Which frailty scale for patients admitted via Emergency Department? A cohort study

Ebony T Lewis, Elsa Dent, Hatem Alkhouri, John Kellett, Margaret Williamson, Stephen 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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Resumé

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.

OriginalsprogEngelsk
TidsskriftArchives of Gerontology and Geriatrics
Vol/bind80
Sider (fra-til)104-114
ISSN0167-4943
DOI
StatusUdgivet - 1. jan. 2019

Fingeraftryk

Hospital Emergency Service
Cohort Studies
Patient Discharge
Self Report
Quality of Life
Prospective Studies
Health

Bibliografisk note

Copyright © 2018 The Author(s). Published by Elsevier B.V. All rights reserved.

Citer dette

Lewis, Ebony T ; Dent, Elsa ; Alkhouri, Hatem ; Kellett, John ; Williamson, Margaret ; Asha, Stephen ; Holdgate, Anna ; Mackenzie, John ; Winoto, Luis ; Fajardo-Pulido, Diana ; Ticehurst, Maree ; Hillman, Ken ; McCarthy, Sally ; Elcombe, Emma ; Rogers, Kris ; Cardona, Magnolia. / Which frailty scale for patients admitted via Emergency Department? A cohort study. I: Archives of Gerontology and Geriatrics. 2019 ; Bind 80. s. 104-114.
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title = "Which frailty scale for patients admitted via Emergency Department?: A cohort study",
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.",
author = "Lewis, {Ebony T} and Elsa Dent and Hatem Alkhouri and John Kellett and Margaret Williamson and Stephen Asha and Anna Holdgate and John Mackenzie and Luis Winoto and Diana Fajardo-Pulido and Maree Ticehurst and Ken Hillman and Sally McCarthy and Emma Elcombe and Kris Rogers and Magnolia Cardona",
note = "Copyright {\circledC} 2018 The Author(s). Published by Elsevier B.V. All rights reserved.",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.archger.2018.11.002",
language = "English",
volume = "80",
pages = "104--114",
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Lewis, ET, Dent, E, Alkhouri, H, Kellett, J, Williamson, M, Asha, S, Holdgate, A, Mackenzie, J, Winoto, L, Fajardo-Pulido, D, Ticehurst, M, Hillman, K, McCarthy, S, Elcombe, E, Rogers, K & Cardona, M 2019, 'Which frailty scale for patients admitted via Emergency Department? A cohort study', Archives of Gerontology and Geriatrics, bind 80, s. 104-114. https://doi.org/10.1016/j.archger.2018.11.002

Which frailty scale for patients admitted via Emergency Department? A cohort study. / Lewis, Ebony T; Dent, Elsa; Alkhouri, Hatem; Kellett, John; Williamson, Margaret; Asha, Stephen; Holdgate, Anna; Mackenzie, John; Winoto, Luis; Fajardo-Pulido, Diana; Ticehurst, Maree; Hillman, Ken; McCarthy, Sally; Elcombe, Emma; Rogers, Kris; Cardona, Magnolia.

I: Archives of Gerontology and Geriatrics, Bind 80, 01.01.2019, s. 104-114.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Which frailty scale for patients admitted via Emergency Department?

T2 - A cohort study

AU - Lewis, Ebony T

AU - Dent, Elsa

AU - Alkhouri, Hatem

AU - Kellett, John

AU - Williamson, Margaret

AU - Asha, Stephen

AU - Holdgate, Anna

AU - Mackenzie, John

AU - Winoto, Luis

AU - Fajardo-Pulido, Diana

AU - Ticehurst, Maree

AU - Hillman, Ken

AU - McCarthy, Sally

AU - Elcombe, Emma

AU - Rogers, Kris

AU - Cardona, Magnolia

N1 - Copyright © 2018 The Author(s). Published by Elsevier B.V. All rights reserved.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

U2 - 10.1016/j.archger.2018.11.002

DO - 10.1016/j.archger.2018.11.002

M3 - Journal article

C2 - 30448693

VL - 80

SP - 104

EP - 114

JO - Archives of Gerontology and Geriatrics

JF - Archives of Gerontology and Geriatrics

SN - 0167-4943

ER -