Short Communication

Scoring the Clinical Frailty Scale in the Emergency Department: The Home FIRsT Experience

Owen Thorpe¹, Elva McCabe¹, Elena Marie Herrero¹, William Ormiston Doyle¹, Aoife Dillon², Lucinda Edge³, Sinéad Flynn⁴, Anna Mullen², Aisling Davis⁵, Aoife Molamphy⁵, Anna Kirwan⁵, Robert Briggs^2,6, Amanda H. Lavan^2,6, Darragh Shields⁷, Geraldine McMahon⁷, Arthur Hennessy⁷, Una Kennedy⁷, Paul Staunton⁷, Emer Kidney⁷, Sarah-Jane Yeung⁷, Deirdre Glynn⁷, Frances Horgan⁸, Conal Cunningham^2,6, Roman Romero-Ortuno^2,6,9

1. School of Medicine, Trinity College Dublin, Ireland
2. MedEL Directorate, St James’s Hospital, Dublin, Ireland
3. Department of Physiotherapy, St James’s Hospital, Dublin, Ireland
4. Department of Social Work, St James’s Hospital, Dublin, Ireland
5. Department of Occupational Therapy, St James’s Hospital, Dublin, Ireland
6. Discipline of Medical Gerontology, Trinity College Dublin, Ireland
7. Emergency Department, St James’s Hospital, Dublin, Ireland
8. School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
9. Global Brain Health Institute, Trinity College Dublin, Ireland

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Keywords: Clinical Frailty Scale, Disability, Emergency Department, Geriatric Assessment, Mobility

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Abstract

We evaluated predictors of the Clinical Frailty Scale (CFS) scored by an interdisciplinary team (Home FIRsT) performing comprehensive geriatric assessment (CGA) in our Emergency Department (ED). This was a retrospective observational study (service evaluation) utilising ED-based CGA data routinely collected by Home FIRsT between January and October 2020. A linear regression model was computed to establish independent predictors of CFS. This was complemented by a classification and regression tree (CRT) to evaluate the main predictors. There were 799 Home FIRsT episodes, of which 740 were unique patients. The CFS was scored on 658 (89%) (median 4, range 1-8; mean age 81 years, 61% women). Independent predictors of higher CFS were older age (p<0.001), history of dementia (p<0.001), mobility (p≤0.007), disability (p<0.001), and higher acuity of illness (p=0.009). Disability and mobility were the main classifiers in the CRT. Results suggest appropriate CFS scoring informed by functional baseline.

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