Frailty assessment in emergency medicine using the Clinical Frailty Scale: a scoping review

Abstract

Background Frailty is a common condition present in older Emergency Department (ED) patients that is associated with poor health outcomes. The Clinical Frailty Scale (CFS) is a tool that measures frailty on a scale from 1 (very fit) to 9 (terminally ill). The goal of this scoping review was to describe current use of the CFS in emergency medicine and to identify gaps in research. Methods We performed a systemic literature search to identify original research that used the CFS in emergency medicine. Several databases were searched from January 2005 to July 2021. Two independent reviewers completed screening, full text review and data abstraction, with a focus on study characteristics, CFS assessment (evaluators, timing and purpose), study outcomes and statistical methods. Results A total of 4818 unique citations were identified; 34 studies were included in the final analysis. Among them, 76% were published after 2018, mainly in Europe or North America (79%). Only two assessed CFS in the pre-hospital setting. The nine-point scale was used in 74% of the studies, and patient consent was required in 69% of them. The main reason to use CFS was as a main exposure (44%), a potential predictor (15%) or an outcome (15%). The most frequently studied outcomes were mortality and hospital admission. Conclusion The use of CFS in emergency medicine research is drastically increasing. However, the reporting is not optimal and should be more standardized. Studies evaluating the impact of frailty assessment in the ED are needed. Registration https://doi.org/10.17605/OSF.IO/W2F8N

Clinical Frailty Scale at presentation to the emergency department: interrater reliability and use of algorithm-assisted assessment

“…Furthermore, establishment of a relation of trust may lead to more confession of deficits. This supports that assessing frailty at triage versus at disposition could be different and have a different impact [ 45 ]. While the primary function of TC is to identify patients who need to be managed quickly to avoid life-threatening events, the focus at triage is categorization of ED patients by acuity.…”

A novel scale for triage assessment of frailty in the emergency department (ED-FraS): a prospective videotaped study

“…The cutoff point of 3 (mildly frail) in the ED-FraS was selected a priori to define frailty. Similar to the CFS, a cutoff point of 5 (living with mild frailty) was used in most studies to define frailty [ 11 , 13 , 19 ].…”

Current Geriatric Emergency Medicine Education and Training in Australasia: How this relates to the global context and opportunities for the future

“…11 Research in frailty assessment in the pre-hospital and ED setting is growing and frailty consideration as part of comprehensive care is important, but there remains scope to better define how frailty assessment should be used specifically in ED, as well as the role of emergency physicians as part of the CGA process. 12…”

“…The growing telehealth sector also requires specific consideration as to how virtual care and telehealth education should be included, and how telehealth should be used with caution/modified in older people, particularly those living with frailty and/or cognitive impairment 11 . Research in frailty assessment in the pre‐hospital and ED setting is growing and frailty consideration as part of comprehensive care is important, but there remains scope to better define how frailty assessment should be used specifically in ED, as well as the role of emergency physicians as part of the CGA process 12 …”