertiary care burn center, we assessed the association between admission frailty in an elderly burn population and outcomes. Methods Retrospective analysis of burn patients > 65 years, admitted to a tertiary care referral burn center from 2015–2019 (n= 652). Patients were assigned to Rockwood frailty subgroups, low (1–3), moderate (4–6), or high (7–9), based on comprehensive medical, social work, physical and occupational therapy assessments. Patients who did not have complete assessments to allow for appropriate frailty scoring were excluded. Hospital-associated infections (HAIs) were identified through the institutional epidemiology database and healthcare utilization data were extracted from burn registry and medical records. Cox proportional hazards regression was used to estimate associations between admission frailty and 30-day inpatient mortality. Results Our study included 644 patients (low: 262, moderate: 345, and high: 37 frailty subgroups). Frailty was associated with higher percent TBSA (median TBSA: low 2.0%; moderate 3.0%; high 3.0%; p=0.01) and older age at admission (p=0.0004). The 30-day cumulative incidence of mortality was 2.3%, 7.0%, and 24.3% among the low, moderate, and high frailty strata, respectively. After adjustment for age, TBSA and inhalation, high frailty was associated with increased 30-day mortality (HR 5.73; 95% CI 1.86, 17.62). Moderate frailty appeared to increase 30-day mortality, although estimates were imprecise (HR 2.19; 95% CI 0.87–5.50). Morbidity and healthcare utilization results are reported in Table 1. Higher frailty was associated with any ICU stay during the hospitalization, need for mechanical ventilation, and higher median hospital cost/day. HAIs were infrequent in all frailty subgroups. The proportion of patients discharged to hospice, rehab, long and short-term care facilities was highest in the high frailty subgroup. Those in the moderate and low subgroups were more likely to be discharged home or home with services. Conclusions High admission frailty is associated with an increased 30-day mortality regardless of age group. Higher frailty correlates with increased morbidity and healthcare utilization.

scholarly journals Outcomes of surgery in patients aged ≥90 years in the general surgical setting

2018 ◽  
Vol 100 (3) ◽  
pp. 172-177 ◽  
Author(s):  
A Sudlow ◽  
H Tuffaha ◽  
AT Stearns ◽  
IA Shaikh
Keyword(s):  
Surgical Procedures ◽  
Emergency Surgery ◽  
Tertiary Care ◽  
Gastrointestinal Surgery ◽  
Care Facility ◽  
Mortality Rates ◽  
Emergency Procedures ◽  
Risk Of Death ◽  
Increased Risk ◽  
The Impact

Introduction An increasing proportion of the population is living into their nineties and beyond. These high risk patients are now presenting more frequently to both elective and emergency surgical services. There is limited research looking at outcomes of general surgical procedures in nonagenarians and centenarians to guide surgeons assessing these cases. Methods A retrospective analysis was conducted of all patients aged ≥90 years undergoing elective and emergency general surgical procedures at a tertiary care facility between 2009 and 2015. Vascular, breast and endocrine procedures were excluded. Patient demographics and characteristics were collated. Primary outcomes were 30-day and 90-day mortality rates. The impact of ASA (American Society of Anesthesiologists) grade, operation severity and emergency presentation was assessed using multivariate analysis. Results Overall, 161 patients (58 elective, 103 emergency) were identified for inclusion in the study. The mean patient age was 92.8 years (range: 90–106 years). The 90-day mortality rates were 5.2% and 19.4% for elective and emergency procedures respectively (p=0.013). The median survival was 29 and 19 months respectively (p=0.001). Emergency and major gastrointestinal operations were associated with a significant increase in mortality. Patients undergoing emergency major colonic or upper gastrointestinal surgery had a 90-day mortality rate of 53.8%. Conclusions The risk for patients aged over 90 years having an elective procedure differs significantly in the short term from those having emergency surgery. In selected cases, elective surgery carries an acceptable mortality risk. Emergency surgery is associated with a significantly increased risk of death, particularly after major gastrointestinal resections.

scholarly journals The impact of non-steroidal anti-inflammatory drugs use in elderly cardiovascular patients: an observational study from tertiary care in South India

