What does this research mean for the field?

Combining the Clinical Frailty Scale (CFS) with standard vital sign-based scoring systems, particularly the Rapid Emergency Medicine Score (REMS), significantly improves the prediction of in-hospital mortality and admission risk in older emergency department patients. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

April 12, 2025Open Access

The clinical frailty scale improves risk prediction in older emergency department patients: a comparison with qSOFA, NEWS2, and REMS

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Older emergency department patients (n=932). Intervention: Clinical Frailty Scale (CFS) combined with REMS vs. REMS alone. Primary outcome: In-hospital mortality prediction (AUROC) (AUROC difference 0.0606, 95% CI 0.793-0.843, p=0.002).

Resultado clave

Combining the Clinical Frailty Scale with the Rapid Emergency Medicine Score significantly improved in-hospital mortality prediction in older emergency department patients (AUROC 0.819 vs 0.758).

Diseño del estudio

Tipo

Cohort (n=932)

Multicéntrico

Sí

PICO estructurado

Does combining the Clinical Frailty Scale (CFS) with vital sign-based scoring systems improve risk prediction for hospital admission, ICU admission, and in-hospital mortality in older emergency department patients?

Población

932 older patients (aged ≥65 years) presenting to the emergency department across three tertiary university hospitals. Mean age 77.56, 47.1% male. Excluded: trauma, non-medical visits, out-of-hospital cardiac arrest, dead on arrival, and uncertain outcomes.

Intervención

Risk stratification using the Clinical Frailty Scale (CFS) combined with vital sign-based scoring systems (qSOFA, NEWS2, REMS)

Comparador

Risk stratification using vital sign-based scoring systems alone (qSOFA, NEWS2, REMS)

Resultado

Hospital admission, intensive care unit (ICU) admission, and in-hospital mortalityhard clinical

Incorporating the Clinical Frailty Scale alongside vital sign-based scores significantly improves risk stratification and prediction of adverse outcomes in older emergency department patients.

Resultado numérico

Estimación del efecto: AUROC difference 0.0606 (95% CI 0.793-0.843)

Tasa de eventos absoluta: 0.819% vs 0.758%

valor p: p=0.002

Limitaciones

Retrospective design and reliance on the NEDIS database limits detailed clinical information
Focus on tertiary university hospitals in South Korea may restrict generalizability
Exclusion of patients with traumatic injuries, including falls
Potential selection bias regarding ICU admission decisions
CFS scoring based on clinical judgment may be influenced by interobserver variability
Potential unmeasured confounders such as socioeconomic factors or comorbidity severity

Resumen

Vital signs are essential for monitoring and prognostication in the emergency department (ED); however, they may not fully capture the complexity of frailty in older adults. In this multicenter retrospective study of 932 older patients who visited the EDs of three tertiary university hospitals between August 1 and October 31, 2023, we investigated the prognostic value of the Clinical Frailty Scale (CFS) in older patients in the ED and its potential to improve existing vital sign-based scoring systems. The primary outcomes were hospital admission, intensive care unit (ICU) admission, and in-hospital mortality. The AUROC was used to evaluate and compare the predictive performance of CFS, qSOFA, NEWS2, and REMS scores individually and in combination. Combining the CFS with these scores significantly improved predictive accuracy compared to individual scores alone. For hospital admission, the AUROCs were 0.715 (95% CI 0.685-0.744), 0.723 (95% CI 0.693-0.752), and 0.688 (95% CI 0.657-0.718) for CFS + qSOFA, CFS + NEWS2, and CFS + REMS, respectively. For ICU admission, the AUROCs were 0.730 (95% CI 0.701-0.759), 0.714 (95% CI 0.684-0.743), and 0.707 (95% CI 0.677-0.736), respectively. For in-hospital mortality, the AUROCs were 0.798 (95% CI: 0.771-0.823), 0.774 (95% CI: 0.746-0.801), and 0.819 (95% CI: 0.793-0.843), respectively, indicating excellent performance. Incorporating frailty assessment using the CFS enhances risk stratification in older patients in the ED by complementing vital sign-based scores. This provides a more comprehensive assessment, enabling better informed clinical decisions. This study supports employing routine frailty assessment in the ED and the development of enhanced risk stratification tools that incorporate frailty.

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Cite This Study

Chung et al. (Sat,) conducted a cohort in Older emergency department patients (n=932). Clinical Frailty Scale (CFS) combined with REMS vs. REMS alone was evaluated on In-hospital mortality prediction (AUROC) (AUROC difference 0.0606, 95% CI 0.793-0.843, p=0.002). Combining the Clinical Frailty Scale with the Rapid Emergency Medicine Score significantly improved in-hospital mortality prediction in older emergency department patients (AUROC 0.819 vs 0.758).

synapsesocial.com/papers/6a1685527729da44b7656a07 https://doi.org/https://doi.org/10.1038/s41598-025-97764-z

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