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Frailty assessment tools help identify at-risk patients in ED

11th November 2022

Two separate frailty assessment tool scores applied to emergency department patients enables the identification of more at-risk patients

Using two separate frailty assessment scores on emergency department patients helps to identify different at-risk patient cohorts and highlights the potential benefit of using both to guide clinical decision-making according to Saudi Arabian researchers.

The term frailty is related to the ageing process and associated with adverse health outcomes. For example, among general surgical patients, the prevalence of frailty has been estimated to range from 10.4 and 37.0% and with a 30-day mortality rate of 8%. Among emergency department (ED) patients, identification of frailty may help guide clinical practice, especially given how the prevalence of frail patients encountered in ED ranges from 9.7% to 43.7%. The Clinical Frailty Scale (CFS) is a recognised frailty assessment tool that can be used to assess the risk of death in patients and has been shown to be an accurate score for predicting poor outcomes and is more practical for use in busy clinical environments such as an ED. An alternative frailty assessment tool is the Hospital Frailty Risk Score (HFRS) and which provides health systems with a low-cost, systematic way to screen for frailty and identify patients at greater risk of adverse outcomes. However, the predictive accuracy of HFRS has not been assessed within an ED and for the present study, the Saudi researchers set out to retrospectively determine the extent to which the CFS and HFRS correlated and their ability to predict adverse hospital-related outcomes for older adults attending an ED. The team developed logistic regression models to estimate the odds ratios (ORs) for both tools to predict both 30-day mortality, a length of stay > 10 days and 30-day remission.

Frailty assessment and clinical outcomes

A total of 12,237 patients with a mean age of 84.6 years (57.8% female) were eligible for inclusion in the analysis.

The correlation between two frailty assessments was low at 0.36 (95% CI 0.34 – 0.38) and the agreement between them was also poor (weighted kappa = 0.10, 95% CI 0.09 – 0.11).

In fully adjusted models, the estimates of 30-day mortality were similar between both frailty assessment tools for patients deemed at a high-risk of frailty (OR = 2.26 vs 2.16, CFS vs HFRS respectively).

The authors concluded that both tools were shown to be predictors of adverse outcomes but given the low level of agreement, each tool was actually identifying a different at-risk population, and which highlighted the potential value of using each tool in ED to help guide clinical decision-making.

Alshibani A et al. A comparison between the clinical frailty scale and the hospital frailty risk score to risk stratify older people with emergency care needs. BMC Emerg Med 2022