2019 ◽  
Vol 7 (5) ◽  
pp. 1787
Author(s):  
Sadhna Sharma ◽  
Biju Govind ◽  
Kondal Rao
Keyword(s):  
Observational Study ◽  
Elderly Patients ◽  
Tertiary Care ◽  
The Elderly ◽  
Left Ventricular ◽  
Risk Of Death ◽  
Increased Risk ◽  
High Prevalence ◽  
One Year ◽  
The Impact

Background: Long-term use of NSAIDs, by patients having cardiovascular conditions, has shown to increase the risk of cardiovascular events and increased risk of death. Hence, the study was conducted to determine the complications related to NSAID use by the elderly patients with cardiovascular disease (CVD).Methods: The study was a single-center prospective observational study conducted November 2017 to October 2018. Elderly patients (>60 years) suffering from various CVDs and reported NSAID intake daily for at least one month were included. A questionnaire included demographic, treatment related history and complete details of NSAIDs intake including nature, dose, indication, source etc. The same questionnaire was again filled at the end of one-year follow-up.Results: A total of 100 participants were included in the study. The mean age was 72±8.6 years. Majority of the patients (93%) had hypertension, and 69% of the patient had previous MI.  Five NSAIDs (diclofenac, ibuprofen, mefenamic acid, naproxen, and ketorolac) were used routinely. At least one over the counter NSAID used was reported by 86%, 57% were prescribed at least one NSAIDs by their orthopaedics and physicians. At the end of 1-year follow-up, authors found that 71% had MI (2% increase), 4% developed reinfarction, 20% had severe left ventricular failure (4% increase), 7% had atrial fibrillation (1% increase), and 2% patients died and 63% patients reported raise in systolic blood pressure by 5mmHg.Conclusions: High prevalence of concomitant NSAID use among elderly CVD patients, which might be contributing towards increase in CVS morbidity and mortality.

Bilateral Inferior Altitudinal Defects Secondary to Stroke: A Case Series

2015 ◽  
Vol 77 (3) ◽  
pp. 23
Author(s):  
Stacey Chong ◽  
Tammy :abreche ◽  
Patricia Hrynchak ◽  
Michelle Steenbakkers
Keyword(s):  
Newborn Infants ◽  
Case Series ◽  
Care Facility ◽  
The Elderly ◽  
The United States ◽  
Visual Field Defects ◽  
Term Care ◽  
Long Term Care Facility ◽  
Risk Of Death ◽  
Increased Risk

Strokes or cerebrovascular accidents are the third leading cause of death in Canada, comprising 6% of all deaths in the country.1 The elderly and the very young (fetus or newborn infants) are at highest risk for having a stroke with an associated increased risk of death or lasting neurological disability. According to the National Stroke Association recovery guidelines, 10% of stroke survivors will recover almost completely, 25% will recover with minor impairments, 40% will survive with moderate to severe impairments that require specialized care, 10% will require care in a long-term care facility, and 15% will die shortly after the stroke. The National Stroke Association estimates that there are 7 million people in the United States that have survived a stroke and are living with impairments. The Heart and Stroke Foundation’s 2013 Stroke Report has estimated that 315,000 Canadians are living with the effects of stroke. This case series serves as a reminder that, although rare, bilateral inferior altitudinal visual field defects can also occur as the result of a stroke, to highlight the difficulties of orientation and mobility that can result, and to offer potential rehabilitative strategies.

Facility of Origin Predicts Mortality After Colonic Perforation

2020 ◽  
pp. 000313482097162
Author(s):  
Samuel D. Butensky ◽  
Emma Gazzara ◽  
Gainosuke Sugiyama ◽  
Gene F. Coppa ◽  
Antonio Alfonso ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Chronic Care ◽  
Care Facility ◽  
Colonic Perforation ◽  
Risk Of Death ◽  
Increased Risk ◽  
Chronic Care Facility ◽  
Partial Colectomy ◽  
Emergent Surgery ◽  
Perforated Viscus

