Frailty Screening in the Emergency Department: Comparing the Variable Indicative of Placement Risk, Clinical Frailty...

Area of Science:

• Gerontology
• Emergency Medicine
• Diagnostic Accuracy

Background:

• Prompt identification of frailty in emergency departments (EDs) is vital for managing patients at high risk of adverse outcomes.
• Existing research often prioritizes predictive validity over diagnostic accuracy for frailty screening instruments.
• There is a need to evaluate the diagnostic performance of commonly used, short frailty screening tools in the ED setting.

Purpose of the Study:

• To compare the diagnostic accuracy of three common short frailty screening instruments against a comprehensive geriatric assessment (CGA).
• To determine which frailty screening tools are most effective for identifying frail older adults in an urban university hospital ED.

Main Methods:

• A comparative diagnostic accuracy study was conducted in an urban university hospital ED.
• Consecutive patients aged 70 years and older were screened using the Variable Indicative of Placement (VIP) risk (3 and 4-item versions), Clinical Frailty Scale (CFS), and PRISMA-7, blinded to CGA results.
• Accuracy was assessed using the area under the receiver operating characteristic curve (AUROC), comparing screening tools against a comprehensive geriatric assessment (CGA).

Main Results:

• A total of 197 patients (median age 79) were included, with 49% identified as frail by CGA.
• The Clinical Frailty Scale (CFS) (AUROC: 0.91) and PRISMA-7 (AUROC: 0.90) showed higher diagnostic accuracy than the VIP-4 (AUROC: 0.84) and VIP-3 (AUROC: 0.84).
• The CFS was significantly more accurate than both VIP versions (p < 0.05), with no significant difference between CFS and PRISMA-7 (p = 0.90).

Conclusions:

• The Clinical Frailty Scale (CFS) and PRISMA-7 are more accurate than the VIP (3 or 4-item versions) for identifying frailty in the ED.
• These findings suggest that CFS and PRISMA-7 should be prioritized for frailty screening in emergency departments.
• Effective frailty screening in the ED can improve patient outcomes by identifying high-risk individuals for targeted interventions.