Screening of the frail patient in the emergency department: A systematic review

Background: Several frailty rating scales have been developed to detect and screen for the level of frailty. It is uncertain what diagnostic value screening of frailty level have in the emergency department.

Aim: To assess the accuracy of the screening tools used in the emergency department to detect frailty in patients≥65years by their ability to identify the risk of adverse outcomes.

Methods: An extensive medical literature search of Embase and PubMed was conducted, to identify studies using frailty screening scales in the emergency department. Data was subsequently extracted and evaluated from the results of the included studies.

Results: Four studies met the exact inclusion criteria. Four different frailty screening scales: Clinical Frailty Scale, Deficit Accumulation Index, Identification of Seniors At Risk and The Study of Osteoporotic Fracture frailty index used in the emergency department were described and compared. Predictive values for various outcomes are represented and discussed.

Conclusions: The results suggest that frailty successfully predicts increased risk of hospitalization, nursing home admission, mortality and prolonged length of stay after an initial emergency department visit. Frailty does however not predict increased risk of 30day emergency department revisit. Further research highlighting the value of screening for frailty level in elderly emergency department patients is needed.

Learning points: Although frail elders in need of further geriatric assessment should be identified as soon as possible, this systematic review only identified four cohort studies of frailty assessment in emergency departments. Although frailty screening appeared to predict the risk of mortality and of admission to hospital/nursing home, these four studies did not show that it could predict return visits to emergency departments within 30days. Randomized clinical trials of frailty screening tools compared to usual care or other methods of assessment are clearly needed.