Frailty Screening in the Emergency Department: Comparing the Variable Indicative of Placement Risk, Clinical Frailty Scale and PRISMA-7
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patients
2.2. Instruments
2.3. Data Collection
2.4. Measures
2.5. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristics | Total (n = 197) | Frail (n = 98) | Non-Frail (n = 99) | Frail vs. Non-Frail |
---|---|---|---|---|
Median (Q3–Q1 or %) | Median (Q3–Q1 or %) | Median (Q3–Q1 or %) | p-Value for Difference | |
Age (Years) | 79 (83–73) | 80 (86–76) | 75 (82–72) | <0.001 |
Sex (Female) | 45% | 49% | 41% | 0.257 |
BMI | 25 (28–22) | 24 (28–21) | 26 (29–23) | 0.009 |
MNA-SF | 12 (13–10) | 11 (13–9) | 13 (14–12) | <0.001 |
AD8 | 1 (2–0) | 1 (3–0) | 0 (1–0) | <0.001 |
4AT | 0 (1–0) | 1 (2–0) | 0 (0–0) | <0.001 |
CBS | 12 (18–3) | 15 (19–9) | 0 (10–0) | 0.001 |
EQ-5D (VAS) | 60 (75–45) | 50 (50–30) | 70 (80–60) | <0.001 |
GSRH (V. Good/Excellent) | 20% | 6% | 35% | <0.001 |
FRAIL scale | 2 (3–1) | 2 (3–2) | 1 (2–0) | <0.001 |
GFI | 4 (6–2) | 6 (8–5) | 2 (3–2) | <0.001 |
CFS | 4 (6–3) | 6 (7–5) | 3 (4–2) | <0.001 |
PRISMA-7 | 4 (5–2) | 5 (6–4) | 2 (3–2) | <0.001 |
VIP 3 | 1 (2–0) | 2 (2–1) | 0 (1–0) | <0.001 |
VIP 4 | 1 (2–0) | 2 (3–1) | 0 (1–0) | <0.001 |
FRAIL (score ≥ 3) | 31% | 47% | 14% | <0.001 |
GFI (score ≥ 4) | 60% | 96% | 24% | <0.001 |
CFS (score ≥ 5) | 45% | 77% | 13% | <0.001 |
PRISMA-7 (score ≥ 3) | 67% | 98% | 36% | <0.001 |
VIP-3 (score ≥ 2) | 30% | 59% | 2% | <0.001 |
VIP-4 (score ≥ 3) | 14% | 29% | 0% | <0.001 |
Admitted | 66% | 82% | 49% | <0.001 |
Length of stay (if admitted) in days | 7 (14–3) | 9 (16–5) | 4 (9–2) | 0.003 |
Died (within 3 months of presenting) | 14 (7%) | 12 (12%) | 2 (2%) | 0.005 |
30-day re-admission (same hospital) | 14 (7%) | 9 (9%) | 5 (5%) | 0.283 |
90-day re-presentation ED /re-admission * | 55 (28%) | 32 (33%) | 23 (23%) | 0.155 |
Agreement (rs) between Frailty Scales (Number of Criteria) | ||||||
Frailty Scales (cut-offs) | CFS (Scale 1–9) | PRISMA-7 (Scale 0–7) | VIP-3 (Scale 0–3) | VIP-4 (Scale 0–4) | FRAIL (Scale 0–5) | GFI (Scale 0–15) |
CFS (scale 1–9) | - | 0.70 ** | 0.56 ** | 0.58 ** | 0.52 ** | 0.62 ** |
PRISMA-7 (scale 0–7) | 0.70 ** | - | 0.48 ** | 0.51 ** | 0.53 ** | 0.63 ** |
VIP-3 (scale 0–3) | 0.56 ** | 0.48 ** | - | 0.98 ** | 0.44 * | 0.59 ** |
FRAIL (scale 0–5) | 0.52 ** | 0.53 ** | 0.44 * | 0.47 * | - | 0.59 ** |
