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Background <p>The Clinical Frailty Scale (CFS) is widely utilized for risk stratification in emergency departments (EDs); however, its predictive value across various age groups remains unclear.</p> Methods <p>In this retrospective multicenter study, we analyzed 6,310 patients in the ED aged ≥ 65 years, categorized into young-old (65–74 years, <i>n</i> = 2,750), middle-old (75–84 years, <i>n</i> = 2,400), and old-old (≥ 85 years, <i>n</i> = 1,160) groups. According to CFS, patients were categorized as robust (scores 1–3), pre-frail (score 4), or frail (scores 5–9). Multivariable logistic regression analyses were performed to evaluate the independent association between frailty categories and clinical outcomes (ICU admission and in-hospital mortality), adjusting for age, sex, and illness severity. Predictive performance was assessed using the area under the receiver operating characteristic curve (AUROC).</p> Results <p>The predictive value of CFS varied significantly across age groups. In the young-old group, frail status was independently associated with increased ICU admission (adjusted odds ratio [aOR] 1.49, 95% confidence interval [CI] 1.076–2.062) and in-hospital mortality (aOR 3.232, 95% CI 1.738–6.009). The middle-old group demonstrated the strongest relationship with mortality for frail patients (aOR 5.361, 95% CI 2.872–10.007), but no significant association with ICU admission after adjustment. In the old-old group, neither pre-frail nor frail status significantly predicted outcomes. AUROC analysis showed the highest discriminative capability for ICU admission in the young-old group (0.616, 95% CI 0.597–0.634) and for mortality in the middle-old group (0.730, 95% CI 0.712–0.748), with reduced predictive value observed in the old-old group.</p> Conclusions <p>The prognostic value of CFS varies significantly by age group, demonstrating the strongest performance in young-old patients and diminishing predictive value in the old-old group. These findings suggest the need for age-specific frailty assessment strategies in emergency care, with additional clinical indicators potentially necessary for risk stratification in the oldest patients.</p> Clinical trial number <p>Not applicable.</p>

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Prognostic value of frailty across age groups in emergency department patients aged 65 and above

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月2日

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  • Yunhyung Choi,
  • Ho Sub Chung,
  • Ji Yeon Lim,
  • Keon Kim,
  • Yoon Hee Choi,
  • Dong Hoon Lee,
  • Sung Jin Bae

摘要

Background

The Clinical Frailty Scale (CFS) is widely utilized for risk stratification in emergency departments (EDs); however, its predictive value across various age groups remains unclear.

Methods

In this retrospective multicenter study, we analyzed 6,310 patients in the ED aged ≥ 65 years, categorized into young-old (65–74 years, n = 2,750), middle-old (75–84 years, n = 2,400), and old-old (≥ 85 years, n = 1,160) groups. According to CFS, patients were categorized as robust (scores 1–3), pre-frail (score 4), or frail (scores 5–9). Multivariable logistic regression analyses were performed to evaluate the independent association between frailty categories and clinical outcomes (ICU admission and in-hospital mortality), adjusting for age, sex, and illness severity. Predictive performance was assessed using the area under the receiver operating characteristic curve (AUROC).

Results

The predictive value of CFS varied significantly across age groups. In the young-old group, frail status was independently associated with increased ICU admission (adjusted odds ratio [aOR] 1.49, 95% confidence interval [CI] 1.076–2.062) and in-hospital mortality (aOR 3.232, 95% CI 1.738–6.009). The middle-old group demonstrated the strongest relationship with mortality for frail patients (aOR 5.361, 95% CI 2.872–10.007), but no significant association with ICU admission after adjustment. In the old-old group, neither pre-frail nor frail status significantly predicted outcomes. AUROC analysis showed the highest discriminative capability for ICU admission in the young-old group (0.616, 95% CI 0.597–0.634) and for mortality in the middle-old group (0.730, 95% CI 0.712–0.748), with reduced predictive value observed in the old-old group.

Conclusions

The prognostic value of CFS varies significantly by age group, demonstrating the strongest performance in young-old patients and diminishing predictive value in the old-old group. These findings suggest the need for age-specific frailty assessment strategies in emergency care, with additional clinical indicators potentially necessary for risk stratification in the oldest patients.

Clinical trial number

Not applicable.