Introduction
Methodology
Search strategy
Eligibility criteria
Screening and data extraction
Quality assessment
Synthesis and certainty of evidence
Results
Characteristics
ID | Author | Year | Country | Registry/ Duration | Population | Total patients | Frailty index | Cut-offs | Main Findings |
---|---|---|---|---|---|---|---|---|---|
1 | Yi, Y. [43] | 2022 | USA | National Inpatient Sample/ 2016–2018 | Patients ≥ 50 years of age with an acute burn diagnosis | 60,515 | Hospital frailty index | Low < 5; moderate 5–15; high > 15 | 1) Multivariable analysis for in-hospital mortality showed the OR [95% CI]: 3.62 [2.81–4.67] for the moderately frail group and 5.70 [3.60–9.02] for the highly frail group; 2) AUROCs for the model including Hospital frailty index: 0.84 |
2 | Wolf Horrell, E. [40] | 2021 | USA | Single center/ 7 months | All admitted acute burn patients ages 45 and older | 85 | FRAIL Scale | Robust; pre-frail; frail | 1) More palliative care consultations in the prefrail/frail group, although it was non-significant (p = 0.096); 2) Increased length of stay in the prefrail/frail group (p = 0.002); 3) Higher level of care discharge in the prefrail/frail group (p = 0.032) |
3 | 2014 | UK | Center based/ 9 years retrospective study | All burn admissions aged ≥ 65 | 228 | Canadian Study for Health and Ageing (CSHA) Clinical Frailty score (CFS) | NA | 1) CFS was significantly higher among non-survivors (p = 0. 010); 2) Multivariate analysis showed that the CFS is an independent predictor of mortality (p = 0. 043); 3) AUROCs analysis: 0.892; 4) Each increase in CFS point showed the OR [95% CI]: 1.588 [1.156–2.179] for mortality | |
4 | Ward. [9] | 2018 | UK | Center based/ 8 years retrospective study | All patients > 65 years admitted to the burns center | 239 | Rockwood’s Clinical Frailty Scale | NA | 1- Mortality: Frailty as an independent predictor of mortality p < 0.0001 2- In-hospital mortality: increased in-hospital mortality OR:2.33, p < 0.0001 3- One-year mortality: increased one-year mortality OR:3.13 (sensitivity = 83.9%) p < 0.0001 4- Spearman correlation coefficient (Rho) for in-hospital mortality: Rho = 0.31 (0.3–0.49 moderate association) p < 0.0001 5- Spearman correlation coefficient (Rho) for 1 year mortality: Rho = 0.5 (0.5 or more, large association) p < 0.0001 |
5 | Wallace, D. L. [42] | 2022 | USA | Center based/ January 2016—December 2017 | Burn patients | 1615 | Modified frailty index-11 | NA | 1- Not an independent predictor of mortality 2- Not an independent predictor of LOS |
6 | Wallace, D. L. [41] | 2022 | USA | Center based/ 2009–2018 | Patients > 50 years with acute burn injuries | 953 | Canadian Study for Health and Ageing (CSHA) Clinical Frailty score (CFS) | NA | 1- Predictor of mortality with OR = 2.9 (≥ 5 v 1–4) 2- Not associated with LOS p = 0.52 3- Predictor of discharge destination p < 0.0001 |
7 | Sepehripour. [37] | 2018 | UK | Center based/ 2009–2010 | Patients > 75 year sustaining a burn injury | 129 | Canadian Study for Health and Ageing (CSHA) Clinical Frailty score (CFS) | NA | 1) Pearson correlation coefficient of p = 0.034 shows a strong correlation between frailty and complication (reduced mobility and cognitive impairment) |
8 | Romanowski. [38] | 2020 | USA | Center based/ 2008–2017 | Burn patients ≥ 60 years old | 83 | Canadian Study for Health and Ageing (CSHA) Clinical Frailty score (CFS) | NA | 1- Not a predictor of mortality (OR [95% CI] = 0.848 [0.492, 1.467], p = .554) 2- Not a predictor of LOS (estimate = − 0.496 [− 5.254, 4.262], p = .836) |
9 | Romanowski. [10] | 2018 | USA | Center based/ 2008–2013 | Burn patients ≥ 50 years old | 502 | Canadian Study for Health and Ageing (CSHA) Clinical Frailty score (CFS) | NA | 1- Independent predictor of mortality p < 0.001 2- Predictor of high level of care discharge destination p < 0.05 3- Multivariate analysis showed frailty is an independent predictor of mortality (OR [95% CI] = 1.94 [1.3 to 2.8]; [45]). Among patients aged 50–64, the estimate was OR [95% CI] = 2.5 [ 1.4–4.6] Among patients aged > 65, the estimate was lower (OR [95% CI] = 1.63[ 1.003–2.7]) |
