Which frailty scale for patients admitted via Emergency Department? A cohort study

Ebony Lewis, Elsa Dent, John Kellett, Hatem Alkhouri, John Kellett, Margaret Williamson, Stephen Edward Asha, Anna Holdgate, John Mackenzie, Luis Winoto, Diana Fajardo-Pulido, Maree Ticehurst, Ken Hillman, Sally McCarthy, Emma Elcombe, Kris Rogers, Magnolia Cardona

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objectives
To determine the prevalence of frailty in Emergency Departments (EDs); examine the ability of frailty to predict poor outcomes post-discharge; and identify the most appropriate instrument for routine ED use..

Methods
In this prospective study we simultaneously assessed adults 65+yrs admitted and/or spent one night in the ED using Fried, the Clinical Frailty Scale (CFS), and SUHB (Stable, Unstable, Help to walk, Bedbound) scales in four Australian EDs for rapid recognition of frailty between June 2015 and March 2016.

Results
899 adults with complete follow-up data (mean (SD) age 80.0 (8.3) years; female 51.4%) were screened for frailty. Although different scales yielded vastly different frailty prevalence (SUHB 9.7%, Fried 30.4%, CFS 43.7%), predictive discrimination of poor discharge outcomes (death, poor self-reported health/quality of life, need for community services post-discharge, or reattendance to ED after the index hospitalization) for all identical final models was equivalent across all scales (AUROC 0.735 for Fried, 0.730 for CFS and 0.720 for SUHB).

Conclusion
This study confirms that screening for frailty in older ED patients can inform prognosis and target discharge planning including community services required. The CFS was as accurate as the Fried and SUHB in predicting poor outcomes, but more practical for use in busy clinical environments with lower level of disruption. Given the limitations of objectively measuring frailty parameters, self-report and clinical judgment can reliably substitute the assessment in EDs. We propose that in a busy ED environment, frailty scores could be used as a red flag for poor follow-up outcome.
LanguageEnglish
Pages104-114
Number of pages11
JournalArchives of Gerontology and Geriatrics
Volume80
Early online date8 Nov 2018
DOIs
Publication statusPublished - 1 Jan 2019

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community service
Hospital Emergency Service
Cohort Studies
hospitalization
quality of life
discrimination
death
planning
Social Welfare
ability
health
Aptitude
Patient Discharge
Self Report
Hospitalization
Quality of Life
Prospective Studies
Health

Cite this

Lewis, Ebony ; Dent, Elsa ; Kellett, John ; Alkhouri, Hatem ; Kellett, John ; Williamson, Margaret ; Asha, Stephen Edward ; Holdgate, Anna ; Mackenzie, John ; Winoto, Luis ; Fajardo-Pulido, Diana ; Ticehurst, Maree ; Hillman, Ken ; McCarthy, Sally ; Elcombe, Emma ; Rogers, Kris ; Cardona, Magnolia. / Which frailty scale for patients admitted via Emergency Department? A cohort study. In: Archives of Gerontology and Geriatrics. 2019 ; Vol. 80. pp. 104-114.
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abstract = "ObjectivesTo determine the prevalence of frailty in Emergency Departments (EDs); examine the ability of frailty to predict poor outcomes post-discharge; and identify the most appropriate instrument for routine ED use..MethodsIn this prospective study we simultaneously assessed adults 65+yrs admitted and/or spent one night in the ED using Fried, the Clinical Frailty Scale (CFS), and SUHB (Stable, Unstable, Help to walk, Bedbound) scales in four Australian EDs for rapid recognition of frailty between June 2015 and March 2016.Results899 adults with complete follow-up data (mean (SD) age 80.0 (8.3) years; female 51.4{\%}) were screened for frailty. Although different scales yielded vastly different frailty prevalence (SUHB 9.7{\%}, Fried 30.4{\%}, CFS 43.7{\%}), predictive discrimination of poor discharge outcomes (death, poor self-reported health/quality of life, need for community services post-discharge, or reattendance to ED after the index hospitalization) for all identical final models was equivalent across all scales (AUROC 0.735 for Fried, 0.730 for CFS and 0.720 for SUHB).ConclusionThis study confirms that screening for frailty in older ED patients can inform prognosis and target discharge planning including community services required. The CFS was as accurate as the Fried and SUHB in predicting poor outcomes, but more practical for use in busy clinical environments with lower level of disruption. Given the limitations of objectively measuring frailty parameters, self-report and clinical judgment can reliably substitute the assessment in EDs. We propose that in a busy ED environment, frailty scores could be used as a red flag for poor follow-up outcome.",
author = "Ebony Lewis and Elsa Dent and John Kellett and Hatem Alkhouri and John Kellett and Margaret Williamson and Asha, {Stephen Edward} and Anna Holdgate and John Mackenzie and Luis Winoto and Diana Fajardo-Pulido and Maree Ticehurst and Ken Hillman and Sally McCarthy and Emma Elcombe and Kris Rogers and Magnolia Cardona",
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Lewis, E, Dent, E, Kellett, J, Alkhouri, H, Kellett, J, Williamson, M, Asha, SE, Holdgate, A, Mackenzie, J, Winoto, L, Fajardo-Pulido, D, Ticehurst, M, Hillman, K, McCarthy, S, Elcombe, E, Rogers, K & Cardona, M 2019, 'Which frailty scale for patients admitted via Emergency Department? A cohort study' Archives of Gerontology and Geriatrics, vol. 80, pp. 104-114. https://doi.org/10.1016/j.archger.2018.11.002

