Creation of a decision aid for goal-setting after geriatric burns: A study from the prognostic assessment of life and limitations after trauma in the elderly [PALLIATE] consortium

OBJECTIVES: We hypothesized that a decision-support aid to predict index admission mortality and discharge disposition for geriatric burns could be constructed using the well-accepted Baux score (age + total body surface area burned) in a geriatric-specific cohort. METHODS: National Burn Repository version 8.0 (2002-2011) was queried for all subjects aged ≥65 years. Baux scores were calculated and patients grouped into deciles. Three discharge outcomes (death, home, discharge to non-home setting) were measured per decile. A receiver operating characteristic analysis was used to determine optimal Baux score cutpoints based on the Youden Index. The odds of mortality at various Baux score cutoffs were estimated using logistic regression. RESULTS: The sample was 8,001 subjects. Withdrawal of care was documented in 264 deaths; median time to withdrawal was 3 days. As Baux score increased, three peaks in disposition were seen. Less than 50% of patients with a Baux score ≥80 were discharged home. Patients with a moderate Baux score (80-130) had an increased likelihood of discharge to a non-home setting. Baux scores ≥130 were nearly uniformly fatal (mortality 94-100%). Baux score ≤86.15 was predictive of discharge home (AUC 0.698, 75.28% sensitivity, 54.64% specificity), and a score >93.3 was predictive of mortality (AUC 0.779, 57.46% sensitivity, 87.08% specificity). CONCLUSION: For geriatric patients whose Baux scores exceed 86, return-to-home rates drop drastically; mortality increases at a score >93, and mortality is nearly universal at a score ≥130. We are piloting a display of these findings as a decision-making aid when setting goals of care with stakeholders after geriatric burns.