Zwawi Ahmad, Wessman Torgny, Wändell Per, Melander Olle, Carlsson Axel C, Ruge Toralph
Department of Emergency and Internal Medicine, Skåne University Hospital, Malmö, Sweden.
Department of Clinical Sciences, Malmö, Lund University & Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden.
Geroscience. 2025 Sep 11. doi: 10.1007/s11357-025-01864-7.
To evaluate a simplified version of the Clinical Frailty Scale (SCFS) among older adults presenting to the emergency department (ED) with acute dyspnea. In this retrospective single-center cohort study, we included patients from the Acute Dyspnea Study (ADYS) cohort. Severity of illness was assessed using the Medical Emergency Triage and Treatment System (METTS). SCFS was operationalized using existing data on municipal care services from the ADYS database and divided into three levels. SCFS 1: Not frail patients with no need for municipal care services, SCFS 2: Patients with municipal care services, including home care, and SCFS 3: Patients with residence in a short-term care facility or nursing home. The primary outcome was 90-day mortality and hospitalization. Multivariable Cox and logistic regression analyses were used to assess associations between SCFS and outcome variables. SCFS criteria were met in 35.2% of patients (668 patients, SCFS group 2 and 3). These individuals had a higher comorbidity burden and increased 90-day mortality (20.9%, p < 0.001). SCFS group 3 was independently associated with a higher risk of 90-day mortality (HR = 2.60, 95% CI: 1.27-5.29, p = 0.009), compared to group 1. ROC curve analysis showed that combining SCFS with METTS significantly improved predictive performance (DeLong's test: p = 0.015 and p = 0.0322 in respective models). For hospitalization, SCFS group 3 was associated with hospitalization independent of age, sex, BMI, comorbidities, and readmission, when compared to SCFS group 1 (OR = 2.57, CI:1.11-6.71, p = 0.037). This association was attenuated and nonsignificant after further adjustment for METTS. SCFS is an independent predictor of 90-day mortality in older ED patients with acute dyspnea. When combined with triage scores like METTS, its predictive value improves. These findings support the potential clinical utility of incorporating frailty assessment into ED triage to aid risk stratification and guide care decisions.
评估急诊科（ED）中因急性呼吸困难就诊的老年人中简化版临床衰弱量表（SCFS）的情况。在这项回顾性单中心队列研究中，我们纳入了急性呼吸困难研究（ADYS）队列中的患者。使用医疗紧急分诊和治疗系统（METTS）评估疾病严重程度。利用ADYS数据库中关于市政护理服务的现有数据实施SCFS，并将其分为三个级别。SCFS 1：无需市政护理服务的非衰弱患者；SCFS 2：接受市政护理服务（包括家庭护理）的患者；SCFS 3：居住在短期护理机构或养老院的患者。主要结局是90天死亡率和住院情况。采用多变量Cox和逻辑回归分析评估SCFS与结局变量之间的关联。35.2%的患者（668例患者，SCFS第2组和第3组）符合SCFS标准。这些个体的合并症负担更高，90天死亡率增加（20.9%，p < 0.001）。与第1组相比，SCFS第3组与90天死亡率较高独立相关（HR = 2.60，95% CI：1.27 - 5.29，p = 0.009）。ROC曲线分析表明，将SCFS与METTS相结合可显著提高预测性能（在各自模型中，DeLong检验：p = 0.015和p = 0.0322）。对于住院情况，与SCFS第1组相比，SCFS第3组与住院独立相关，不受年龄、性别、BMI、合并症和再入院的影响（OR = 2.57，CI：1.11 - 6.71，p = 0.037）。在进一步调整METTS后，这种关联减弱且无统计学意义。SCFS是急诊科急性呼吸困难老年患者90天死亡率的独立预测因子。当与METTS等分诊评分相结合时，其预测价值提高。这些发现支持将衰弱评估纳入急诊科分诊以帮助进行风险分层和指导护理决策的潜在临床实用性。
