Diagnostic Accuracy of Frailty Screening Instruments Validated for Use among Older Adults Attending Emergency Departments: A Systematic Review and Meta-Analysis

Abstract

Early identification of frailty can prevent functional decline. Although multiple frailty screens exist for use in Emergency Departments (EDs), few are validated against diagnostic standards such as comprehensive geriatric assessment. To examine the diagnostic accuracy of ED screens for frailty, scientific databases were searched for prospective diagnostic accuracy test studies from January 2000 to September 2022. Studies were assessed for risk of bias using QUADAS-C. Psychometric properties were extracted and analysed using R. Six studies involving 1,663 participants describing seven frailty screening instruments (PRISMA-7, CFS, VIP, FRESH, BPQ, TRST, and ISAR), representing 13 unique data points, were included. The mean age of participants ranged from 76 to 86 years. The proportion that was female ranged from 45 to 60%. The pooled prevalence rate of frailty was high at 59%. The pooled estimate for sensitivity was 0.85 (95% CI: 0.76–0.91) versus 0.77 (95% CI: 0.62–0.88) for specificity. Pooled accuracy based on area under the ROC curve was 0.89 (95% CI: 0.86–0.90). Although few studies were found, limiting the ability to conduct a meta-analysis of individual instruments, available frailty screens can accurately diagnose frailty in older adults attending the ED. As specificity was comparatively low, additional assessment may be required to identify those requiring inpatient management or onward community referral. Further study is therefore required.

The Prevalence of the Frailty Syndrome in a Hospital Setting—Is Its Diagnosis a Challenge? A Comparison of Four Frailty Scales in a Cross-Sectional Study

“…Partially, they may result from different purposes for which they were created (clinical, scientific, or social), so when choosing a specific scale, one should also take into account its suitability for specific “recipients”. A meta-analysis on the accuracy of different screening tools in emergency departments [ 42 ] showed that available frailty screens could accurately diagnose frailty in older adults attending. Still, specificity was comparatively low, and additional assessment may be required to identify those requiring in-hospital management.…”

Comparison of Diagnostic Accuracies of Frailty Assessment Tools for Frailty in Older People

“…Regarding the diagnostic accuracy of various tools used in the eld, a partial review is now available. Clegg et al have summarized a report on the diagnostic accuracy of simple tools for identifying frailty in older people in the community (24), and Moloney et al have summarized information on the diagnostic accuracy of frailty screening instruments currently used in emergency departments to identify frailty (25). However, their analyses have focused on a speci c population in a particular area or on a particular assessment tool, and no meta-analyses have been conducted.…”