Prognostic value of frailty across age groups in emergency department patients aged 65 and above
Abstract 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 yea...
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2025-07-01
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| Series: | BMC Geriatrics |
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| Online Access: | https://doi.org/10.1186/s12877-025-06092-4 |
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| author | Yunhyung Choi Ho Sub Chung Ji Yeon Lim Keon Kim Yoon Hee Choi Dong Hoon Lee Sung Jin Bae |
| author_facet | Yunhyung Choi Ho Sub Chung Ji Yeon Lim Keon Kim Yoon Hee Choi Dong Hoon Lee Sung Jin Bae |
| author_sort | Yunhyung Choi |
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| description | Abstract 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. |
| format | Article |
| id | doaj-art-02db9e59b66f4e1fa19cbe19556c3801 |
| institution | Kabale University |
| issn | 1471-2318 |
| language | English |
| publishDate | 2025-07-01 |
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| series | BMC Geriatrics |
| spelling | doaj-art-02db9e59b66f4e1fa19cbe19556c38012025-08-20T03:45:32ZengBMCBMC Geriatrics1471-23182025-07-0125111110.1186/s12877-025-06092-4Prognostic value of frailty across age groups in emergency department patients aged 65 and aboveYunhyung Choi0Ho Sub Chung1Ji Yeon Lim2Keon Kim3Yoon Hee Choi4Dong Hoon Lee5Sung Jin Bae6Department of Emergency Medicine, College of Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang UniversityDepartment of Emergency Medicine, College of Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang UniversityDepartment of Emergency Medicine, College of Medicine, Ewha Womans University Seoul Hospital, Ewha Womans UniversityDepartment of Emergency Medicine, College of Medicine, Ewha Womans University Seoul Hospital, Ewha Womans UniversityDepartment of Emergency Medicine, College of Medicine, Ewha Womans University Mokdong Hospital, Ewha Womans University 1071Department of Emergency Medicine, College of Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang UniversityDepartment of Emergency Medicine, College of Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang UniversityAbstract 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.https://doi.org/10.1186/s12877-025-06092-4FrailtyClinical frailty scaleEmergency departmentOlder patientsRisk stratification |
| spellingShingle | Yunhyung Choi Ho Sub Chung Ji Yeon Lim Keon Kim Yoon Hee Choi Dong Hoon Lee Sung Jin Bae Prognostic value of frailty across age groups in emergency department patients aged 65 and above BMC Geriatrics Frailty Clinical frailty scale Emergency department Older patients Risk stratification |
| title | Prognostic value of frailty across age groups in emergency department patients aged 65 and above |
| title_full | Prognostic value of frailty across age groups in emergency department patients aged 65 and above |
| title_fullStr | Prognostic value of frailty across age groups in emergency department patients aged 65 and above |
| title_full_unstemmed | Prognostic value of frailty across age groups in emergency department patients aged 65 and above |
| title_short | Prognostic value of frailty across age groups in emergency department patients aged 65 and above |
| title_sort | prognostic value of frailty across age groups in emergency department patients aged 65 and above |
| topic | Frailty Clinical frailty scale Emergency department Older patients Risk stratification |
| url | https://doi.org/10.1186/s12877-025-06092-4 |
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