Shannon M Fernando1,2, Kevin H Guo3, Matthew Lukasik3, Bram Rochwerg4,5, Deborah J Cook4,5, Kwadwo Kyeremanteng2,3, Jeffrey J Perry1,3,6. 1. Department of Emergency Medicine, University of Ottawa, Ottawa, ON. 2. Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON. 3. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON. 4. Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON. 5. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON. 6. School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON.
Abstract
BACKGROUND: Prognosis and disposition among older emergency department (ED) patients with suspected infection remains challenging. Frailty is increasingly recognized as a predictor of poor prognosis among critically ill patients; however, its association with clinical outcomes among older ED patients with suspected infection is unknown. METHODS: We conducted a multicenter prospective cohort study at two tertiary care EDs. We included older ED patients (≥75 years) with suspected infection. Frailty at baseline (before index illness) was explicitly measured for all patients by the treating physicians using the Clinical Frailty Scale (CFS). We defined frailty as a CFS 5-8. The primary outcome was 30-day mortality. We used multivariable logistic regression to adjust for known confounders. We also compared the prognostic accuracy of frailty with the Systemic Inflammatory Response Syndrome (SIRS) and Quick Sequential Organ Failure Assessment (qSOFA) criteria. RESULTS: We enrolled 203 patients, of whom 117 (57.6%) were frail. Frail patients were more likely to develop septic shock (adjusted odds ratio [aOR], 1.83; 95% confidence interval [CI], 1.08-2.51) and more likely to die within 30 days of ED presentation (aOR 2.05; 95% CI, 1.02-5.24). Sensitivity for mortality was highest among the CFS (73.1%; 95% CI, 52.2-88.4), compared with SIRS ≥ 2 (65.4%; 95% CI, 44.3-82.8) or qSOFA ≥ 2 (38.4; 95% CI, 20.2-59.4). CONCLUSIONS: Frailty is a highly prevalent prognostic factor that can be used to risk-stratify older ED patients with suspected infection. ED clinicians should consider screening for frailty to optimize disposition in this population.
BACKGROUND: Prognosis and disposition among older emergency department (ED) patients with suspected infection remains challenging. Frailty is increasingly recognized as a predictor of poor prognosis among critically illpatients; however, its association with clinical outcomes among older ED patients with suspected infection is unknown. METHODS: We conducted a multicenter prospective cohort study at two tertiary care EDs. We included older ED patients (≥75 years) with suspected infection. Frailty at baseline (before index illness) was explicitly measured for all patients by the treating physicians using the Clinical Frailty Scale (CFS). We defined frailty as a CFS 5-8. The primary outcome was 30-day mortality. We used multivariable logistic regression to adjust for known confounders. We also compared the prognostic accuracy of frailty with the Systemic Inflammatory Response Syndrome (SIRS) and Quick Sequential Organ Failure Assessment (qSOFA) criteria. RESULTS: We enrolled 203 patients, of whom 117 (57.6%) were frail. Frail patients were more likely to develop septic shock (adjusted odds ratio [aOR], 1.83; 95% confidence interval [CI], 1.08-2.51) and more likely to die within 30 days of ED presentation (aOR 2.05; 95% CI, 1.02-5.24). Sensitivity for mortality was highest among the CFS (73.1%; 95% CI, 52.2-88.4), compared with SIRS ≥ 2 (65.4%; 95% CI, 44.3-82.8) or qSOFA ≥ 2 (38.4; 95% CI, 20.2-59.4). CONCLUSIONS: Frailty is a highly prevalent prognostic factor that can be used to risk-stratify older ED patients with suspected infection. ED clinicians should consider screening for frailty to optimize disposition in this population.