Which frailty scale for patients admitted via Emergency Department? A cohort study. / Lewis, Ebony; Dent, Elsa ; Kellett, John; Alkhouri, Hatem; Kellett, John; Williamson, Margaret; Asha, Stephen Edward; Holdgate, Anna; Mackenzie, John; Winoto, Luis; Fajardo-Pulido, Diana; Ticehurst, Maree; Hillman, Ken; McCarthy, Sally; Elcombe, Emma; Rogers, Kris ; Cardona, Magnolia.

In: Archives of Gerontology and Geriatrics, Vol. 80, 01.01.2019, p. 104-114.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Which frailty scale for patients admitted via Emergency Department? A cohort study

AU - Lewis, Ebony

AU - Dent, Elsa

AU - Kellett, John

AU - Alkhouri, Hatem

AU - Kellett, John

AU - Williamson, Margaret

AU - Asha, Stephen Edward

AU - Holdgate, Anna

AU - Mackenzie, John

AU - Winoto, Luis

AU - Fajardo-Pulido, Diana

AU - Ticehurst, Maree

AU - Hillman, Ken

AU - McCarthy, Sally

AU - Elcombe, Emma

AU - Rogers, Kris

AU - Cardona, Magnolia

PY - 2019/1/1

Y1 - 2019/1/1

N2 - ObjectivesTo determine the prevalence of frailty in Emergency Departments (EDs); examine the ability of frailty to predict poor outcomes post-discharge; and identify the most appropriate instrument for routine ED use..MethodsIn this prospective study we simultaneously assessed adults 65+yrs admitted and/or spent one night in the ED using Fried, the Clinical Frailty Scale (CFS), and SUHB (Stable, Unstable, Help to walk, Bedbound) scales in four Australian EDs for rapid recognition of frailty between June 2015 and March 2016.Results899 adults with complete follow-up data (mean (SD) age 80.0 (8.3) years; female 51.4%) were screened for frailty. Although different scales yielded vastly different frailty prevalence (SUHB 9.7%, Fried 30.4%, CFS 43.7%), predictive discrimination of poor discharge outcomes (death, poor self-reported health/quality of life, need for community services post-discharge, or reattendance to ED after the index hospitalization) for all identical final models was equivalent across all scales (AUROC 0.735 for Fried, 0.730 for CFS and 0.720 for SUHB).ConclusionThis study confirms that screening for frailty in older ED patients can inform prognosis and target discharge planning including community services required. The CFS was as accurate as the Fried and SUHB in predicting poor outcomes, but more practical for use in busy clinical environments with lower level of disruption. Given the limitations of objectively measuring frailty parameters, self-report and clinical judgment can reliably substitute the assessment in EDs. We propose that in a busy ED environment, frailty scores could be used as a red flag for poor follow-up outcome.

AB - ObjectivesTo determine the prevalence of frailty in Emergency Departments (EDs); examine the ability of frailty to predict poor outcomes post-discharge; and identify the most appropriate instrument for routine ED use..MethodsIn this prospective study we simultaneously assessed adults 65+yrs admitted and/or spent one night in the ED using Fried, the Clinical Frailty Scale (CFS), and SUHB (Stable, Unstable, Help to walk, Bedbound) scales in four Australian EDs for rapid recognition of frailty between June 2015 and March 2016.Results899 adults with complete follow-up data (mean (SD) age 80.0 (8.3) years; female 51.4%) were screened for frailty. Although different scales yielded vastly different frailty prevalence (SUHB 9.7%, Fried 30.4%, CFS 43.7%), predictive discrimination of poor discharge outcomes (death, poor self-reported health/quality of life, need for community services post-discharge, or reattendance to ED after the index hospitalization) for all identical final models was equivalent across all scales (AUROC 0.735 for Fried, 0.730 for CFS and 0.720 for SUHB).ConclusionThis study confirms that screening for frailty in older ED patients can inform prognosis and target discharge planning including community services required. The CFS was as accurate as the Fried and SUHB in predicting poor outcomes, but more practical for use in busy clinical environments with lower level of disruption. Given the limitations of objectively measuring frailty parameters, self-report and clinical judgment can reliably substitute the assessment in EDs. We propose that in a busy ED environment, frailty scores could be used as a red flag for poor follow-up outcome.

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