A comparison between the clinical frailty scale and the hospital frailty risk score to risk stratify older people with emergency care needs

Abstract

Background Older adults living with frailty who require treatment in hospitals are increasingly seen in the Emergency Departments (EDs). One quick and simple frailty assessment tool—the Clinical Frailty Scale (CFS)—has been embedded in many EDs in the United Kingdom (UK). However, it carries time/training and cost burden and has significant missing data. The Hospital Frailty Risk Score (HFRS) can be automated and has the potential to reduce costs and increase data availability, but has not been tested for predictive accuracy in the ED. The aim of this study is to assess the correlation between and the ability of the CFS at the ED and HFRS to predict hospital-related outcomes. Methods This is a retrospective cohort study using data from Leicester Royal Infirmary hospital during the period from 01/10/2017 to 30/09/2019. We included individuals aged + 75 years as the HFRS has been only validated for this population. We assessed the correlation between the CFS and HFRS using Pearson’s correlation coefficient for the continuous scores and weighted kappa scores for the categorised scores. We developed logistic regression models (unadjusted and adjusted) to estimate Odds Ratios (ORs) and Confidence Intervals (CIs), so we can assess the ability of the CFS and HFRS to predict 30-day mortality, Length of Stay (LOS) > 10 days, and 30-day readmission. Results Twelve thousand two hundred thirty seven individuals met the inclusion criteria. The mean age was 84.6 years (SD 5.9) and 7,074 (57.8%) were females. Between the CFS and HFRS, the Pearson correlation coefficient was 0.36 and weighted kappa score was 0.15. When comparing the highest frailty categories to the lowest frailty category within each frailty score, the ORs for 30-day mortality, LOS > 10 days, and 30-day readmission using the CFS were 2.26, 1.36, and 1.64 and for the HFRS 2.16, 7.68, and 1.19. Conclusion The CFS collected at the ED and the HFRS had low/slight agreement. Both frailty scores were shown to be predictors of adverse outcomes. More research is needed to assess the use of historic HFRS in the ED.

The Limited Utility of the Hospital Frailty Risk Score as a Frailty Assessment Tool in Neurosurgery: A Systematic Review

“…HFRS has seen widespread implementation as a frailty measure across various medical and surgical specialties, including neurosurgery. 6,[9][10][11][12][13][14][15][16][17][18] HFRS' widespread adoption may be a result of its strong predictive power of "hospital-related harm and resource use." 7 However, these studies may better reflect HFRS' ability to capture acute conditions that cause major morbidity inherent to their ICD-10 code inclusion.…”

“…HFRS has seen widespread implementation as a frailty measure across various medical and surgical specialties, including neurosurgery. 6,9-18 HFRS' widespread adoption may be a result of its strong predictive power of “hospital-related harm and resource use.” 7 However, these studies may better reflect HFRS' ability to capture acute conditions that cause major morbidity inherent to their ICD-10 code inclusion. Thus, HFRS may not reflect any true measurement of the frailty phenotype or an individual's baseline physiological reserve that surgical frailty research attempts to consistently quantify.…”

The effect of relative hypotension on 30-day mortality in older people receiving emergency care

“…The CFS considers the phenotypic manifestations of frailty on function and dependence, while the HFRS considers the sensitive diagnoses contributing to frailty-related risks. Elsewhere, these measures have both been shown to predict adverse health outcomes but are only weakly correlated, meaning they may identify different populations who are at risk [ 15 , 16 ].…”