Integrating the clinical frailty scale with emergency department triage systems for elder patients: A prospective study

Ng, Chip-Jin; Chien, Liang-Tien; Huang, Chia-Jung; Chaou, Chung-Hsien; Gao, Shi-Ying; Chiu, Yueh‐Hsia; Hsu, Kuang-Hung; Chien, Cheng-Yu

doi:10.1016/j.ajem.2023.01.002

Cited by 14 publications

(9 citation statements)

References 33 publications

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“…Ng et al published a study on the application of the CFS to the Taiwan Triage and Acuity Scale (TTAS) in 2023. They also showed that upgrading older patients by one triage level, from a CFS level of four to nine, had greater predictive power for ICU admission and in-hospital mortality, similar to our findings [ 28 ]. Comparable results were observed for the two triage systems, KTAS and TTAS (both developed based on the CTAS), suggesting that frailty screening (an easy and quick form of the CFS) may be considered and adjusted during the triage process of older patients.…”

Section: Discussionsupporting

confidence: 90%

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Validation of the Korean Version of the Clinical Frailty Scale-Adjusted Korean Triage and Acuity Scale for Older Patients in the Emergency Department

Chung,

Choi,

Lim

et al. 2024

Medicina

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Background and Objectives: The Clinical Frailty Scale (CFS), used to screen for prehospital frailty in patients aged >65 years, is simple, time-efficient, and has been validated in emergency departments (EDs). In this study, we analyzed whether the Korean Triage and Acuity Scale (KTAS) classification by level in older patients determined to have frailty based on the Korean version of the CFS increases the triage performance of the current KTAS. Materials and Methods: The primary outcome was 30-day in-hospital mortality, and secondary outcomes were hospital and intensive care unit (ICU) admissions. This study retrospectively analyzed prospectively collected data from three ED centers. Patients with a CFS score ranging from five (mildly frail) to nine (terminally ill) were categorized into the frailty group. We upgraded the KTAS classification of the frailty group by one level of urgency and defined this as the CFS-KTAS. Results: The cutoff values for predicting admission were three and two for the KTAS and CFS-KTAS, respectively. A significant difference was observed in the area under the receiver operating characteristic (AUROC) curve between the KTAS and CFS-KTAS. To predict ICU admission, the cutoff score was two for both scales. A significant difference was observed in the AUROC curve between the KTAS and CFS-KTAS. For predicting in-hospital mortality, the cutoff score was two for both scales. A significant difference was observed in the AUROC curve between the KTAS and CFS-KTAS. Conclusions: This study showed that the CFS-adjusted KTAS has a more useful prognostic value than the KTAS alone for predicting hospital outcomes in older patients.

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Section: Discussionsupporting

confidence: 90%

“…The triage scale was designed to evaluate the patient’s urgency. However, several previous studies selected admission, ICU admission, and mortality rates as outcomes of triage performance [ 3 , 4 , 5 , 6 , 28 ]. Moreover, if patients were admitted or died, this could reflect the urgency at the triage level.…”

Section: Discussionmentioning

confidence: 99%

Validation of the Korean Version of the Clinical Frailty Scale-Adjusted Korean Triage and Acuity Scale for Older Patients in the Emergency Department

Chung,

Choi,

Lim

et al. 2024

Medicina

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“…Possible uses of a valid frailty index or screening tool at the time of triage are to predict admission, 18,19 death within 28 days, 12,18,20 and a need for a more comprehensive geriatric assessment 12,18 . Ng 21 reported that a combination of a triage acuity scale and a triage frailty scale reduced the rate of under triage among older patients. Generally, compliance with geriatric screening is deficient; a Canadian study found geriatric screening with the ISAR at approximately 50% 22 .…”

Section: Resultsmentioning

confidence: 99%

Frailty assessment tools in the emergency department: A geriatric emergency department guidelines 2.0 scoping review

