Original ArticleScreening of the frail patient in the emergency department: A systematic review
Introduction
The total number of people aged over 65 years attending emergency departments (EDs) is increasing [1], [2], with the result that emergency physicians have less time to manage them [3], [4]. Elderly patients are generally more demanding with a greater number of co-morbidities and communication problems. A substantial number of people ≥ 65 years are considered frail, the percentages have been reported to vary between 5 and 15% at the age of 65, increasing to 20–25% at the age of 85 [5], [6]. Frailty is a geriatric syndrome where patients are more vulnerable to adverse outcomes such as hospital admission and death. More than one operational definition exists [7]; these are difficult to use in everyday clinical practice because of their complexity.
Frailty screening tools that can identify elderly patients at greater risk of adverse outcomes and in need of further geriatric assessment and treatment would be of great clinical value in EDs [8], [9], [10], [11]. Rapid accurate risk stratification would allow for a more focused use of time and resources to the patients that need it the most. This systematic review assessed those screening tools that have been used in EDs to identify frail patients aged over 65 years.
Section snippets
Methods
Since the current concepts of frailty are relatively recent, this systematic review of the literature confined itself only to studies published in either English or Danish the last 10 years. PRISMA guidelines were followed [12]. PubMed and Embase were searched using the following terms:
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Population: Frail OR Frail Elder etc. AND ED OR Emergency Department OR Emergency Room etc.
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Intervention: Frailty Screening OR Frailty Assessment etc.
The quality of selected studies was assessed using described
Results
A literature search performed in March 2016 of PubMed and Embase yielded 794 unique papers reporting frailty and ED. After titles, abstracts and full text were screened to exclude those papers that only reported the use of a comprehensive geriatric assessment by a geriatric specialist and those not taking place in EDs, 790 papers were excluded. Only four papers dealt specifically with the assessment of frailty in patients at the time of presentation to an ED. All four papers were prognostic
Discussion
Given the small number of studies it is difficult to draw firm conclusions from their results. Moreover, the four studies identified were all cohort studies. Cohort studies do not provide the highest level of evidence [21]. This systematic review clearly identifies the need for randomized clinical trials of frailty screening tools compared to usual care or other methods of assessment. Nevertheless the four studies show that the use of frailty screening in the ED can be successful in predicting
Conclusion
This systematic review only identified four cohort studies of frailty assessment in EDs. There is clearly a need for randomized clinical trials of frailty screening tools compared to usual care or other methods of assessment.
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