Predictive ability of two frailty screening tools for older patients in an emergency department: a comparative study.

Frailty identification is crucial for guiding individualized treatment in emergency geriatric care. The aims were to prospectively evaluate frailty status in all patients aged 65 and older presenting with acute illness in the emergency department (ED), and to compare the predictive performance of bedside-assessed Brief Multidimensional Prognostic Index (B-MPI), with healthcare professional-assessed Clinical Frailty Scale (CFS) for unplanned readmissions and 30- and 90-day mortality. This prospective observational cohort study evaluated frailty status in 402 patients aged 65 years or older admitted to the ED at Aarhus University Hospital, Denmark, between April 2023 and January 2025 and included through convenience sampling. Frailty was assessed using two validated tools: the CFS, administered by physicians or geriatric healthcare staff, and the B-MPI, administered bedside incorporating patient interviews or caregiver input, and electronic medical record data. Data showed that 40% of the older patients were classified as frail by the CFS, while 50% were moderately or severely frail according to the B-MPI. Both tools predicted 30-day and 90-day mortality with no difference in accuracy for predicting mortality. Neither tool effectively predicted unplanned hospital readmissions. Mortality rates in the cohort were 5.7% at 30 days and 12.9% at 90 days post-admission. The findings suggest that both tools are valuable for identifying frailty and predicting mortality in older acutely ill patients. However, the absence of a statistically significant difference between the tools should not be interpreted as evidence of equivalence or comparable performance.