Comparing the predictive performance of in-hospital mortality of different frailty scales for elderly patients in the emergency department

Assessments for frailty, comorbidity and disability should be conducted for elderly patients in the emergency department (ED) using suitable scales. We evaluated the predictive values derived from the Eastern Cooperative Oncology Group Performance Status Scale (ECOG), Charlson Comorbidity Index (CCI), and Clinical Frailty Scale (CFS) in an ED context. This prospective cohort study, conducted in the EDs of two Taoyuan City, Taiwan hospitals for 8 months. Patients aged 65 or older and their families participated in interviews and filled out questionnaires. The study then analyzed the scales’ performance in predicting patient mortality and average hospital stay length. The study included 593 patients. Participants had a mean age of 75.8 years. The majority, 74.4%, were categorized as level III under the Taiwan Triage and Acuity Scale (TTAS). Meanwhile, 114 patients (19.2%) were deemed critical (TTAS levels II or I). Admission and mortality rate were significant associated with three scales above cut-off value after adjusted to age, gender and TTAs by logistic regression analysis, except for ECOG >3 group in predicting admission to hospital (p = 0.055). The CCI demonstrated significantly higher predictability for mortality compared to other scales, boasting an area under the curve (AUC) of 0.810 (95% confidence interval (CI): 0.730–0.891). This was followed by the CFS with an AUC of 0.706 (95% CI: 0.614–0.799) and the Eastern Cooperative Oncology Group Performance Status (ECOG-PS) with an AUC of 0.660 (95% CI: 0.565–0.754). However, there was no significant difference among these scales in predicting hospital admission (CCI AUC: 0.600, 95% CI: 0.552–0.648; CFS AUC: 0.583, 95% CI: 0.535–0.632; ECOG-PS AUC: 0.580, 95% CI: 0.531–0.628). As conclusion, this study evaluated the performance of ECOG, CCI, and CFS in predicting outcomes during ED triage. Although CCI can predict in-hospital mortality, its application in ED needs more comprehensive research.

Geriatric assessment; Health status; Aged; Health services for the aged; Emergency; Medicine

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