The clinical frailty scale improves risk prediction in older emergency department patients: a comparison with qSOFA, NEWS2, and REMS
Abstract Vital signs are essential for monitoring and prognostication in the emergency department (ED); however, they may not fully capture the complexity of frailty in older adults. In this multicenter retrospective study of 932 older patients who visited the EDs of three tertiary university hospit...
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Nature Portfolio
2025-04-01
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| Online Access: | https://doi.org/10.1038/s41598-025-97764-z |
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| author | Ho Sub Chung Yunhyung Choi Ji Yeon Lim Keon Kim Yoon Hee Choi Dong Hoon Lee Sung Jin Bae |
| author_facet | Ho Sub Chung Yunhyung Choi Ji Yeon Lim Keon Kim Yoon Hee Choi Dong Hoon Lee Sung Jin Bae |
| author_sort | Ho Sub Chung |
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| description | Abstract Vital signs are essential for monitoring and prognostication in the emergency department (ED); however, they may not fully capture the complexity of frailty in older adults. In this multicenter retrospective study of 932 older patients who visited the EDs of three tertiary university hospitals between August 1 and October 31, 2023, we investigated the prognostic value of the Clinical Frailty Scale (CFS) in older patients in the ED and its potential to improve existing vital sign-based scoring systems. The primary outcomes were hospital admission, intensive care unit (ICU) admission, and in-hospital mortality. The AUROC was used to evaluate and compare the predictive performance of CFS, qSOFA, NEWS2, and REMS scores individually and in combination. Combining the CFS with these scores significantly improved predictive accuracy compared to individual scores alone. For hospital admission, the AUROCs were 0.715 (95% CI 0.685–0.744), 0.723 (95% CI 0.693–0.752), and 0.688 (95% CI 0.657–0.718) for CFS + qSOFA, CFS + NEWS2, and CFS + REMS, respectively. For ICU admission, the AUROCs were 0.730 (95% CI 0.701–0.759), 0.714 (95% CI 0.684–0.743), and 0.707 (95% CI 0.677–0.736), respectively. For in-hospital mortality, the AUROCs were 0.798 (95% CI: 0.771–0.823), 0.774 (95% CI: 0.746–0.801), and 0.819 (95% CI: 0.793–0.843), respectively, indicating excellent performance. Incorporating frailty assessment using the CFS enhances risk stratification in older patients in the ED by complementing vital sign-based scores. This provides a more comprehensive assessment, enabling better informed clinical decisions. This study supports employing routine frailty assessment in the ED and the development of enhanced risk stratification tools that incorporate frailty. |
| format | Article |
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| institution | DOAJ |
| issn | 2045-2322 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Nature Portfolio |
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| spelling | doaj-art-fac6410c8bb742f4a1fdb01c8a62b6cb2025-08-20T03:06:54ZengNature PortfolioScientific Reports2045-23222025-04-0115111110.1038/s41598-025-97764-zThe clinical frailty scale improves risk prediction in older emergency department patients: a comparison with qSOFA, NEWS2, and REMSHo Sub Chung0Yunhyung Choi1Ji 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 UniversityDepartment 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 Vital signs are essential for monitoring and prognostication in the emergency department (ED); however, they may not fully capture the complexity of frailty in older adults. In this multicenter retrospective study of 932 older patients who visited the EDs of three tertiary university hospitals between August 1 and October 31, 2023, we investigated the prognostic value of the Clinical Frailty Scale (CFS) in older patients in the ED and its potential to improve existing vital sign-based scoring systems. The primary outcomes were hospital admission, intensive care unit (ICU) admission, and in-hospital mortality. The AUROC was used to evaluate and compare the predictive performance of CFS, qSOFA, NEWS2, and REMS scores individually and in combination. Combining the CFS with these scores significantly improved predictive accuracy compared to individual scores alone. For hospital admission, the AUROCs were 0.715 (95% CI 0.685–0.744), 0.723 (95% CI 0.693–0.752), and 0.688 (95% CI 0.657–0.718) for CFS + qSOFA, CFS + NEWS2, and CFS + REMS, respectively. For ICU admission, the AUROCs were 0.730 (95% CI 0.701–0.759), 0.714 (95% CI 0.684–0.743), and 0.707 (95% CI 0.677–0.736), respectively. For in-hospital mortality, the AUROCs were 0.798 (95% CI: 0.771–0.823), 0.774 (95% CI: 0.746–0.801), and 0.819 (95% CI: 0.793–0.843), respectively, indicating excellent performance. Incorporating frailty assessment using the CFS enhances risk stratification in older patients in the ED by complementing vital sign-based scores. This provides a more comprehensive assessment, enabling better informed clinical decisions. This study supports employing routine frailty assessment in the ED and the development of enhanced risk stratification tools that incorporate frailty.https://doi.org/10.1038/s41598-025-97764-zClinical frailty scale (CFS)Emergency department (ED)Risk stratificationPrognostic scoring systemsOlder people |
| spellingShingle | Ho Sub Chung Yunhyung Choi Ji Yeon Lim Keon Kim Yoon Hee Choi Dong Hoon Lee Sung Jin Bae The clinical frailty scale improves risk prediction in older emergency department patients: a comparison with qSOFA, NEWS2, and REMS Scientific Reports Clinical frailty scale (CFS) Emergency department (ED) Risk stratification Prognostic scoring systems Older people |
| title | The clinical frailty scale improves risk prediction in older emergency department patients: a comparison with qSOFA, NEWS2, and REMS |
| title_full | The clinical frailty scale improves risk prediction in older emergency department patients: a comparison with qSOFA, NEWS2, and REMS |
| title_fullStr | The clinical frailty scale improves risk prediction in older emergency department patients: a comparison with qSOFA, NEWS2, and REMS |
| title_full_unstemmed | The clinical frailty scale improves risk prediction in older emergency department patients: a comparison with qSOFA, NEWS2, and REMS |
| title_short | The clinical frailty scale improves risk prediction in older emergency department patients: a comparison with qSOFA, NEWS2, and REMS |
| title_sort | clinical frailty scale improves risk prediction in older emergency department patients a comparison with qsofa news2 and rems |
| topic | Clinical frailty scale (CFS) Emergency department (ED) Risk stratification Prognostic scoring systems Older people |
| url | https://doi.org/10.1038/s41598-025-97764-z |
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