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Comparison of Frailty Screening Instruments in the Emergency Department

Author

Listed:
  • Rónán O’Caoimh

    (Clinical Sciences Institute, National University of Ireland, Galway, Costello Road, H91 TK33 Galway City, Ireland
    Department of Geriatric and Stroke Medicine, University Hospital Galway, Newcastle Rd, H91 YR71 Galway City, Ireland
    Centre for Gerontology and rehabilitation, University College Cork, St Finbarr’s Hospital, Douglas Road, T12 XH60 Cork City, Ireland
    Mercy University Hospital, Grenville Place, T12 WE28 Cork City, Ireland)

  • Maria Costello

    (Clinical Sciences Institute, National University of Ireland, Galway, Costello Road, H91 TK33 Galway City, Ireland)

  • Cliona Small

    (Clinical Sciences Institute, National University of Ireland, Galway, Costello Road, H91 TK33 Galway City, Ireland)

  • Lynn Spooner

    (Centre for Gerontology and rehabilitation, University College Cork, St Finbarr’s Hospital, Douglas Road, T12 XH60 Cork City, Ireland)

  • Antoinette Flannery

    (Clinical Sciences Institute, National University of Ireland, Galway, Costello Road, H91 TK33 Galway City, Ireland)

  • Liam O’Reilly

    (Department of Emergency Medicine, University Hospital Galway, Newcastle Rd, H91 YR71 Galway City, Ireland)

  • Laura Heffernan

    (Department of Emergency Medicine, University Hospital Galway, Newcastle Rd, H91 YR71 Galway City, Ireland)

  • Edel Mannion

    (Clinical Sciences Institute, National University of Ireland, Galway, Costello Road, H91 TK33 Galway City, Ireland)

  • Anna Maughan

    (Primary, Community and Continuing Care, Shantalla Health Centre, Costello Rd, H91 YR71 Galway City, Ireland)

  • Alma Joyce

    (Primary, Community and Continuing Care, Shantalla Health Centre, Costello Rd, H91 YR71 Galway City, Ireland)

  • D. William Molloy

    (Department of Geriatric and Stroke Medicine, University Hospital Galway, Newcastle Rd, H91 YR71 Galway City, Ireland
    Mercy University Hospital, Grenville Place, T12 WE28 Cork City, Ireland)

  • John O’Donnell

    (Department of Emergency Medicine, University Hospital Galway, Newcastle Rd, H91 YR71 Galway City, Ireland)

Abstract

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.

Suggested Citation

  • Rónán O’Caoimh & Maria Costello & Cliona Small & Lynn Spooner & Antoinette Flannery & Liam O’Reilly & Laura Heffernan & Edel Mannion & Anna Maughan & Alma Joyce & D. William Molloy & John O’Donnell, 2019. "Comparison of Frailty Screening Instruments in the Emergency Department," IJERPH, MDPI, vol. 16(19), pages 1-13, September.
    • Handle: RePEc:gam:jijerp:v:16:y:2019:i:19:p:3626-:d:271376
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    References listed on IDEAS

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    1. Alice Coffey & Patricia Leahy-Warren & Eileen Savage & Josephine Hegarty & Nicola Cornally & Mary Rose Day & Laura Sahm & Kieran O’Connor & Jane O’Doherty & Aaron Liew & Duygu Sezgin & Rónán O’Caoimh, 2019. "Interventions to Promote Early Discharge and Avoid Inappropriate Hospital (Re)Admission: A Systematic Review," IJERPH, MDPI, vol. 16(14), pages 1-16, July.
    2. Giuseppe Liotta & Silvia Ussai & Maddalena Illario & Rónán O’Caoimh & Antonio Cano & Carol Holland & Regina Roller-Winsberger & Alessandra Capanna & Chiara Grecuccio & Mariacarmela Ferraro & Francesca, 2018. "Frailty as the Future Core Business of Public Health: Report of the Activities of the A3 Action Group of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA)," IJERPH, MDPI, vol. 15(12), pages 1-26, December.
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    Cited by:

    1. Elizabeth Moloney & Mark R. O’Donovan & Duygu Sezgin & Evelyn Flanagan & Keith McGrath & Suzanne Timmons & Rónán O’Caoimh, 2023. "Diagnostic Accuracy of Frailty Screening Instruments Validated for Use among Older Adults Attending Emergency Departments: A Systematic Review and Meta-Analysis," IJERPH, MDPI, vol. 20(13), pages 1-18, July.
    2. Debbie Rand & Shelley A. Sternberg & Reut Gasner Winograd & Zvi Buckman & Netta Bentur, 2022. "The Contribution of Frailty to Participation of Older Adults," IJERPH, MDPI, vol. 19(3), pages 1-9, January.
    3. Laura Gaffney & Agnes Jonsson & Conor Judge & Maria Costello & John O’Donnell & Rónán O’Caoimh, 2022. "Using the “Surprise Question” to Predict Frailty and Healthcare Outcomes among Older Adults Attending the Emergency Department," IJERPH, MDPI, vol. 19(3), pages 1-11, February.
    4. Rónán O’Caoimh, 2023. "Validation of the Risk Instrument for Screening in the Community ( RISC ) among Older Adults in the Emergency Department," IJERPH, MDPI, vol. 20(4), pages 1-17, February.
    5. Rónán O’Caoimh & Jane McGauran & Mark R. O’Donovan & Ciara Gillman & Anne O’Hea & Mary Hayes & Kieran O’Connor & Elizabeth Moloney & Megan Alcock, 2022. "Frailty Screening in the Emergency Department: Comparing the Variable Indicative of Placement Risk, Clinical Frailty Scale and PRISMA-7," IJERPH, MDPI, vol. 20(1), pages 1-13, December.

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