GFI (scale 0–15) | 0.62 ** | 0.63 ** | 0.59 ** | 0.61 ** | 0.59 ** | - |
Agreement (κ) between Frailty Cut-Offs and Comprehensive Geriatric Assessment | ||||||
Frailty Scales (cut-offs) | CFS (Frail ≥ 5) | PRISMA-7 (Frail ≥ 3) | VIP-3 (Frail ≥ 2) | VIP-4 (Frail ≥ 3) | FRAIL (Frail ≥ 3) | GFI (Frail ≥ 4) |
CFS (frail ≥ 5) | - | 0.48 ** | 0.46 ** | 0.25 ** | 0.26 ** | 0.50 ** |
PRISMA-7 (frail ≥ 3) | 0.48 ** | - | 0.29 ** | 0.15 ** | 0.26 ** | 0.59 ** |
VIP-3 (frail ≥ 2) | 0.46 ** | 0.29 ** | - | 0.56 ** | 0.16 * | 0.41 ** |
FRAIL (frail ≥ 3) | 0.26 ** | 0.26 ** | 0.16 * | 0.21 * | - | 0.29 ** |
GFI (frail ≥ 4) | 0.50 ** | 0.59 ** | 0.41 ** | 0.17 ** | 0.29 ** | - |
CGA (frail/non-frail) | 0.64 ** | 0.62 ** | 0.56 ** | 0.29 ** | 0.32 ** | 0.72 ** |
Frailty Screen Cut-Off | Youden’s Index | Sensitivity (95% CI) | Specificity (95% CI) | PPV (95% CI) | NPV (95% CI) | False Positive (95% CI) | False Negative (95% CI) | PLR † (95% CI) | NLR † (95% CI) |
---|---|---|---|---|---|---|---|---|---|
CFS | |||||||||
≥2 | 0.15 | 1 (0.92–1.0) | 0.15 (0.09–0.24) | 0.53 (0.46–0.61) | 1 (0.75–1.0) | 0.47 (0.39–0.54) | 0 (0–0.25) | 1.1 (0.93–1.4) | 0 (0.0–0.0) |
≥3 | 0.39 | 1 (0.95–1.0) | 0.39 (0.30–0.49) | 0.61 (0.53–0.69) | 1 (0.89–1.0) | 0.39 (0.31–0.47) | 0 (0–0.11) | 1.6 (1.3–2.0) | 0 (0–0) |
≥4 ^ | 0.66 | 0.95 (0.88–0.98) | 0.70 (0.60–0.79) | 0.76 (0.67–0.83) | 0.93 (0.84–0.98) | 0.25 (0.17–0.33) | 0.07 (0.02–0.16) | 3.1 (2.2–4.3) | 0.07 (0.03–0.17) |
≥5 * | 0.64 | 0.77 (0.67–0.85) | 0.87 (0.78–0.93) | 0.85 (0.76–0.92) | 0.80 (0.71–0.87) | 0.15 (0.08–0.24) | 0.20 (0.13–0.29) | 5.8 (3.5–9.6) | 0.25 (0.17–0.37) |
≥6 | 0.50 | 0.53 (0.42–0.63) | 0.97 (0.91–0.99) | 0.94 (0.84–0.99) | 0.68 (0.59–0.75) | 0.06 (0.01–0.16) | 0.32 (0.25–0.41) | 17 (5.6–51) | 0.47 (0.37–0.61) |
≥7 | 0.25 | 0.27 (0.19–0.37) | 0.98 (0.92–1.0) | 0.93 (0.75–0.99) | 0.58 (0.50–0.65) | 0.07 (0.01–0.25) | 0.42 (0.35–0.50) | 13 (3.4–49.6) | 0.72 (0.6–0.87) |
≥8 | 0.01 | 0.03 (0.01–0.09) | 0.98 (0.92–1.0) | 0.60 (0.17–0.93) | 0.51 (0.44–0.58) | 0.4 (0.07–0.83) | 0.49 (0.42–0.56) | 1.5 (0.41–5.5) | 0.96 (0.82–1.12) |
PRISMA-7 | |||||||||
≥2 | 0.22 | 1 (0.95–1.0) | 0.23 (0.15–0.33) | 0.56 (0.48–0.63) | 1 (0.82–1.0) | 0.44 (0.37–0.52) | 0 (0.0–0.18) | 1.3 (1.0–1.6) | 0 (0–0) |
≥3* | 0.62 | 0.98 (0.92–0.99) | 0.64 (0.54–0.73) | 0.73 (0.64–0.80) | 0.97 (0.86–0.99) | 0.27 (0.20–0.36) | 0.03 (0.01–0.11) | 2.7 (2–3.6) | 0.03 (0.01–0.12) |
