Introduction Frailty is common in hospitalised older adults. This study compared efficacy of a modified Hospital Frailty Risk Score (mHFRS) to standard HFRS and Clinical Frailty Scale (CFS) to determine whether mHFRS can be used to identify frail hospitalised patients. Methods Anonymised retrospective review of Electronic Health Records was undertaken in patients = > 65 years old attending the Emergency Department (ED) and admitted to hospital 1st July 2022 to 31st March 2023. mHFRS utilises 2 prior emergency admissions within 2 years to generate a frailty risk score, whereas HFRS requires an index admission plus 2 prior emergency admissions. Hospitalisation outcomes and predictive models were evaluated with correlation and measures of agreement between CFS and HFRS, CFS and mHFRS using Spearman’s rank correlation and Cohen’s kappa. Results Of 3042 patients, CFS categorised 1635 patients as non-frail (CFS 1–4) and 1407 as frail (CFS 5–9). Using mHFRS, only 1623 patients could be categorised and of these, 608 were deemed low, 657 intermediate and 358 high risk of frailty. Frail patients were older (81.8 years, SD 8.41 vs 75.3 years, SD 7.20, p = <.001), had significantly longer LOS (52.5% % vs 31.5%, p = <0.001), higher 30-day unplanned hospital readmissions (18.5% vs 9.9%, p = <0.001), and higher in-patient (6.1% vs 2.0%, p < 0.001), 30-day (9.1% vs 2.3%, p < 0.001), and 90-day (15.8% vs 5.1%, p < 0.001) mortality. mHFRS achieved comparable association with hospitalisation outcomes compared to CFS & HFRS. Cohens’s kappa, showed fair agreement across HFRS and mHFRS, κ of 0.235 0.243 respectively. mHFRS was less sensitive at identifying frail patients but had better specificity to identify non frail patients. Conclusion mHFRS is a comparable frailty screening tool that doesn’t require clinical assessment but is standardised and easy to use in those who can be scored.

中文翻译：

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2346 改良医院虚弱风险评分 （mHFRS） 作为识别虚弱住院老年人的工具


简介 虚弱在住院的老年人中很常见。本研究将改良医院衰弱风险评分 （mHFRS） 与标准 HFRS 和临床衰弱量表 （CFS） 的疗效进行了比较，以确定 mHFRS 是否可用于识别虚弱住院患者。方法 对 2022 年 7 月 1 日至 2023 年 3 月 31 日就诊急诊科 （ED） 并入院的 65 岁患者 = > 进行电子健康记录的匿名回顾性审查。mHFRS 利用 2 年内 2 次既往急诊入院来生成虚弱风险评分，而 HFRS 需要指数入院加上 2 次既往急诊入院。使用 Spearman 秩相关和 Cohen κ κ 通过 CFS 和 HFRS、CFS 和 mHFRS 之间的相关性和一致性测量来评估住院结果和预测模型。结果 在 3042 名患者中，CFS 将 1635 名患者归类为非虚弱患者 （CFS 1-4），1407 名患者归类为虚弱 （CFS 5-9）。使用 mHFRS，只能对 1623 名患者进行分类，其中 608 名被认为是低风险，657 名中等风险和 358 名高风险患者。虚弱患者年龄较大（81.8 岁，SD 8.41 对 75.3 岁，SD 7.20，p = <.001），LOS 显著更长（52.5% % 对 31.5%，p = <0.001），更高的 30 天计划外再入院率（18.5% 对 9.9%，p = <0.001），住院率更高（6.1% 对 2.0%，p < 0.001），30 天（9.1% 对 2.3%，p < 0.001）和 90 天（15.8% 对 5.1%， p < 0.001） 死亡率。与CFS和HFRS相比，mHFRS实现了与住院结果相当的关联。Cohens 的 kappa 在 HFRS 和 mHFRS 之间显示出公平的一致性，κ 分别为 0.235 和 0.243。mHFRS 在识别虚弱患者方面敏感性较低，但在识别非虚弱患者方面具有更好的特异性。 结论 mHFRS 是一种类似的衰弱筛查工具，不需要临床评估，但标准化且易于在可以评分的人中使用。