The clinical frailty scale predicts 1-year mortality in emergency department patients aged 65 years and older

Marco Rueegg, Søren Kabell Nissen, Mikkel Brabrand, Tobias Kaeppeli, Thomas Dreher, Christopher R Carpenter, Roland Bingisser, Christian H Nickel, Marco Rueegg, Søren Kabell Nissen, Mikkel Brabrand, Tobias Kaeppeli, Thomas Dreher, Christopher R Carpenter, Roland Bingisser, Christian H Nickel

Abstract

Objective: To validate the Clinical Frailty Scale (CFS) for prediction of 1-year all-cause mortality in the emergency department (ED) and compare its performance to the Emergency Severity Index (ESI).

Methods: Prospective cohort study at the ED of a tertiary care center in Northwestern Switzerland. All patients aged ≥65 years were included from March 18 to May 20, 2019, after informed consent. Frailty status was assessed using CFS, excluding level 9 (palliative). Acuity level was assessed using ESI. Both CFS and ESI were adjusted for age, sex and presenting condition in multivariable logistic regression. Prognostic performance was assessed for discrimination and calibration separately. Estimates were internally validated by Bootstrapping. Restricted mean survival time (RMST) was determined for all levels of CFS.

Results: In the final study population of 2191 patients, 1-year all-cause mortality was 17% (n = 372). RMST values ranged from 219 days for CFS 8 to 365 days for CFS 1. The adjusted CFS model had an area under receiver operating characteristic of 0.767 (95% confidence interval [CI]: 0.741-0.793), compared to 0.703 (95% CI: 0.673-0.732) for the adjusted ESI model.

Conclusion: The CFS predicts 1-year all-cause mortality for older ED patients and predicts survival time in a graded manner. The CFS is superior to the ESI when adjusted for age, sex, and presenting condition.

Trial registration: ClinicalTrials.gov NCT03892551.

Conflict of interest statement

M.R. reports no conflict of interest. S.K.N. reports no conflict of interest. M.B. reports no conflict of interest. T.K. reports no conflict of interest. T.D. reports no conflict of interest. C.R.C. is contracted collaborator with the Geriatric ED Collaborative, Geriatric Emergency Care Applied Research (GEAR) Network, and ACEP Geriatric ED Accreditation Board of Governors. RB reports no conflicts of interest. CHN reports no conflicts of interest.

© 2022 The Authors. Academic Emergency Medicine published by Wiley Periodicals LLC on behalf of Society for Academic Emergency Medicine.

Figures

FIGURE 1
FIGURE 1
The chart displays recruitment and follow‐up procedure of consecutive ED patients aged 65 and older
FIGURE 2
FIGURE 2
Survival curves for the populations of each CFS level, except level 9 (“terminally ill”), is shown. CFS levels 1 and 2 were included here, in contrast to how these values were excluded in the logistic regression model (Table 2), as this graph is a descriptive representation. The graph was cropped to 0.5 on the y‐axis
FIGURE 3
FIGURE 3
Comparison of the three adjusted logistic regression models for prediction of 1‐year mortality, featuring CFS groups or ESI levels, and Null model. The AUROC of the CFS model was 0.767 (95% CI 0.741–0.793) and of the ESI model was 0.703 (95% CI 0.673–0.732). The calibration slope measured 0.959 in the CFS model and 0.973 in the ESI model

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