≥4 ^ | 0.68 | 0.87 (0.78–0.92) | 0.82 (0.73–0.89) | 0.83 (0.74–0.89) | 0.86 (0.77–0.92) | 0.17 (0.11–0.26) | 0.14 (0.08–0.23) | 4.7 (3.1–7.3) | 0.16 (0.1–0.26) |
≥5 | 0.56 | 0.64 (0.54–0.74) | 0.92 (0.84–0.96) | 0.89 (0.78–0.95) | 0.72 (0.64–0.80) | 0.11 (0.05–0.22) | 0.28 (0.20–0.36) | 7.9 (4.1–15.2) | 0.38 (0.29–0.51) |
≥6 | 0.28 | 0.31 (0.22–0.41) | 0.97 (0.91–0.99) | 0.91 (0.75–0.98) | 0.59 (0.51–0.66) | 0.09 (0.02–0.25) | 0.41 (0.34–0.49) | 10 (3.4–29.6) | 0.7 (0.6–0.85) |
≥7 | 0.04 | 0.04 (0.01–0.11) | 1 (0.95–1.0) | 1 (0.40–1.0) | 0.52 (0.44–0.59) | 0 (0–0.60) | 0.49 (0.41–0.56) | NA | 0.94 (0.8–1.1) |
VIP-3 | |||||||||
≥1 | 0.43 | 0.87 (0.78–0.92) | 0.57 (0.46–0.66) | 0.66 (0.57–0.74) | 0.81 (0.70–0.89) | 0.34 (0.26–0.43) | 0.19 (0.11–0.30) | 2.0 (1.5–2.6) | 0.23 (0.14–0.38) |
≥2 * ^ | 0.57 | 0.58 (0.48–0.68) | 0.98 (0.92–0.99) | 0.97 (0.87–0.99) | 0.70 (0.62–0.78) | 0.03 (0.01–0.13) | 0.29 (0.22–0.38) | 28.5 (7.3–111) | 0.42 (0.33–0.55) |
≥3 | 0.15 | 0.14 (0.08–0.23) | 1 (0.95–1.0) | 1 (0.73–1.0) | 0.54 (0.47–0.61) | 0 (0–0.27) | 0.46 (0.39–0.53) | NA | 0.85 (0.72–1.0) |
VIP-4 | |||||||||
≥1 | 0.42 | 0.87 (0.78–0.92) | 0.56 (0.45–0.65) | 0.66 (0.57–0.74) | 0.81 (0.69–0.89) | 0.34 (0.26–0.43) | 0.19 (0.11–0.31) | 1.9 (1.5–2.5) | 0.24 (0.14–0.39) |
≥2 ^ | 0.61 | 0.63 (0.53–0.73) | 0.98 (0.92–0.99) | 0.97 (0.88–0.99) | 0.73 (0.64–0.80) | 0.03 (0.01–0.12) | 0.27 (0.20–0.36) | 31 (8–121) | 0.37 (0.28–0.49) |
≥3 * | 0.29 | 0.29 (0.20–0.39) | 1 (0.95–1.0) | 1 (0.85–1.0) | 0.59 (0.51–0.66) | 0 (0–0.15) | 0.41 (0.34–0.49) | NA | 0.71 (0.59–0.85) |
≥4 | 0.05 | 0.05 (0.02–0.12) | 1 (0.95–1.0) | 1 (0.46–1.0) | 0.52 (0.44–0.59) | 0 (0–0.54) | 0.48 (0.41–0.55) | NA | 0.94 (0.8–1.1) |
Diagnostic Approach | CFS | PRISMA-7 | VIP-3 | VIP-4 |
---|---|---|---|---|
AUC (95% confidence intervals) for differentiating frail from non-frail | ||||
CGA | 0.91 (0.87–0.95) p < 0.001 | 0.90 (0.86–0.95) p < 0.001 | 0.84 (0.78–0.89) p < 0.001 | 0.84 (0.79–0.90) p < 0.001 |
FRAIL scale i.e., physical frailty (frail ≥ 3 criteria) | 0.69 (0.62–0.77) p < 0.001 | 0.70 (0.62–0.77) p < 0.001 | 0.63 (0.55–0.71) p = 0.004 | 0.66 (0.57–0.74) p < 0.001 |
GFI (frail ≥ 4 criteria) | 0.82 (0.76–0.88) p < 0.001 | 0.85 (0.79–0.91) p < 0.001 | 0.78 (0.71–0.84) p < 0.001 | 0.78 (0.72–0.85) p < 0.001 |
AUC (95% confidence intervals) for differentiating frail from pre-frail | ||||
CGA | 0.83 (0.75–0.91) p < 0.001 | 0.83 (0.75–0.91) p < 0.001 | 0.82 (0.75–0.89) p < 0.001 | 0.83 (0.77–0.90) p < 0.001 |