Introduction Colonic perforation often requires emergent intervention and carries high morbidity and mortality. The objective of this study was to determine whether nonclinical factors, such as transition of care from outpatient facilities to inpatient settings, are associated with increased risk of mortality in patients who underwent emergent surgical intervention for colonic perforation. Materials and Methods Using the 2006-2015 ACS National Surgical Quality Improvement Program database, we identified adult patients who underwent emergent partial colectomy with primary anastomosis ± protecting ostomy or partial colectomy with ostomy with intraoperative finding of wound class III or IV for a diagnosis of perforated viscus. The outcome of interest was 30-day postoperative mortality. Univariate and multivariate analyses using logistic regression were performed. Results 4705 patients met criteria, of which 841 (17.9%) died. Univariate analysis showed that patients who died after emergent surgery for perforated viscus were more likely to present from a chronic care facility (13.4% vs. 4.4%, P < .0001) and had longer time from admission to undergoing surgery (mean 4.1 vs. 2.0 days, P < .0001. Logistic regression demonstrated that septic shock vs. none (OR 3.60, P < .0001), sepsis vs. none (OR 1.57, P = .00045), transfer from chronic care facility vs. home (OR 1.87, P < .0001), and increased time from admission vs. operation (OR 1.01, P = .0055) were independently associated with increased risk of death. Discussion Transfer from a chronic care facility was independently associated with increased mortality in patients undergoing emergent surgery for perforated viscus.

scholarly journals Dementia Adjudication Triggers Associated With Increased Mortality for Older Australians: Evidence From ASPREE

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 161-161
Author(s):  
Jane Banaszak-Holl ◽  
Xiaoping Lin ◽  
Jing Xie ◽  
Stephanie Ward ◽  
Henry Brodaty ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
The Elderly ◽  
Cox Proportional Hazards ◽  
Service Planning ◽  
Cox Proportional Hazards Model ◽  
Cognitive Test ◽  
Risk Of Death ◽  
Hazards Model ◽  
Using Data

Abstract Research Aims: This study seeks to understand whether those with dementia experience higher risk of death, using data from the ASPREE (ASPirin in Reducing Events in the Elderly) clinical trial study. Methods: ASPREE was a primary intervention trial of low-dose aspirin among healthy older people. The Australian cohort included 16,703 dementia-free participants aged 70 years and over at enrolment. Participants were triggered for dementia adjudication if cognitive test results were poorer than expected, self-reporting dementia diagnosis or memory problems, or dementia medications were detected. Incidental dementia was adjudicated by an international adjudication committee using the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) criteria and results of a neuropsychological battery and functional measures with medical record substantiation. Statistical analyses used a cox proportional hazards model. Results: As previously reported, 1052 participants (5.5%) died during a median of 4.7 years of follow-up and 964 participants had a dementia trigger, of whom, 575 (60%) were adjucated as having dementia. Preliminary analyses has shown that the mortality rate was higher among participants with a dementia trigger, regardless of dementia adjudication outcome, than those without (15% vs 5%, Χ2 = 205, p &lt;.001). Conclusion: This study will provide important analyses of differences in the hazard ratio for mortality and causes of death among people with and without cognitive impairment and has important implications on service planning.

Cognitive Impairment after Lacunar Stroke and the Risk of Recurrent Stroke and Death

2021 ◽  
pp. 1-7
Author(s):  
Abraham Kwan ◽  
Jingkai Wei ◽  
N. Maritza Dowling ◽  
Melinda C. Power ◽  
Zurab Nadareshvili ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Memory Impairment ◽  
Recurrent Stroke ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Cognitive Screening ◽  
Lacunar Stroke ◽  
Domain Specific ◽  
Risk Of Death ◽  
Increased Risk

Introduction: Patients with poststroke cognitive impairment appear to be at higher risk of recurrent stroke and death. However, whether cognitive impairment after lacunar stroke is associated with recurrent stroke and death remains unclear. We assessed whether global or domain-specific cognitive impairment after lacunar stroke is associated with recurrent stroke and death. Methods: We considered patients from the Secondary Prevention of Small Subcortical Strokes (SPS3) trial with a baseline cognitive exam administered in English by certified SPS3 personnel, 14–180 days after qualifying lacunar stroke. We considered a baseline score of ≤86 on the Cognitive Assessment Screening Instrument to indicate global cognitive impairment, <10 on the Clock Drawing on Command test to indicate executive function impairment, and domain-specific summary scores in the lowest quartile to indicate memory and nonmemory impairment. We used Cox proportional hazards models to estimate the association between poststroke cognitive impairment and subsequent risk of recurrent stroke and death. Results: The study included 1,528 participants with a median enrollment time of 62 days after qualifying stroke. During a mean follow-up of 3.9 years, 11.4% of participants had recurrent stroke and 8.2% died. In the fully adjusted models, memory impairment was independently associated with an increased risk of recurrent stroke (hazard ratio, 1.48; 95% confidence interval [95% CI]: 1.04–2.09) and death (hazard ratio, 1.87; 95% CI: 1.25–2.79). Global impairment (hazard ratio, 1.66; 95% CI: 1.06–2.59) and nonmemory impairment (hazard ratio, 1.74; 95% CI: 1.14–2.67) were associated with an increased risk of death. Discussion/Conclusion: After lacunar stroke, memory impairment was an independent predictor of recurrent stroke and death, while global and nonmemory impairment were associated with death. Cognitive screening in lacunar stroke may help identify populations at higher risk of recurrent stroke and death.

