227 Screening for Frailty in the Emergency Department: Comparison of Tools

Numerous tools exist to screen for frailty in clinical settings but a single international standard has not yet been adopted. Recent research indicates that more than one tool is often deployed by clinicians to diagnose frailty. This study aimed to compare the use of two screening tools in the emergency department and assess the predictive ability of keywords in triage notes to detect frailty.

Frailty screening was carried out on 198 individuals (100 female / 98 male) attending the emergency department of a large urban teaching hospital, using the Rockwood Clinical Frailty Scale and the Variable Indicative of Placement Risk (VIP) scale. Average screening time for Rockwood was 43.1 ± 21.7s, whilst average screening time for VIP was 11.8 ± 8.5s. Results were dichotomised to frail, corresponding to Rockwood scores of ≥4 or VIP scores of ≥1, or non-frail (Rockwood=1-3 or VIP=0) for comparisons. Triage notes were reviewed to find keywords associated with frail patients.

Among 198 individuals screened, 149 (75.3%) were frail according to Rockwood, and 143 (72.2%) according to VIP. 25 (12.6%) of the 198 individuals were categorised as frail according to Rockwood but were non-frail according to VIP. Among these, 8 were female (8% of all female patients; 6 were 75+ years of age, and 2 were under 75) and 17 were male (17.3% of all male patients; 11 were 75+ years of age and 6 were under 75). Keywords associated with frailty were identified from triage notes, across the following categories: Falls/ mobility/ balance; Cognition; Living circumstances; Nutrition; Other frailty-associated conditions; and General deterioration.

Comparison of the two scales suggests that frailty could be missed if relying on a single index. This effect may be more frequent in men than women. Screening triage notes to identify frailty-associated keywords may be a helpful adjunct to existing tools.