Aims:
The aim is to determine if increased frailty and a greater 4AT result on initial emergency department (ED) presentation have additive combined risk for mortality. This is alongside validating frailty assessment and 4AT as independent predictors of mortality.
Methods:
This is a prospective observational study of routinely collected clinical data to include descriptive epidemiology alongside 14-day, 28-day, 6-month and 12-month outcomes of care. Frailty was assessed by Clinical Frailty Scale score (CFS) and delirium was assessed by 4AT. Relative risk of mortality was calculated using 2x2 contingency table. Chi-square testing was used to determine significance.
Results:
473 older patients were assessed in one year. The mean age of patients assessed was 82 years. The median CFS was 6 and the median 4AT value was 1. The mortality rate at 28 days was 6.4%, with all deceased patients at 28 days having a CFS score greater than or equal to 5. The relative risk of mortality was 6.5 times greater in those with a 4AT score greater than or equal to 4. 6-month mortality was 5.5 times higher in those who are frail. Those patients with a CFS score of 5 or greater combined with a 4AT of 5 and above had the highest mortality of all groups, with the association of CFS, 4AT and mortality reaching statistical significance.
Conclusions:
In older patients living with frailty, using both CFS and 4AT together in routine clinical assessment has the potential to predict mortality more accurately than CFS or 4AT in isolation.