Ebony T Lewis1, Elsa Dent2, Hatem Alkhouri3, John Kellett4, Margaret Williamson5, Stephen Asha6, Anna Holdgate7, John Mackenzie8, Luis Winoto9, Diana Fajardo-Pulido10, Maree Ticehurst11, Ken Hillman12, Sally McCarthy13, Emma Elcombe14, Kris Rogers15, Magnolia Cardona16. 1. The University of New South Wales, School of Public Health and Community Medicine, Gate 11, Botany Street, Randwick, NSW, 2052, Australia. Electronic address: ebony.lewis@unsw.edu.au. 2. Torrens University Australia, 220 Victoria Square, Adelaide, SA, 5000, Australia; Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne VIC 3004, Australia. Electronic address: elsa.dent@laureate.edu.au. 3. Agency for Clinical Innovation, Emergency Care Institute, PO Box 699, Chatswood, NSW, 2057, Australia; The University of New South Wales, Faculty of Medicine, High St, Kensington, NSW 2052, Australia. Electronic address: Hatem.Alkhouri@health.nsw.gov.au. 4. Hospital of South West Jutland, Department of Emergency Medicine, Esbjerg, Denmark. Electronic address: jgkellett@eircom.net. 5. The University of New South Wales, The Simpson Centre for Health Services Research, South Western Sydney Clinical School, 1 Campbell Street, Liverpool, NSW, 2170, Australia. Electronic address: m.williamson@unsw.edu.au. 6. St George Hospital Emergency Department, Gray St, Kogarah, Sydney, NSW, 2217, Australia. Electronic address: Stephen.Asha@health.nsw.gov.au. 7. Liverpool Hospital Emergency Department, Corner of Elizabeth and Goulburn Streets, Liverpool, Sydney, NSW, 2170, Australia. Electronic address: Anna.Holdgate@health.nsw.gov.au. 8. Prince of Wales Hospital Emergency Department, Barker St, Randwick, Sydney, NSW, 2031, Australia. Electronic address: John.Mackenzie@health.nsw.gov.au. 9. Sutherland Hospital Emergency Department, The Kingsway, Caringbah, Sydney, NSW, 2229, Australia. Electronic address: luis.winoto@icloud.com. 10. The University of New South Wales, The Simpson Centre for Health Services Research, South Western Sydney Clinical School, 1 Campbell Street, Liverpool, NSW, 2170, Australia. Electronic address: diana.fajardopulido@mq.edu.au. 11. The University of New South Wales, The Simpson Centre for Health Services Research, South Western Sydney Clinical School, 1 Campbell Street, Liverpool, NSW, 2170, Australia. Electronic address: m.ticehurst@unsw.edu.au. 12. The University of New South Wales, The Simpson Centre for Health Services Research, South Western Sydney Clinical School, 1 Campbell Street, Liverpool, NSW, 2170, Australia; Liverpool Hospital Intensive Care Unit, Corner of Elizabeth and Goulburn Streets, Liverpool, NSW, 2170, Australia. Electronic address: k.hillman@unsw.edu.au. 13. Prince of Wales Hospital Emergency Department, Barker St, Randwick, Sydney, NSW, 2031, Australia. Electronic address: Sally.McCarthy@health.nsw.gov.au. 14. The Ingham Institute for Applied Medical Research, Western Sydney University, 1 Campbell St, Liverpool, NSW, 2170, Australia. Electronic address: E.Elcombe@westernsydney.edu.au. 15. The George Institute for Global Health, Level 5, 1 King Street, Newtown, NSW, 2042, Australia. Electronic address: krogers@georgeinstitute.org. 16. Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, 14 University Drive, Robina, QLD, 4226, Australia; Gold Coast Hospital and Health Service, 1 Hospital Blvd, Southport, QLD, 4215, Australia. Electronic address: mcardona@bond.edu.au.
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.
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.
Authors: Katherine M Hunold; Elizabeth M Goldberg; Jeffrey M Caterino; Ula Hwang; Timothy F Platts-Mills; Manish N Shah; Tony Rosen Journal: Acad Emerg Med Date: 2021-09-28 Impact factor: 3.451
Authors: E Dent; J E Morley; A J Cruz-Jentoft; L Woodhouse; L Rodríguez-Mañas; L P Fried; J Woo; I Aprahamian; A Sanford; J Lundy; F Landi; J Beilby; F C Martin; J M Bauer; L Ferrucci; R A Merchant; B Dong; H Arai; E O Hoogendijk; C W Won; A Abbatecola; T Cederholm; T Strandberg; L M Gutiérrez Robledo; L Flicker; S Bhasin; M Aubertin-Leheudre; H A Bischoff-Ferrari; J M Guralnik; J Muscedere; M Pahor; J Ruiz; A M Negm; J Y Reginster; D L Waters; B Vellas Journal: J Nutr Health Aging Date: 2019 Impact factor: 4.075
Authors: Cheng-Fu Lin; Po-Chen Lin; Sung-Yuan Hu; Yu-Tse Tsan; Wei-Kai Liao; Shih-Yi Lin; Tzu-Chieh Lin Journal: Int J Environ Res Public Health Date: 2021-06-07 Impact factor: 3.390