Validation of the hospital frailty risk score in a tertiary care hospital in Switzerland: results of a prospective, observational study

Abstract

ObjectivesRecently, the Hospital Frailty Risk Score based on a derivation and validation study in the UK has been proposed as a low-cost, systematic screening tool to identify older, frail patients who are at a greater risk of adverse outcomes and for whom a frailty-attuned approach might be useful. We aimed to validate this Score in an independent cohort in Switzerland.DesignSecondary analysis of a prospective, observational study (TRIAGE study).SettingOne 600-bed tertiary care hospital in Aarau, Switzerland.ParticipantsConsecutive medical inpatients aged ≥75 years that presented to the emergency department or were electively admitted between October 2015 and April 2018.Primary and secondary outcome measuresThe primary endpoint was all-cause 30-day mortality. Secondary endpoints were length of hospital stay, hospital readmission, functional impairment and quality of life measures. We used multivariate regression analyses.ResultsOf 4957 included patients, 3150 (63.5%) were classified as low risk, 1663 (33.5%) intermediate risk, and 144 (2.9%) high risk for frailty. Compared with the low-risk group, patients in the moderate risk and high-risk groups had increased risk for 30-day mortality (OR (OR) 2.53, 95% CI 2.09 to 3.06, p<0.001 and OR 4.40, 95% CI 2.94 to 6.57, p<0.001) with overall moderate discrimination (area under the ROC curve 0.66). The results remained robust after adjustment for important confounders. Similarly, we found longer length of hospital stay, more severe functional impairment and a lower quality of life in higher risk group patients.ConclusionOur data confirm the prognostic value of the Hospital Frailty Risk Score to identify older, frail people at risk for mortality and adverse outcomes in an independent patient population.Trial registration numberNCT01768494; Post-results.

The hospital frailty risk score is of limited value in intensive care unit patients

“…This finding contrasts validating studies for the emergency department [5]. Possibly, there is a relevant lack in ICD coding for relevant comorbidities in very old patients on the ICU.…”

Frailty Is a Risk Factor for Postoperative Mortality in Patients With Cirrhosis Undergoing Diverse Major Surgeries

“…This would not necessarily replace an objective assessment of frailty, but could perhaps serve as an initial screen to identify at-risk patients who require closer assessment for frailty. However, as the HFRS has been validated against other frailty indexes, (25,35,36) other routine assessments of frailty in patients with cirrhosis may in fact correspond well to HFRS categories.…”

Analysis of Frailty in Geriatric Patients as a Prognostic Factor in Endovascular Treated Patients with Large Vessel Occlusion Strokes

“…Only 20% of the medium risk group achieve a favorable outcome after 3 months (mRs 0–2; Figure 1 ). The effect on neurological outcome might be influenced by premorbid disabilities, since frail patients suffer more often from dementia and premorbid stroke [ 23 ] than non-frail patients. Although more detailed analyses are warranted to better understand the possible influence of distinct premorbid diseases on disability and, hence on outcome, further data on premorbid disability beyond specific diseases might also help to address this in future studies.…”