604 Emergency Department Disposition Among Older Americans with Burn Injury

TL;DR

Older adults with burn injuries are less likely to be discharged home from the emergency department compared to younger adults, especially if they are frail.

Contribution

This study quantifies the relationship between age, frailty, and ED disposition for burn injuries in older adults using national data.

Findings

80+ year-olds had significantly lower odds of being discharged home compared to younger adults.

Frailer patients had much lower odds of being discharged home from the ED.

Most burn injury visits resulted in discharge to home, but this was less common for older and frailer individuals.

Abstract

Older adults (those greater than 65 years of age) represent 17% of the U.S. population and 10% of burn injured patients. Such patients are distinctly different than their younger counterparts given their higher levels of frailty, increased rates of comorbid conditions, and altered physiologic responses to injury. In this context, we sought to better understand the impact of burn injury among this growing and vulnerable population.

We queried the Nationwide Emergency Department Sample (NEDS) for burn injury visits among all patients 18 years and older between 2019 and 2021. This data was weighted to allow for national estimates. Patients were categorized into age groups (18-40, 41-60, 61-80, 80+ years old). Frailty was quantified using the Hospital Frailty Risk Score (HFRS), which uses ICD-10 codes to stratify patients. Multivariable logistic regression analysis was used to assess the association of emergency department (ED) visit disposition and age, adjusting for gender, race, primary insurance, frailty, burn mechanism and hospital-level characteristics.

Between 2019 and 2021, there were 211,565 visits for adult burn injury. Of these, 90% (n=189,590) resulted in a discharge to home. Older adults had decreased odds of discharge home from the ED compared with younger adults (61-80 year-olds: OR 0.81, [95% CI: 0.76-0.87]; 81+ year-olds: OR 0.57 [95% CI: 0.51-0.64]). Furthermore, there was a strong correlation with frailer patients having lower odds of discharge to home from the ED (High HFRS: OR < 0.001 [95% CI: < 0.001-0.001]; Intermediate HFRS: OR 0.02 [95% CI: 0.021-0.024]).

Older, frail adults have the highest association with non-home discharge following burn injury visits in the emergency department. Next steps in research can examine ways to optimize burn care for older adults and identify interventions that can facilitate a return to home after burn injury.

This study identifies an important target for research in how burn injury affects older and frailer adults in the United States.

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