Prospective Validation of A Novel Scale for Triage Assessment of Frailty in the Emergency Department (ED-FraS)

Older adults account for a disproportionate share of emergency department (ED) visits and are often present with complex needs. Frailty is a key determinant of adverse outcomes in this population. We previously developed the Emergency Department Frailty Scale (ED-FraS), a novel clinician-judgment-based instrument. This study prospectively validated the ED-FraS when used by triage nurses and evaluated its predictive performance for hospital admission and ED length of stay (EDLOS).

This prospective observational study was conducted at a tertiary academic medical center in Taiwan between February and July 2025. Triage nurses assessed patients aged ≥ 65 years using the ED-FraS during routine triage encounters. We evaluated the association between ED-FraS levels (1-5) and hospital admission and EDLOS. We compared the predictive performance of ED-FraS, the standard Taiwan Triage and Acuity Scale (TTAS), and a modified TTAS (mTTAS), which integrated frailty scores. Discriminative ability was measured using the area under the receiver operating characteristic curve (AUROC).

A total of 550 older adults were enrolled (mean age 77.2 years). Higher ED-FraS levels were significantly associated with increased admission rates (25.0% in level 1 vs. 59.4% in level 5) and prolonged median EDLOS (2.6 vs. 27.3 h). The mTTAS demonstrated superior discriminatory ability for hospital admission (AUROC 0.720) compared to TTAS (0.657) or ED-FraS alone (0.638). Nurses reported the tool was feasible, taking < 30 s to complete.

The ED-FraS is a feasible and valid tool for identifying older adults at risk of adverse outcomes during triage. Integrating frailty assessment into standard triage systems enhances risk stratification and may improve resource allocation for vulnerable older adults.