10 | Romanowski, K. S. [11] | 2015 | USA | Center based/ 2011–2013 | Acute burn patients 65 years or older | 89 | Canadian Study for Health and Ageing (CSHA) Clinical Frailty score (CFS) | NA | 1) Frailty scores were greater among non-survivors (5.2 ± 1.2 vs 4.4 ± 1.2) 2) Frailty scores were greater among those with poor discharged location (5.34 ± 0.9 vs 4.1 ± 1.2) 3) Multivariate analysis showed admission frailty scores are independently associate with poor discharge location 2.5 [1.3–4.8, 95% CI]) and mortality 1.67 [1.01–2.7, 95% CI]) |
11 | Özlü, Ö. [15] | 2022 | Turkey | Center based/ 2017–2020 | Hospitalized burn patients 65 years or older | 67 | Canadian Study for Health and Ageing (CSHA) Clinical Frailty score (CFS) | Normal: (CFS:1–3); Vulnerable: (CFS:4); Frail: (CFS:5–9) | 1) CFS is an independent predictor of poor prognosis (those died or had major amputation) OR [95% CI] = 6.7 [0.8–55.6] for vulnerable group and OR [95% CI] = 47.8 [6.5–340.6] for frail group; p = 0.0001 |
12 | Maxwell, D. W. [36] | 2018 | USA | Center based/ 2013–2017 | Burn patients 65 years or older | 100 | Emergency General Surgery Frailty Index (EGSFI) | NA | Frail patients showed more 1) complications (61.8% vs 10.6%) (p < 0.05); 2) non-home discharges (67.6% vs 13.6%), 3) ICU admissions (52.9% vs 10.6%), 4) longer ICU stays (17 ± 23.0 vs 1 ± 7.0 days), and 5) in hospital mortalities (11.8% vs 1.5%) |
13 | Masud, D. [12] | 2013 | UK | Center based/ 2005–2009 | Burn patients 65 years or older | 42 | Canadian Study for Health and Ageing (CSHA) Clinical Frailty score (CFS) | NA | 1) Mortality: significantly lower frailty scores Median IQR 3 (2–7) compared to the non-survivors Median 5 (p = 0.0001) 2) Optimal cut off value for frailty score for mortality is > 3 (sensitivity = 100%, specificity = 72%) 3) Multivariate analysis showed for every 1-point increase in the frailty score the probability of death increases by 2.1 [95% CI] = 1.0798–4.0480) |
14 | Madni, T. D. [35] | 2018 | USA | Center based/ 2009–2014 | Burn patients 65 years or older | 126 | Canadian Study for Health and Ageing (CSHA) Clinical Frailty score (CFS) | NA | 1) The mean (SD) regarding the frailty score was significantly higher in those needed goals of care discussion (4.7 ± 1.3 vs. 3.8 ± 0.95; p = 0.0006), OR [95% CI] 3.42 ([1.54–7.60]; 2) The mean (SD) regarding the frailty score was significantly higher in those with unfavorable disposition (5.0 ± 1.3 vs. 33.6 ± 0.80; p = 0.0001), OR [95% CI] = 9.01 [ 3.91–20.78] |
15 | Iles, K. A. [14] | 2022 | USA | Center based/ 2015–2019 | Burn patients 65 years or older | 652 | Canadian Study for Health and Ageing (CSHA) Clinical Frailty score (CFS) | Low (1–3), medium (4–6), or high (7–9) | 1) Mortality: greatest in the high frailty group 24.3%, 7.0%, and 2.3%. Hazard ratios comparing high vs. low frailty group and high vs. moderate frailty group were 5.73; 95% CI (1.86, 17.62) and 2.19; 95% CI (0.87–5.50), respectively; 2) Median LOS was similar between subgroups (median 6–9 days); 3) ICU stay: greatest in the high frailty group (68% vs 37% and 21%, p < .001); 4) Need for mechanical ventilation: greatest in the high frailty group (27% vs 19% and 8%, p < .001), compared to moderate and low frailty |
16 | Galet, C. [13] | 2022 | USA | Center based/ 2009–2019 | Burn patients 50 years or older | 851 | Canadian Study for Health and Ageing (CSHA) Clinical Frailty score (CFS) | Non frail < 5, frail > = 5 | Multivariate analysis showed frailty was associated with increased: 1) Acute respiratory failure (OR [95% CI] = 2.599 [1.460–4.628], p = .001); 2) Mortality (OR [95% CI] = 6.080 [2.316–15.958]; p < .001); 3) Poor discharge disposition (OR [95% CI] = 3.135 [1.784–5.508], p < .001) |
17 | Andre, J. A. [39] | 2021 | USA | Secondary analysis from Transfusion Requirement in Burn Care Evaluation (TRIBE) study/ 2021 | Burn Population | 347 | Modified frailty index-11/ Modified frailty index-5 | Frail: MFI > 1 on either scale | 1) As continuous variable, MFI-5 (OR [95% CI] = 1.86; [1.11–3.11]; p = 0.02) and MFI-11 (OR [95% CI] = 1.83[ 1.18–2.8]; p = 0.007) were independent predictors of mortality 2) MFI-11 > 1 was an independent predictor of mortality (OR [95% CI] = 2.91; [1.1–7.7]; p = 0.03); whereas, MFI-5 > 1 was not (OR [95% CI] = 2.6[ 0.95–7]; p = 0.06) |
