Predictors of Discharge Disposition in Older Adults with Burn Injury: A Nationwide Emergency Department Analysis

Burn injuries in older adults present unique clinical challenges due to age-related health changes, including impaired wound healing and diminished immune responses. Frailty, characterized by decreased physiologic reserve, has emerged as a powerful predictor of outcomes after burn injury, yet its impact on emergency department disposition remains understudied. This retrospective, cross-sectional study analyzed adult emergency department visits for thermal burn injuries using data from the Nationwide Emergency Department Sample from 2019 to 2022. Adult patients with thermal burns were classified by age, gender, race, household income, and frailty score. Multivariable logistic regression was used to assess factors associated with discharge disposition, focusing on home discharge as a marker of functional independence. Of over one million identified encounters, older age and higher frailty scores were significant, independent predictors of reduced likelihood of discharge home. Patients with intermediate and high frailty scores were disproportionately represented among those admitted or transferred, regardless of chronological age. Additional factors associated with disposition included burn mechanism, injury region, and patient demographics. These findings suggest that routine frailty assessment at the point of emergency department care may improve risk stratification and guide resource allocation, helping identify older adults at risk for loss of independence. Integration of frailty screening into emergency burn care pathways, alongside development of age-specific guidelines, may optimize outcomes for this vulnerable population.