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Open AccessArticle

Comparison of Frailty Screening Instruments in the Emergency Department

1
Clinical Sciences Institute, National University of Ireland, Galway, Costello Road, H91 TK33 Galway City, Ireland
2
Department of Geriatric and Stroke Medicine, University Hospital Galway, Newcastle Rd, H91 YR71 Galway City, Ireland
3
Centre for Gerontology and rehabilitation, University College Cork, St Finbarr’s Hospital, Douglas Road, T12 XH60 Cork City, Ireland
4
Mercy University Hospital, Grenville Place, T12 WE28 Cork City, Ireland
5
Department of Emergency Medicine, University Hospital Galway, Newcastle Rd, H91 YR71 Galway City, Ireland
6
Primary, Community and Continuing Care, Shantalla Health Centre, Costello Rd, H91 YR71 Galway City, Ireland
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(19), 3626; https://doi.org/10.3390/ijerph16193626
Received: 1 August 2019 / Revised: 1 September 2019 / Accepted: 24 September 2019 / Published: 27 September 2019
(This article belongs to the Special Issue Efficient Use of Acute Hospital Services for Older People)
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. View Full-Text
Keywords: older people; frailty; emergency department; screening; sensitivity; specificity older people; frailty; emergency department; screening; sensitivity; specificity
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O’Caoimh, R.; Costello, M.; Small, C.; Spooner, L.; Flannery, A.; O’Reilly, L.; Heffernan, L.; Mannion, E.; Maughan, A.; Joyce, A.; Molloy, D.W.; O’Donnell, J. Comparison of Frailty Screening Instruments in the Emergency Department. Int. J. Environ. Res. Public Health 2019, 16, 3626.

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