Does the Clinical Frailty Scale at Triage Predict Outcomes From Emergency Care for Older People? - 21/05/21
Abstract |
Study objective |
We determine whether the Clinical Frailty Scale applied at emergency department (ED) triage is associated with important service- and patient-related outcomes.
Methods |
We undertook a single-center, retrospective cohort study examining hospital-related outcomes and their associations with frailty scores assessed at ED triage. Participants were aged 65 years or older, registered on their first ED presentation during the study period at a single, centralized ED in the United Kingdom. Baseline data included age, sex, Clinical Frailty Scale score, National Early Warning Score–2 and the Charlson Comorbidity Index score; outcomes included length of stay, readmissions (any future admissions), and mortality (inhospital or out of hospital) up to 2 years after ED presentation. Survival analysis methods (standard and competing risks) were applied to assess associations between ED triage frailty scores and outcomes. Unadjusted incidence curves and adjusted hazard ratios are presented.
Results |
A total of 52,562 individuals representing 138,328 ED attendances were included; participants’ mean age was 78.0 years, and 55% were women. Initial admission rates generally increased with frailty. Mean length of stay after 30- or 180-day follow-up was relatively low; all Clinical Frailty Scale categories included patients who experienced zero days’ length of stay (ie, ambulatory care) and patients with relatively high numbers of inhospital days. Overall, 46% of study participants were readmitted by the 2-year follow-up. Readmissions increased with Clinical Frailty Scale score up until a score of 6 and then attenuated. Mortality rates increased with increasing frailty; the adjusted hazard ratio was 3.6 for Clinical Frailty Scale score 7 to 8 compared with score 1 to 3.
Conclusion |
Frailty assessed at ED triage (with the Clinical Frailty Scale) is associated with adverse outcomes in older people. Its use in ED triage might aid immediate clinical decisionmaking and service configuration.
Le texte complet de cet article est disponible en PDF.Plan
| Please see page 621 for the Editor’s Capsule Summary of this article. |
|
| Supervising editor: Timothy F. Platts-Mills, MD, MSc. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
|
| Author contributions: JB and SC conceived the original idea for the work. NT and LT undertook the analysis. AE, FA, and JvO helped with the implementation of the Clinical Frailty Scale. WJ supported data abstraction and linage. All authors contributed to the writing of the article and gave final approval for it. SC takes responsibility for the paper as a whole. |
|
| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
|
| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. Drs. Banerjee and Conroy receive travel fees and payment for teaching on geriatric emergency medicine. Dr. Conroy has received funding for research into geriatric emergency medicine. |
|
| Readers: click on the link to go directly to a survey in which you can provide HCT7YCZ to Annals on this particular article. |
|
| A podcast for this article is available at www.annemergmed.com. |
Vol 77 - N° 6
P. 620-627 - juin 2021 Retour au numéro
Article précédent
- Intravenous Haloperidol Versus Ondansetron for Cannabis Hyperemesis Syndrome (HaVOC): A Randomized, Controlled Trial
- Aaron J. Ruberto, Marco L.A. Sivilotti, Savannah Forrester, Andrew K. Hall, Frances M. Crawford, Andrew G. Day
- Is the 4AT Score Accurate in Identifying Delirium in Older Adults?
- Rachel E. Bridwell, Michael D. April, Brit Long
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?