Impact of Diabetes Mellitus and Insulin Use on Survival After Colorectal Cancer Diagnosis: The Cancer Prevention Study-II Nutrition Cohort

2012 ◽  
Vol 30 (1) ◽  
pp. 53-59 ◽  
Author(s):  
Ahmed N. Dehal ◽  
Christina C. Newton ◽  
Eric J. Jacobs ◽  
Alpa V. Patel ◽  
Susan M. Gapstur ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Colorectal Cancer ◽  
Cancer Prevention ◽  
Cox Proportional Hazards ◽  
Prevention Study ◽  
Men And Women ◽  
Risk Of Death ◽  
Increased Risk ◽  
Specific Mortality ◽  
Insulin Use

Purpose To examine the association between type 2 diabetes mellitus (T2DM) and survival among patients with colorectal cancer (CRC) and to evaluate whether this association varies by sex, insulin treatment, and durations of T2DM and insulin use. Patients and Methods This study was conducted among 2,278 men and women diagnosed with nonmetastatic colon or rectal cancer between 1992 and 2007 in the Cancer Prevention Study-II Nutrition Cohort, a prospective study of cancer incidence. In 1992 to 1993, participants completed a detailed, self-administrated questionnaire. Vital status and cause of death were ascertained through the end of 2008. Multivariable-adjusted relative risks (RRs) and 95% CIs were estimated using Cox proportional hazards regression. Results Among the 2,278 men and women with nonmetastatic CRC, there were 842 deaths by the end of follow-up (including 377 deaths from CRC and 152 deaths from cardiovascular disease [CVD]). Among men and women combined, compared with patients without T2DM, patients with CRC and T2DM were at higher risk of all-cause mortality (RR, 1.53; 95% CI, 1.28 to 1.83), CRC-specific mortality (RR, 1.29; 95% CI, 0.98 to 1.70), and CVD-specific mortality (RR, 2.16; 95% CI, 1.44 to 3.24), with no apparent differences by sex or durations of T2DM or insulin use. Insulin use, compared with no T2DM, was associated with increased risk of death from all causes (RR, 1.68; 95% CI, 1.22 to 2.31) and CVD (RR, 3.87; 95% CI, 2.12 to 7.08) but not from CRC (RR, 0.58; 95% CI, 0.28 to 1.19). Conclusion Patients with CRC and T2DM have a higher risk of mortality than patients with CRC who do not have T2DM, especially a higher risk of death from CVD.

Accelerated aging and mortality in long-term survivors of childhood cancer: A report from the St. Jude Lifetime Cohort (SJLIFE).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10045-10045
Author(s):  
AnnaLynn M. Williams ◽  
Jeanne S. Mandelblatt ◽  
Mingjuan Wang ◽  
Kirsten K. Ness ◽  
Gregory T. Armstrong ◽  
...  
Keyword(s):  
Childhood Cancer ◽  
Proportional Hazards ◽  
Accelerated Aging ◽  
Cox Proportional Hazards ◽  
Premature Aging ◽  
Self Report ◽  
Deficit Accumulation ◽  
Risk Of Death ◽  
Increased Risk ◽  
Survivors Of Childhood Cancer

