Frailty Screening in the Swedish Emergency Department Setting

This prospective observational study will investigate the correlation of frailty in relation to serious outcomes. Serious outcomes are defined as: mortality within 30 days, admission to hospital, length of stay in the Emergency Department(ED), in hospital length of stay and revisits to the ED.

The exposure, frailty, will be assessed according to Clinical Frailty Scale. ED patients >65 years of age in a Swedish regional health care system (Region Östergötland, Sweden) comprising three EDs in Linköping, Norrköping and Motala. The outcomes will be compared according to the degree of frailty and censored over 7, 30 and 90 days respectively.

Study Overview

• Status: Completed
• Conditions: Frailty; Frailty Syndrome; Emergency Department; Geriatric Assessment; CFS

Detailed Description

Frailty is a common clinical syndrome in older adults that carries an increased risk for poor health outcomes including falls, incident disability, hospitalization, and mortality.

The clinical frailty scale (CFS) is a measure of frailty based on clinical judgement in a 9 level scale, categorized as "vulnerable" (1-4), "mildly frail" (5), moderatly frail (6) and severely and very severely frail (7-8).". A validation study of the CFS in community-dwelling older people showed that it performed better than measures of cognition, function or comorbidity in assessing risk for death. In a prospective observational study including consecutive ED patients aged 65 years or older The Hosmer-Lemeshow test indicated a good agreement between predicted probability and observed frequency of 30-day mortality and ICU admission.

The aim of this study will be to investigate if the fraily, assessed according to CFS, is associated with increased 30-day mortality. in a Swedish Emergency Care context. Secondary outcomes included 7-and 90-day mortality, ED length of stay, hospital admission, hospital length of stay, subsequent falls and medication changes. Additionally, we collect data on morbidity and comorbidities to assess the association with the level of frailty. Since this is a multicenter study, possible geographic differences will be studied as well. Based on the results of this study, possible interventions could be identified to improve the care of the frail geriatric patients presenting at the ED.

• Study Type: Observational
• Enrollment (Actual): 1800

Contacts and Locations

Study Locations

• Sweden
  • Östergötland
    • Linköping, Östergötland, Sweden, 58185
      • University Hospital Linköping

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 65 years and older (Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Patients of all genders at the age of ≥65 years seeking medical care at the three ED instances in Region Östergötland.

Description

Inclusion Criteria:

• ≥65 years, able to answer any questions, alternatively have a proxy

Exclusion Criteria:

- Patients: <65 years

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mortality in 30 days	Investigate level of mortality in cohort at 30 days	All cause mortality up to 90 days from index visit

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mortality in 7 and 90 days	Investigate level of mortality in cohort at 7 and 90 days	All cause mortality up to 90 days from index visit
Admission to hospital	Investigate level of all cause admissions in cohort	Hospital admission on index visit, censored at 90 days
ED length of stay	Investigate length of stay at ED	Length of stay at ED, censored at 4 days
Hospital length of stay	Investigate hospital length of stay	Hospital length of stay from index visit, censored at 90 days
Revisitis to the ED	Number of newly registered visits to the emergency department after index visit	Number of newly registered visits to the emergency department after index visit, censored at 90 days
Fall prevalence after the index visit	Falls that resulted in further ED visits	Falls that resulted in further ED visits after index visit, censored in 90 days
Alterations in medication during the visit (based on codes for Anatomical, Therapeutic, Chemical classification (ATC-code))	Alterations in medication and during the follow-up period	Alterations in medications from index visit and during the follow-up period, censored at 90 days

Collaborators and Investigators

• Sponsor: University Hospital, Linkoeping

Publications and helpful links

General Publications

• Xue QL. The frailty syndrome: definition and natural history. Clin Geriatr Med. 2011 Feb;27(1):1-15. doi: 10.1016/j.cger.2010.08.009.
• Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005 Aug 30;173(5):489-95. doi: 10.1503/cmaj.050051.
• Kaeppeli T, Rueegg M, Dreher-Hummel T, Brabrand M, Kabell-Nissen S, Carpenter CR, Bingisser R, Nickel CH. Validation of the Clinical Frailty Scale for Prediction of Thirty-Day Mortality in the Emergency Department. Ann Emerg Med. 2020 Sep;76(3):291-300. doi: 10.1016/j.annemergmed.2020.03.028. Epub 2020 Apr 24.
• Rockwood K, Theou O. Using the Clinical Frailty Scale in Allocating Scarce Health Care Resources. Can Geriatr J. 2020 Sep 1;23(3):210-215. doi: 10.5770/cgj.23.463. eCollection 2020 Sep.
• Wallis SJ, Wall J, Biram RW, Romero-Ortuno R. Association of the clinical frailty scale with hospital outcomes. QJM. 2015 Dec;108(12):943-9. doi: 10.1093/qjmed/hcv066. Epub 2015 Mar 15.

Study record dates

Study Major Dates

• Study Start (Actual): May 17, 2021
• Primary Completion (Actual): November 14, 2021
• Study Completion (Actual): November 14, 2021

Study Registration Dates

• First Submitted: May 1, 2021
• First Submitted That Met QC Criteria: May 3, 2021
• First Posted (Actual): May 7, 2021

Study Record Updates

• Last Update Posted (Actual): June 23, 2022
• Last Update Submitted That Met QC Criteria: June 22, 2022
• Last Verified: June 1, 2022

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Emergencies; Frailty
• Other Study ID Numbers: 2021-00875FSSED

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No