Clinical Frailty Score for Hospital Outcome for Patients Aged ≥ 75 Following Emergency Department Resuscitation Room Admission: A Retrospective Monocenter Study

Introduction: Elderly patients (≥ 75 years) often require resuscitation room (RR) care in the emergency department (ED), yet decisions regarding intensive care unit (ICU) admission remain complex. Assessment of quality of life and frailty is necessary to determine the level of care required for elderly patients. The Clinical Frailty Scale (CFS) is a validated tool for assessing frailty and predicting mortality, but its role in ICU triage remains unclear. The aim of this study was to compare the CFS of patients admitted to the ICU with those admitted to the general inpatient unit (GIU) after receiving initial intensive care. Methods: This was a retrospective, single-centre study including patients aged ≥ 75 years admitted to the ED RR from November 1, 2023, to March 31, 2024. The primary outcome was the comparison of CFS between ICU and GIU admissions. Secondary outcomes included predictive performance of CFS for ICU admission and in-hospital mortality. Results: Of the 392 patients enrolled, 170 (43%) were admitted to the ICU and 222 (57%) to the GIU. The median CFS was 3 [2–4] in ICU-admitted patients and 4 [3–5] in GIU-admitted patients (p < 0.001). In-hospital mortality rate was 35/222 (16%) in GIU-admitted group and 30/180 (18%) in ICU-admitted group (p = 0.72). CFS predictive value for ICU admission had an area under curve of 0.68 (95% confidence interval (95%CI): 0.63–0.73) and for in-hospital mortality of 0.62 (95%CI: 0.55–0.69). Conclusions: CFS differed between ICU and GIU groups, suggesting its potential role in orientation after RR admission. Although CFS’s predictive value remains limited, in this study it was better than the Charlson Index or SAPS 2 for predicting ICU admission. Further prospective studies should evaluate its integration with other clinical parameters to optimize decision making in elderly ED patients.