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Abstract Background Older adults attending the Emergency Department (ED) should be assessed using a frailty screening tool as older adults living with frailty are more likely to experience adverse outcomes. The Clinical Frailty Scale (CFS) is commonly used for this. This systematic review and meta-analysis synthesise the literature studying predictive accuracy of the CFS for identifying older adults at risk of adverse outcomes following ED visit, and the diagnostic accuracy of the CFS for identifying older adults living with frailty attending the ED. Methods A systematic literature search was conducted to identify studies that attempted to validate the diagnostic and predictive accuracy of the CFS for older adults in the ED setting. The population included were older adults over 65 years of age who presented to the ED with undifferentiated medical complaints. All included studies assessed the diagnostic accuracy of the CFS in comparison to a reference standard: Frailty Index, Comprehensive Geriatric Assessment or Frailty Phenotype. The adverse outcomes included were mortality, falls, functional decline, ED re-attendance, hospital admission, length of stay and institutionalisation. Results Nineteen studies were included with sixteen individual cohorts. All studies investigated predictive accuracy and four studies assessed diagnostic accuracy for the CFS. The CFS showed predictive accuracy for the outcomes of mortality at all timepoints (RR 3.05 (CI 2.22, 4.21)), ED re-attendance at 30 days (RR 1.47 (CI 1.12, 1.94)), hospital admission at index visit (RR 1.72 (CI 1.26, 2.34) and institutionalisation (RR 3.63 (CI 1.41, 9.36). The studies included had an overall low risk of bias. Conclusion The CFS successfully identifies those at risk of adverse outcomes of death, ED revisit, hospitalisation and institutionalisation. However, there is a paucity of studies which assess its diagnostic accuracy. Overall, it is a useful screening tool to identify those who may benefit from comprehensive multidisciplinary assessment in the ED setting.
Koay et al. (Sun,) studied this question.