Age, functional status predict return to acute care for burn patients

By Helen Albert, Senior medwireNews Reporter

Older age and lower functional status at admission increase a patient's likelihood of being transferred from a burn rehabilitation unit back to acute care, show study findings.

"Transfer to acute care from rehabilitation represents an interruption in a patient's recovery and a potential deficiency in quality of care," say Jeffrey Schneider (Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA) and colleagues.

They hope that their research will help pinpoint burn patients who are in need of extra initial care before being transferred to an inpatient rehabilitation unit to prevent readmission to acute care.

Schneider and team analyzed data collected from the Uniform Data System for Medical Rehabilitation from 2002 to 2010 on 4572 patients in 537 inpatient rehabilitation units in the USA.

Overall, 13% (n=586) of transfers from the rehabilitation units were to acute care, and 2% (n=78) of these occurred within the first 3 days of being admitted.

Writing in the Journal of Trauma and Acute Care Surgery, the team reports that lower functional level at admission (functional independence measure [FIM] mean score of 51.2 vs 65.2), older age (mean age 59.4 vs 51.4 years), and having previously been admitted to an inpatient rehabilitation facility were all significant predictors of being transferred to acute care within 3 days.

Although patients readmitted to acute care had larger burns on first hospital admission (mean total body surface area of 30-39% vs 20-29%), this was not a significant predictor of being transferred to acute care within 3 days, neither was having medical comorbidities.

Using age category (approximate 10-year groups), history of rehabilitation unit admission, and FIM score, the team created a scoring system to predict risk for acute transfer. They calculated that those with the lowest score (-1) were very unlikely to be transferred to acute care within 3 days (0.1%), whereas those with the highest score (10 points) had a 28.4% risk for being transferred within this period.

"Efforts to reduce readmissions to acute care should include greater scrutiny of older, lower-functioning patients with burn injury who are evaluated for admission to inpatient rehabilitation," conclude Schneider et al.

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