Vital signs are essential for monitoring and prognostication in the emergency department (ED); however, they may not fully capture the complexity of frailty in older adults. In this multicenter retrospective study of 932 older patients who visited the EDs of three tertiary university hospitals between August 1 and October 31, 2023, we investigated the prognostic value of the Clinical Frailty Scale (CFS) in older patients in the ED and its potential to improve existing vital sign-based scoring systems. The primary outcomes were hospital admission, intensive care unit (ICU) admission, and in-hospital mortality. The AUROC was used to evaluate and compare the predictive performance of CFS, qSOFA, NEWS2, and REMS scores individually and in combination. Combining the CFS with these scores significantly improved predictive accuracy compared to individual scores alone. For hospital admission, the AUROCs were 0.715 (95% CI 0.685–0.744), 0.723 (95% CI 0.693–0.752), and 0.688 (95% CI 0.657–0.718) for CFS + qSOFA, CFS + NEWS2, and CFS + REMS, respectively. For ICU admission, the AUROCs were 0.730 (95% CI 0.701–0.759), 0.714 (95% CI 0.684–0.743), and 0.707 (95% CI 0.677–0.736), respectively. For in-hospital mortality, the AUROCs were 0.798 (95% CI: 0.771–0.823), 0.774 (95% CI: 0.746–0.801), and 0.819 (95% CI: 0.793–0.843), respectively, indicating excellent performance. Incorporating frailty assessment using the CFS enhances risk stratification in older patients in the ED by complementing vital sign-based scores. This provides a more comprehensive assessment, enabling better informed clinical decisions. This study supports employing routine frailty assessment in the ED and the development of enhanced risk stratification tools that incorporate frailty.

Background and Objectives: The Clinical Frailty Scale (CFS), used to screen for prehospital frailty in patients aged >65 years, is simple, time-efficient, and has been validated in emergency departments (EDs). In this study, we analyzed whether the Korean Triage and Acuity Scale (KTAS) classification by level in older patients determined to have frailty based on the Korean version of the CFS increases the triage performance of the current KTAS. Materials and Methods: The primary outcome was 30-day in-hospital mortality, and secondary outcomes were hospital and intensive care unit (ICU) admissions. This study retrospectively analyzed prospectively collected data from three ED centers. Patients with a CFS score ranging from five (mildly frail) to nine (terminally ill) were categorized into the frailty group. We upgraded the KTAS classification of the frailty group by one level of urgency and defined this as the CFS-KTAS. Results: The cutoff values for predicting admission were three and two for the KTAS and CFS-KTAS, respectively. A significant difference was observed in the area under the receiver operating characteristic (AUROC) curve between the KTAS and CFS-KTAS. To predict ICU admission, the cutoff score was two for both scales. A significant difference was observed in the AUROC curve between the KTAS and CFS-KTAS. For predicting in-hospital mortality, the cutoff score was two for both scales. A significant difference was observed in the AUROC curve between the KTAS and CFS-KTAS. Conclusions: This study showed that the CFS-adjusted KTAS has a more useful prognostic value than the KTAS alone for predicting hospital outcomes in older patients.

Background: The coronavirus disease 2019 (COVID-19) pandemic has obviously caused a remarkable change in patients’ emergency department (ED) visits; however, data from multicenter studies are lacking. We aimed to present a comprehensive analysis of injury-related ED visits in Republic of Korea before and during the COVID-19 pandemic. Materials and Methods: Data from 23 tertiary hospitals based on Emergency Department-based Injury In-depth Surveillance were used for this retrospective cross-sectional study. A total of 541,515 ED visits (age ≥ 20 years) between 1 January 2018 and 31 December 2020 were included, and the trend of injuries related to motor vehicular accidents, falls, self-harm and suicide, assault, and poisoning were compared between the pre-COVID-19 time period and during the COVID-19 pandemic. Results: In the first year of the COVID-19 period, a decline in the number of ED visits was observed (41,275, 21%) compared to the previous year. Injuries caused by motor vehicles (36,332 in 2019 vs. 27,144 in 2020), falls and slips (61,286 in 2019 vs. 49,156 in 2020), assaults (10,528 in 2019 vs. 8067 in 2020), and poisonings (7859 in 2019 vs. 7167 in 2020) decreased, whereas self-harm and suicide (8917 in 2019 vs. 8911 in 2020) remained unchanged. The hospitalization (16.6% in 2019 vs. 18.8% in 2020) and ED mortality rate (0.6% in 2019 vs. 0.8% in 2020) also increased. Conclusion: The COVID-19 pandemic led to a decline in the overall number of trauma patients seeking medical care; however, the proportion of patients requiring hospitalization or intensive care unit admission increased, indicating more severe injuries among those who did seek care. Suicide attempt rates remained unchanged, highlighting the need for targeted care and support for vulnerable patients. During the pandemic, EDs had to continue to provide care to patients with medical emergencies unrelated to COVID-19, which requires a delicate and adaptable approach to ED operations. To manage the increased stress and workload caused by the pandemic, increased resources and support for healthcare workers were needed.