Early identification of frailty through targeted screening can facilitate the delivery of comprehensive geriatric assessment (CGA) and may improve outcomes for older inpatients. As several instruments are available, we aimed to investigate which is the most accurate and reliable in the Emergency Department (ED). We compared the ability of three validated, short, frailty screening instruments to identify frailty in a large University Hospital ED. Consecutive patients aged ≥70 attending ED were screened using the Clinical Frailty Scale (CFS), Identification of Seniors at Risk Tool (ISAR), and the Programme on Research for Integrating Services for the Maintenance of Autonomy 7 item questionnaire (PRISMA-7). An independent CGA using a battery of assessments determined each patient’s frailty status. Of the 280 patients screened, complete data were available for 265, with a median age of 79 (interquartile ±9); 54% were female. The median CFS score was 4/9 (±2), ISAR 3/6 (±2), and PRISMA-7 was 3/7 (±3). Based upon the CGA, 58% were frail and the most accurate instrument for separating frail from non-frail was the PRISMA-7 (AUC 0.88; 95% CI:0.83–0.93) followed by the CFS (AUC 0.83; 95% CI:0.77–0.88), and the ISAR (AUC 0.78; 95% CI:0.71–0.84). The PRISMA-7 was statistically significantly more accurate than the ISAR (p = 0.008) but not the CFS (p = 0.15). Screening for frailty in the ED with a selection of short screening instruments, but particularly the PRISMA-7, is reliable and accurate.

The study evaluates the usefulness of some commonly used screening investigations in the management of elderly acutely ill medical patients. It was performed on 50 consecutive admissions to one ward and all patients received a full blood count, ESR, urea and electrolyte estimation, liver function tests, thyroid function tests, examination of a mid-stream urine specimen and P-A chest X-ray examination. When performed in the absence of clinical indication these tests were considered to be screening tests. On assessing the tests performed prospectively, it was shown that only a full blood count, urea and electrolyte estimation, ward testing of urine, and, possibly, a P-A chest X-ray examination are worthwhile screening investigations in this patient population. The ESR and liver function tests and mid-stream urine specimens seem to be of little value in the absence of clinical indication.

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