Frailty Screening in the Emergency Department: Comparing the Variable Indicative of Placement Risk, Clinical Frailty Scale and PRISMA-7

Abstract

Prompt recognition of frailty in the emergency department (ED) is important to identify patients at higher risk of adverse outcomes. Despite this, few studies examine the diagnostic accuracy of screening instruments for frailty, instead focusing on predictive validity. We compared three commonly used, short frailty screens to an independent comprehensive geriatric assessment (CGA) in an urban University Hospital ED. Consecutive attendees aged ≥70 years were screened by trained raters, blind to the CGA, with the Variable Indicative of Placement risk (VIP), 3 and 4-item versions, Clinical Frailty Scale (CFS) and PRISMA-7. Accuracy was measured from the area under the ROC curve (AUROC). In total, 197 patients were included, median age 79 (±10); 46% were female. Half (49%) were confirmed as frail after CGA. All instruments differentiated frail from non-frail states, although the CFS (AUROC: 0.91) and PRISMA-7 (AUROC: 0.90) had higher accuracy compared to the VIP-4 (AUROC: 0.84) and VIP-3 (AUROC: 0.84). The CFS was significantly more accurate than the VIP-3 (p = 0.026) or VIP-4 (p = 0.047). There was no significant difference between the CFS and PRISMA-7 (p = 0.90). The CFS and PRISMA-7 were more accurate and should be considered in preference to the VIP (3 or 4-item versions) to identify frailty in EDs.

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

“…A PRISMA flow diagram illustrates the selection details in Figure 1 . Accordingly, six studies [ 8 , 10 , 34 , 35 , 36 , 37 , 38 ] describing seven frailty screening instruments were included in this systematic review. Some papers included more than one of these instruments, yielding 13 unique data points.…”

“…Some papers included more than one of these instruments, yielding 13 unique data points. Additional details were requested from the authors of one relevant paper, initially found as an abstract publication [ 37 ], as the full-text article was unpublished at the time of the literature search (now published [ 38 ]). A table providing additional details of the search strategy utilised is included in Appendix A .…”

Impact of Frailty on Healthcare Outcomes after Cardioembolic Ischaemic Stroke Due to Atrial Fibrillation

“…Indeed, as there can be tensions around the need to make rapid decisions to identify who may benefit most from rehabilitation, understanding the role frailty has in the course of these patients’ admission and subsequent recovery is paramount [ 50 ]. Here, we have shown the need to identify frailty early upon admission, even with relatively simple instruments such as the CFS and other similar brief screens, which can be performed quickly on arrival to hospital, e.g., to the emergency department [ 51 ]. Instruments such as the CFS have the potential to identify those at a higher risk both on admission and discharge from rehabilitation units with increases in these scores being associated with three-month and one-year mortality [ 52 ].…”

Frailty in der Notaufnahme

“…Zur Prävalenz von Frailty bei Patienten in der notfallmedizinischen Versorgung gibt es bisher nur vereinzelte Angaben. Diese schätzen, dass 38 % der über 65-jährigen und 50 % der über 70-jährigen Notaufnahmepatienten frail (fragil, gebrechlich) sind [5,6].…”

“…Beim Vergleich verschiedener Instrumente für den Einsatz in dem durch Zeitdruck geprägten Alltag der Notaufnahme zeigte sich die Klinische Frailty-Skala (CFS) als praktikabel, anwenderfreundlich, effizient und präzise [5,6,11]. Die CFS ist im Setting der Notaufnahme zur Be-urteilung von Frailty bei über 65-jährigen Patienten ohne dauerhaft stabile Behinderung validiert und besitzt trotz ihrer Subjektivität eine ausreichend hohe Interrater-Reliabilität (Cohens κ: 0,74, KI [0,64; 0,85]) [6].…”