10045 Background: Survivors of childhood cancer have functional limitations and health-related morbidity consistent with an accelerated aging phenotype. We characterized aging using a Deficit Accumulation Index (DAI) which examines the accumulation of multiple aging-related deficits readily available from medical records and self-report. DAI’s are used as surrogates of biologic aging and are validated to predict mortality in adult cancer patients. Methods: We included childhood cancer survivors (N = 3,758, mean age 30 [SD 8], 22 [9] years post diagnosis, 52% male) and community controls (N = 575, mean age 34 [10] 44% male) who completed clinical assessments and questionnaires and who were followed for mortality through December 31st, 2018 (mean follow-up 6.1 [3.1] years). Using the initial SJLIFE clinical assessment, a DAI score was generated as the proportion of deficits out of 44 items related to aging, including chronic conditions (e.g. hearing loss, hypertension), psychosocial and physical function, and activities of daily living. The total score ranged 0 to 1; scores > 0.20 are robust, while moderate and large clinically meaningful differences are 0.02 and 0.06, respectively. Linear regression compared the DAI in survivors and controls with an age*survivor/control interaction and examined treatment associations in survivors. Cox-proportional hazards models estimated risk of death associated with DAI. All models were adjusted for age, sex, and race. Results: Mean [SD] of DAI was 0.17 [0.11] for survivors and 0.10 [0.08] for controls. 32% of survivors had a DAI above the 90th percentile of the control distribution (p < 0.001). After adjustment for covariates, survivors had a statistically and clinically meaningfully higher DAI score than controls (β = 0.072 95%CI 0.062, 0.081; p < 0.001). When plotted against age, the adjusted DAI at the average age of survivors (30 years) was 0.166 (95% CI 0.160,0.171), which corresponded to 60 years of age in controls, suggesting premature aging of 30 years. The mean difference in DAI between survivors and controls increased with age from 0.06 (95% CI 0.04, 0.07) at age 20 to 0.11 (95% CI 0.08, 0.13) at age 60, consistent with an accelerated aging phenotype (p = 0.014). Cranial radiation, abdominal radiation, cyclophosphamide, platinum agents, neurosurgery, and amputation were each associated with a higher DAI (all p≤0.001). Among survivors, a 0.06 increase in DAI was associated with a 41% increased risk of all-cause mortality (HR 1.41 95%CI 1.32, 1.50; p < 0.001). Conclusions: Survivors of childhood cancer experience significant age acceleration that is associated with an increased risk of mortality; longitudinal analyses are underway to validate these findings. Given the ease of estimating a DAI, this may be a feasible method to quickly identify survivors for novel and tailored interventions that can improve health and prevent premature mortality.

scholarly journals Predictors of mortality in adult patients with dengue: a study from South India

2018 ◽  
Vol 6 (5) ◽  
pp. 1605 ◽  
Author(s):  
Vasudeva Acharya ◽  
Mohammed Fahad Khan ◽  
Srinivas Kosuru ◽  
Sneha Mallya
Keyword(s):  
Renal Failure ◽  
Prothrombin Time ◽  
Tertiary Care ◽  
P Value ◽  
Bleeding Tendency ◽  
Care Hospital ◽  
Laboratory Parameters ◽  
Prolonged Prothrombin Time ◽  
Risk Of Death ◽  
Increased Risk

Background: Dengue is one of the important causes of acute febrile illnesses in India. Dengue can be a fatal disease, however there are no reliable markers which can predict mortality among these patients.Methods: A prospective cross sectional study was done in patients who were admitted to a tertiary care hospital with features of dengue fever. A total of 364 patients with IgM dengue serology positive were included in the study. Relevant clinical and laboratory parameters were collected from all patients. Association between clinico-laboratory parameters with mortality was studied using appropriate statistical methods.Results: Among the 364 patients recruited in this study, 14 (3.85%) patients died. Mortality among patients with age group 18-40 years was 2.04%, in patients aged above 40 years was 7.56%. Mortality among patients with hypotension was 42.42% (14 out of 33), bleeding manifestations was 15.38% (8/52), platelets <20,000/mm3 was 10.41% (10/96), ALT >200 was 13.04% (6/46), AST>200 was 12.34% (10/81), prolonged prothrombin time was 60%(12/20), renal failure was 28%(14/50), encephalopathy was 31.57% (6/19), multi organ dysfunction syndrome(MODS) was 43.33% (13/30), acute respiratory distress syndrome (ARDS) was 45.45% (5/11), pleural effusion was 7.5% (6/80).Conclusions: The overall mortality in the present study was 3.85%. Following variables were associated with increased risk of death among the dengue patients: Age >40 years, presence of hypotension, platelets <20000 cells/mm3, ALT>200U/L, AST>200U/L, prolonged prothrombin time, presence of renal failure, encephalopathy, MODS, ARDS and bleeding tendency (p value <0.05). Early identification of factors associated with mortality can help to make appropriate decision on care required.

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