Frailty assessment in middle-aged and older patients with burn injuries, a prospective comparative study on the clinimetric properties of existing screening tools

Abstract

Introduction: Frailty is frequently seen in burn patients aged ≥ 50 years and can negatively influence outcomes, yet performance of available screening tools in specialized burn care remains unclear. This study evaluated feasibility, reliability, and validity of the Clinical Frailty Scale (CFS), Burn Frailty Index (BFI), and Groningen Frailty Indicator (GFI), and determined the prevalence of frailty among patients with burns.

Methodology: A multicentre prospective cohort study was conducted in Dutch burn centres in patients aged ≥ 50 years. Feasibility, inter-rater reliability, predictive validity, known-group validity, convergent validity, and prevalence of frailty and its association with patient characteristics and clinical outcomes were assessed.

Results: Among 145 patients (median age 66 years, median TBSA burned 6.4 %), the CFS and GFI were highly feasible (completion rate up to 97 %), while the BFI was less feasible. Inter-rater reliability was moderate to good for CFS and BFI. Frailty (CFS, BFI, GFI) predicted non-home discharge, but not complications or length of stay. Frail patients were more likely to be older (CFS, BFI), have more comorbidity (CFS, BFI, GFI), and have polypharmacy (CFS, GFI). Frailty scores correlated moderately with reference standards. Frailty prevalence varied: 42.1 % (GFI), 19.4 % (CFS), and 6.2 % (BFI).

Conclusion: Systematic frailty screening can play an important role in acute burn care for older patients, with the CFS emerging as most feasible, reliable, and valid option for clinical implementation.

Keywords: Burn Frailty Index; Burn injury; Clinical Frailty Scale; Feasibility; Frailty assessment; Groningen Frailty Indicator; Reliability; Specialized burn care; Validity.