FRAIL scale (physical frailty) | 0.62 (0.53–0.71) p = 0.012 | 0.61 (0.52–0.70) p = 0.021 | 0.55(0.46–0.65) p = 0.275 | 0.59 (0.49–0.68) p = 0.077 |
CGA (pre-frail/robust) | 0.81 (0.72–0.89) p < 0.001 | 0.82 (0.73–0.90) p < 0.001 | 0.57 (0.45–0.68) p = 0.260 | 0.56 (0.44–0.67) p = 0.325 |
FRAIL scale (i.e., physical frailty) | 0.78 (0.69–0.86) p < 0.001 | 0.78 (0.70–0.86) p < 0.001 | 0.74 (0.66–0.82) p < 0.001 | 0.75 (0.67–0.83) p < 0.001 |
AUC (95% confidence intervals) for predicting adverse health-related outcomes | ||||
Outcomes (Yes/No) | CFS | PRISMA-7 | VIP-3 | VIP-4 |
Admission | 0.78 (0.70–0.85) p < 0.001 | 0.65 (0.56–0.74) p < 0.001 | 0.59 (0.51–0.67) p = 0.032 | 0.60 (0.52–0.68) p = 0.026 |
Length of Stay (>7 days, i.e., median LOS) | 0.60 (0.51–0.70) p = 0.044 | 0.61 (0.51–0.70) p = 0.036 | 0.66 (0.57–0.76) p = 0.001 | 0.68 (0.58–0.77) p < 0.001 |
Readmission to hospital (within 30–90 days) | 0.69 (0.61–0.78) p = 0.005 | 0.60 (0.49–0.72) p = 0.130 | 0.60 (0.47–0.73) p = 0.149 | 0.60 (0.47–0.74) p = 0.125 |
Died within 3 months of presentation | 0.71 (0.59–0.83) p = 0.008 | 0.71 (0.58–0.84) p = 0.009 | 0.66 (0.50–0.82) p = 0.050 | 0.67 (0.51–0.83) p = 0.036 |
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O’Caoimh, R.; McGauran, J.; O’Donovan, M.R.; Gillman, C.; O’Hea, A.; Hayes, M.; O’Connor, K.; Moloney, E.; Alcock, M. Frailty Screening in the Emergency Department: Comparing the Variable Indicative of Placement Risk, Clinical Frailty Scale and PRISMA-7. Int. J. Environ. Res. Public Health 2023, 20, 290. https://doi.org/10.3390/ijerph20010290
O’Caoimh R, McGauran J, O’Donovan MR, Gillman C, O’Hea A, Hayes M, O’Connor K, Moloney E, Alcock M. Frailty Screening in the Emergency Department: Comparing the Variable Indicative of Placement Risk, Clinical Frailty Scale and PRISMA-7. International Journal of Environmental Research and Public Health. 2023; 20(1):290. https://doi.org/10.3390/ijerph20010290
Chicago/Turabian StyleO’Caoimh, Rónán, Jane McGauran, Mark R. O’Donovan, Ciara Gillman, Anne O’Hea, Mary Hayes, Kieran O’Connor, Elizabeth Moloney, and Megan Alcock. 2023. "Frailty Screening in the Emergency Department: Comparing the Variable Indicative of Placement Risk, Clinical Frailty Scale and PRISMA-7" International Journal of Environmental Research and Public Health 20, no. 1: 290. https://doi.org/10.3390/ijerph20010290