The Prognostic Accuracy of Frailty and Vulnerability Screening for Older Adults in the Emergency Department: A Systematic Review and Meta-analysis
Abstract
Study objective: Frailty and vulnerability are associated with increased morbidity and mortality in older adults, yet the optimal screening tool for predicting adverse outcomes in the emergency department (ED) remains unclear. Our question is: Which frailty or vulnerability screening instrument has the highest prognostic accuracy for adverse outcomes in older adults visiting the ED?
Methods: We included observational studies involving patients aged more than or equal to 60 years presenting to the ED that applied frailty or vulnerability instruments and reported sensitivity, specificity, and area under the curve (AUC). We searched MEDLINE, EMBASE, Cochrane Library, CINAHL, and CNKI through January 2025. Study quality was assessed using an updated the Quality in Prognosis Studies tool. Two investigators independently screened studies. Meta-analysis was conducted for instruments with consistent cutoffs reported in more than or equal to 4 studies.
Results: Fifty-seven studies (125,412 patients) assessed 39 instruments with varied cutoffs. The Identification of Seniors at Risk and Clinical Frailty Scale were studied most. Most tools demonstrated high sensitivity but low specificity. For 30-day mortality, pooled Identification of Seniors at Risk estimates were as follows: sensitivity 92% (95% confidence interval, 84 to 96), specificity 37% (26 to 50), likelihood ratio (LR)+ 1.47 (1.25 to 1.79), LR- 0.24 (0.11 to 0.42), and AUC 0.84 (0.60-0.89). Clinical Frailty Scale (cut-off of…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 125,412 participants or records.
Read the paper
Related studies
- The Matrisome: In Silico Definition and In Vivo Characterization by Proteomics of Normal and Tumor Extracellular Matrices
- The Escherichia coli MG1655 in silico metabolic genotype: Its definition, characteristics, and capabilities
- In silico pharmacology for drug discovery: methods for virtual ligand screening and profiling
- In silico prediction of splice-altering single nucleotide variants in the human genome
- In silico clinical trials: how computer simulation will transform the biomedical industry
- In silico optimization of a guava antimicrobial peptide enables combinatorial exploration for peptide design
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.