The Prognostic Value of the Clinical Frailty Scale in Critically Ill Older Adult Patients in the Emergency Department

As populations age, emergency department (ED) visits by older patients are rising, many of whom present in critically ill state. This trend necessitates frailty assessment in clinical decision-making to guide appropriate goals of care.

This study aims to evaluate the prognostic value of the Clinical Frailty Scale (CFS) among critically ill older ED patients.

In this prospective cohort study at a South Korean tertiary hospital, patients aged ≥65 years with Korean Triage and Acuity Scale levels 1 or 2 were included and grouped by CFS scores: nonfrail (1-3), mildly frail (4-5), moderately frail (6), severely frail (7), and very severely frail (8). The primary outcome was 3-month mortality. Data were analyzed using the Cox proportional hazards model and area under the receiver operating characteristic curve (AUROC).

A cohort of 502 patients was analyzed (median age 78 years). The median CFS score was 5, with 73.8% classified as frail (CFS ≥ 4). The 3-month mortality rate was 29.0%. Hazard ratios (95% confidence intervals [CIs]) for 3-month mortality were 1.97 (1.14-3.39) for CFS 6, 2.56 (1.51-4.32) for CFS 7, and 3.99 (2.03-7.86) for CFS 8. Adding CFS categories significantly improved 3-month mortality prediction (AUROC [95% CI] with CFS: 0.74 [0.69-0.79], without CFS: 0.70 [0.65-0.75], p = 0.003), although the overall predictive performance remained similar.

Higher CFS scores were significantly associated with increased 3-month mortality among critically ill older ED patients, highlighting the prognostic value of the CFS.