Background: Frailty epitomizes the most complex consequence of an aging population. This study aimed to evaluate the impact of frailty, measured using the Clinical Frailty Scale (CFS), on outcomes of older people in an emergency department (ED).

Methods: We conducted a prospective observational study enrolling patients aged 65 years and older in a medical center of Taiwan between March 8, 2021, and November 30, 2021. The primary outcome was 90-day mortality rate. Individuals were categorized into three groups based on the CFS scores. Logistic regression was employed to examine the influence of frailty on clinical outcomes following covariate adjustment. Survival analysis was conducted using Kaplan-Meier curves and Log rank tests.

Results: A total of 473 individuals were included in the study, with a mean age of 82.1 years, and 60.5% of them were males. The 90-day mortality rate was 10.6%. Among these groups, the CFS score 7-9 group had the highest 90-day mortality rate (15.9%), followed by the CFS score 4-6 group (8.0%) and the CFS score 1-3 group (7.1%). The multiple logistic regression analyses demonstrated a significant impact of CFS score on prognosis, with adjusted odd ratios of 1.24 (95% CI 1.06-1.47) for 90-day mortality, 1.18 (95% CI 1.06-1.31) for hospitalization, and 1.30 (95% CI 1.12-1.52) for 180-day mortality. The Kaplan-Meier curves revealed a significantly higher 90-day mortality rate for patients with high CFS scores (Log rank tests, p = 0.019).

Conclusion: In the older ED population, the severity of frailty assessed by the CFS emerged as a significant and important prognostic factor for hospitalization, 90-day mortality, and 180-day mortality.

Keywords: emergency service; frailty; hospital; mortality; triage.

© 2024 Lin et al.

背景: 脆弱性是老龄化人口最复杂的结果之一。本研究旨在评估使用临床脆弱性量表（CFS）测量的脆弱性对老年人在急诊科（ED）结果的影响。

方法: 我们进行了一项前瞻性观察研究，纳入了2021年3月8日至2021年11月30日期间，在台湾一家医疗机构就诊的65岁及以上的患者。主要结局指标是90天死亡率。根据CFS评分将个体分为三组。采用逻辑回归分析在调整协变量后脆弱性对临床结果的影响，并使用Kaplan-Meier曲线和Log-rank检验进行生存分析。

结果: 本研究共纳入473名参与者，平均年龄为82.1岁，其中60.5%是男性。90天死亡率为10.6%。在这些组中，CFS评分7-9分的组别具有最高的90天死亡率（15.9%），其次是CFS评分4-6分的组别（8.0%）和CFS评分1-3分的组别（7.1%）。多变量逻辑回归分析显示，CFS评分对预后有显著影响，调整后的比值比为：90天死亡率为1.24（95% CI 1.06-1.47），住院为1.18（95% CI 1.06-1.31），以及180天死亡率为1.30（95% CI 1.12-1.52）。Kaplan-Meier曲线显示，高CFS评分患者的90天死亡率显著升高（Log-rank检验，p = 0.019）。

结论: 在老年急诊科患者中，通过CFS评估的脆弱性严重程度成为住院、90天死亡率和180天死亡率的重要预后因素。

关键词: 急诊服务；脆弱性；医院；死亡率；分诊。