#176 Development of a novel frailty trigger for use at triage in the emergency department

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Background Frailty is not routinely identified at Emergency Department (ED) triage. The introduction of a frailty modifier has been recommended in international ED triage guidelines but is yet to be widely adopted. We developed a short Frailty Trigger for use at triage. Methods The Frailty Trigger was developed following a systematic review examining ED frailty screening instruments. A two-round electronic Delphi followed to determine the core components of ED frailty screening. The 3 highest scoring statements relating to components were edited to create the questions. A diagnostic test accuracy study was undertaken among consecutive adults aged ≥70 years, who attended one ED between December 2021 and February 2022, comparing the Trigger against three, validated frailty screening instruments; the Clinical frailty Scale (CFS), Variable indicative of Placement (VIP) and PRISMA-7. An independent comprehensive geriatric assessment (CGA) determined each patient’s frailty status. Results 313 adults aged ≥70 years were available, median age 78±9 years. Excellent accuracy for frailty demonstrated, (AUC) 0.822 (95% CI:0.780-0.865). Mean administrative time 25.5 seconds (SD ±10.9s). It had similar accuracy to VIP (AUC 0.820, p=0.937), lower than PRISMA-7 (AUC 0.896, p<0.001) and CFS (AUC 0.946, p<0.001). A positive score was independently associated with longer ED stays (mean 32.5 versus 26.7 hours) and hospital stays (mean 10 versus 4 days, p<0.001). Conclusion The Frailty Trigger showed excellent diagnostic accuracy for frailty versus three longer, validated screens and was quicker to use. It predicted ED and hospital length of stay. Larger studies in ED are required to examine accuracy and effect on triage pathways.

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