Wolf,

Lo,

Serina

et al. 2023

JACEP Open

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ObjectiveGiven the aging population and growing burden of frailty, we conducted this scoping review to describe the available literature regarding the use and impact of frailty assessment tools in the assessment and care of emergency department (ED) patients older than 60 years.MethodsA search was made of the available literature using the Covidence system using various search terms. Inclusion criteria comprised peer‐reviewed literature focusing on frailty screening tools used for a geriatric population (60+ years of age) presenting to EDs. An additional search of PubMed, EBSCO, and CINAHL for articles published in the last 5 years was conducted toward the end of the review process (January 2023) to search specifically for literature describing interventions for frailty, yielding additional articles for review. Exclusion criteria comprised articles focusing on an age category other than geriatric and care environments outside the emergency care setting.ResultsA total of 135 articles were screened for inclusion and 48 duplicates were removed. Of the 87 remaining articles, 20 were deemed irrelevant, leaving 67 articles for full‐text review. Twenty‐eight were excluded for not meeting inclusion criteria, leaving 39 full‐text studies. Use of frailty screening tools were reported in the triage, care, and discharge decision‐making phases of the ED care trajectory, with varying reports of usefulness for clinical decision‐making.ConclusionThe literature reports tools, scales, and instruments for identifying frailty in older patients at ED triage; multiple frailty scores or tools exist with varying levels of utilization. Interventions for frailty directed at the ED environment were scant. Further research is needed to determine the usefulness of frailty identification in the context of emergency care, the effects of care delivery interventions or educational initiatives for front‐line medical professionals on patient‐oriented outcomes, and to ensure these initiatives are acceptable for patients.

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“…Despite the overall validity and reliability of the TTAS, it lacks a modifier for older patients [ 29 , 30 ]. Ng et al have reported that the incorporation of the CFS into TTAS has the potential to reduce the under-triage of older adults in the ED [ 31 ]. Similarly, the mTTAS, which incorporated the frailty screening tool we developed, showed improved ability in predicting all ED outcomes.…”

Section: Discussionmentioning

confidence: 99%

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

Liew,

Chen,

Sung

et al. 2024

BMC Geriatr

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Background Rapid recognition of frailty in older patients in the ED is an important first step toward better geriatric care in the ED. We aimed to develop and validate a novel frailty assessment scale at ED triage, the Emergency Department Frailty Scale (ED-FraS). Methods We conducted a prospective cohort study enrolling adult patients aged 65 years or older who visited the ED at an academic medical center. The entire triage process was recorded, and triage data were collected, including the Taiwan Triage and Acuity Scale (TTAS). Five physician raters provided ED-FraS levels after reviewing videos. A modified TTAS (mTTAS) incorporating ED-FraS was also created. The primary outcome was hospital admission following the ED visit, and secondary outcomes included the ED length of stay (EDLOS) and total ED visit charges. Results A total of 256 patients were included. Twenty-seven percent of the patients were frail according to the ED-FraS. The majority of ED-FraS was level 2 (57%), while the majority of TTAS was level 3 (81%). There was a weak agreement between the ED-FraS and TTAS (kappa coefficient of 0.02). The hospital admission rate and charge were highest at ED-FraS level 5 (severely frail), whereas the EDLOS was longest at level 4 (moderately frail). The area under the Receiver Operating Characteristic curve (AUROC) in predicting hospital admission for the TTAS, ED-FraS, and mTTAS were 0.57, 0.62, and 0.63, respectively. The ED-FraS explained more variation in EDLOS (R2 = 0.096) compared with the other two methods. Conclusions The ED-Fras tool is a simple and valid screening tool for identifying frail older adults in the ED. It also can complement and enhance ED triage systems. Further research is needed to test its real-time use at ED triage internationally.

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Integrating the clinical frailty scale with emergency department triage systems for elder patients: A prospective study

Cited by 14 publications

References 33 publications

Validation of the Korean Version of the Clinical Frailty Scale-Adjusted Korean Triage and Acuity Scale for Older Patients in the Emergency Department

Validation of the Korean Version of the Clinical Frailty Scale-Adjusted Korean Triage and Acuity Scale for Older Patients in the Emergency Department

Frailty assessment tools in the emergency department: A geriatric emergency department guidelines 2.0 scoping review

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

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