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

Abstract

Introduction: The Clinical Frailty Scale (CFS) is a frailty identification tool based on clinical judgement. A concern is that in busy acute care settings, CFS scoring may be based on subjective 'eyeballing' rather than pre-illness functional baseline. We evaluated predictors of CFS scored by an interdisciplinary team (Home FIRsT) performing comprehensive geriatric assessment (CGA) in our Emergency Department (ED). Methods: This was a retrospective observational study (service evaluation) utilising data routinely collected by Home FIRsT between January and October 2020. As part of the ED-based CGA, Home FIRsT collected pre-attendance sociodemographics, comorbidities including dementia, activities of daily living (ADLs), and mobility and falls history; and related to attendance, they recorded present complaint, acuity of illness (Manchester Triage Category: MTC), and delirium (4AT). 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. Results: During the study period, there were 799 Home FIRsT episodes, of which 740 were unique patients (mean age 81 years, 61% women). Among the latter, the CFS was scored on 658 (89%) (median 4, range 1-8). Independent predictors of higher CFS were older age (p<0.001), history of dementia (p<0.001), mobility (p<0.001), ADLs (p<0.001) and higher acuity of illness (p = 0.010). ADLs and mobility were the main classifiers in the CRT. Conclusions: Pre-attendance ADLs and mobility were the most important geriatric dimensions considered by Home FIRsT for CFS scoring in the ED. This suggests appropriate CFS scoring mostly informed by functional baseline.