18 | Maxwell, D | 2019 | USA | Center-based/ February 10, 2011 to June 8, 2017 | Burn patients > 65-years | 100 | Burn frailty index | Frail > = 0.30 | 1- Mortality: 12 occurred in frail group, 1 occurred in non-frail 2- Median length of stay for not frail and BFI frail patients was 5 days (range 1–67) and 15 days (range 1–96), respectively 3- Sensitivity and specificity of the BFI predicting all-cause mortality is 0.923 (95% CI = 0.621–0.996) and 0.771 (95% CI = 0.608–0.807) 4- Patients classified as frail had significantly more complications (p < 0.001), non-home discharges (p < 0.001), ICU admissions, and longer hospital and ICU lengths of stay (p < 0.001), decreased 1 and 3-year survival (p = 0.001) |
Summary of frailty indices used
Frailty and postadmission outcomes
Outcome | No. of Studies based on each scale | Effect Estimate (In favor/ not in favor) | Risk Of Bias | Inconsistency | Indirectness | Imprecision | Publication Bias | Certainty of Evidenceb
|
---|---|---|---|---|---|---|---|---|
Mortality | CFS: 10 | 9/1 | Not serious | Not serious | Not serious | Not serious | Not serious | High |
Hospital frailty index: 1 | 1/0 | Not serious | NA | Not serious | Very serious | Not serious | Low | |
mFI-11: 2 | 1/1 (345 patients/ 1615 patients) | Serious | Serious | Not serious | Serious | Not serious | Very low | |
mFI-5: 1 | 0/1 | Serious | NA | Not serious | Serious | Not serious | Very low | |
EGSFI: 1 | 1/0 | Not serious | NA | Not serious | Very serious | Not serious | Low | |
Burn frailty index: 1 | 1/0 | Not serious | NA | Not serious | Very serious | Not serious | Low | |
Length of stay | CFS: 3 | 0/3 | Not serious | Not serious | Not serious | Serious | Not serious | Moderate |
FRAIL Scale: 1 | 1/0 | Serious | NA | Not serious | Very serious | Not serious | Very low | |
mFI-11: 1 | 0/1 | Serious | NA | Not serious | Very serious | Not serious | Very low | |
Burn frailty index: 1 | 1/0 | Not serious | NA | Not serious | Very serious | Not serious | Low | |
Poor dischargea | CFS: 5 | 5/0 | Not serious | Not serious | Not serious | Serious | Not serious | Moderate |
FRAIL Scale: 1 | 1/0 | Serious | NA | Not serious | Very serious | Not serious | Very low | |
EGSFI: 1 | 1/0 | Not serious | NA | Not serious | Very serious | Not serious | Low | |
Burn frailty index: 1 | 1/0 | Not serious | NA | Not serious | Very serious | Not serious | Low | |
ICU stay | CFS: 1 | 1/0 | Not serious | NA | Not serious | Very serious | Not serious | Low |
EGSFI: 1 | 1/0 | Not serious | NA | Not serious | Very serious | Not serious | Low | |
Burn frailty index: 1 | 1/0 | Not serious | NA | Not serious | Very serious | Not serious | Low | |
Need for mechanical ventilation | CFS: 1 | 1/0 | Not serious | NA | Not serious | Very serious | Not serious | Low |
Goals of care discussion | CFS: 1 | 1/0 | Not serious | NA | Not serious | Very serious | Not serious | Low |
Quality of the included studies
Study id | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | Total assessment |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Yi-2022 [43] | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | No | Yes | No | Yes | Yes | Good |
Ward-2018 [9] | Yes | Yes | Yes | Yes | No | Yes | Yes | No | Yes | No | Yes | NA | Yes | Yes | Good |
Sepehripour-2018 [37] | Yes | Yes | No | Yes | No | Yes | Yes | No | Yes | No | Yes | No | Yes | No | Poor |
Romanowski-2020 [38] | Yes | Yes | No | Yes | No | Yes | Yes | No | Yes | No | Yes | CD | Yes | No | Fair |
Romanowski-2018 [10] | Yes | Yes | Yes | Yes | No | Yes | Yes | No | Yes | No | Yes | No | Yes | Yes | Good |
Romanowski-2015 [11] | Yes | Yes | No | Yes | No | Yes | Yes | No | Yes | No | Yes | No | Yes | Yes | Fair |
Ozlu-2022 | Yes | Yes | No | Yes | No | Yes | Yes | Yes | Yes | No | Yes | No | Yes | Yes | Fair |
Masud-2013 [12] | Yes | Yes | No | Yes | No | Yes | Yes | No | Yes | No | Yes | No | Yes | Yes | Fair |
Madni-2018 [35] | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | Yes | No | Yes | No | Yes | Yes | Good |
Iles-2022 [14] | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | No | Yes | No | Yes | Yes | Good |
Galet-2022 [13] | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | No | Yes | No | Yes | Yes | Good |
Maxwell-2019 [44] | Yes | Yes | No | Yes | Yes | Yes | Yes | No | Yes | No | Yes | No | Yes | Yes | Fair |