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

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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.
Original languageEnglish
Pages (from-to)104-114
Number of pages11
JournalArchives of Gerontology and Geriatrics
Volume80
Early online date8 Nov 2018
DOIs
Publication statusPublished - 1 Jan 2019

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