Rendimiento de tres escalas de fragilidad para predecir resultados adversos a 30 días en los pacientes mayores dados de alta en los servicios de urgencias

Cesáreo Fernández Alonso1, Carmen Del Arco Galán2, Raquel Torres Garate3, José Fernando Madrigal Valdés4, Rodolfo Romero Pareja5, Carlos Bibiano Guillén6, Belén Rodríguez Miranda7, Martín S. Ruiz Grinspan8, Sonia Gutiérrez Gabriel9, Ana Del Rey Ubago2, Manuel E. Fuentes Ferrer10, Francisco Javier Martín-Sánchez1, en representación del Registro Frail-ED-Madrid.

Affiliation of the authors

1Emergency Department, Hospital Universitario Clínico San Carlos, Madrid, Spain. 2Emergency Department, Hospital Universitario de la Princesa, Madrid, Spain. 3Emergency Department, Severo Ochoa University Hospital, Leganés, Madrid, Spain. 4Emergency Department, Hospital de El Escorial, El Escorial, Madrid, Spain. 5Emergency Department, Hospital Universitario de Getafe, Madrid, Spain. 6Emergency Department, Hospital Universitario Infanta Leonor, Madrid, Spain. 7Emergency Department, Hospital Universitario Rey Juan Carlos, Madrid, Spain. 8Emergency Department, Hospital Universitario del Henares, Coslada, Madrid, Spain. 9Emergency Department, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain. 10Research Unit, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain.



Fernández Alonso C, Del Arco Galán C, Torres Garate R, Madrigal Valdés JF, Romero Pareja R, Bibiano Guillén C, et al. Performance of 3 frailty scales for predicting adverse outcomes at 30 days in older patients discharged from emergency departments. Emergencias. 2023;35:196-204



To compare the ability of 3 frailty scales (the Clinical Frailty Scale [CFS], the Functional Index – eMergency [FIM], and the Identification of Seniors at Risk [ISAR] scale) to predict adverse outcomes at 30 days in older patients discharged from hospital emergency departments (EDs).


Secondary analysis of data from the FRAIL-Madrid registry of patients aged 75 years or older who were discharged from Madrid EDs over a period of 3 months in 2018 and 2019. Frailty was defined by a CFS score over 4, a FIM score over 2, or an ISAR score over 3. The outcome variables were revisits to an ED, hospitalization, functional decline, death, and a composite variable of finding any of the previously named variables within 30 days of discharge.


A total of 619 patients were studied. The mean (SD) age was 84 (7) years, and 59.1% were women. The CFS identified as frail a total of 339 patients (54.8%), the FIM 386 (62.4%), and the ISAR 301 (48.6%). An adverse outcome occurred within 30 days in 226 patients (36.5%): 21.5% revisited, 12.6% were hospitalized, 18.4% experienced functional decline, and 3.6% died. The areas under the receiver operating characteristic curves were as follows: CFS, 0.66 (95% CI, 0.62-0.70; P = .022); FIM, 0.67 (95% CI, 0.62-0.71; P = .021), and ISAR, 0.64 (95% CI, 0.60-0.69; P = .023). Adjusted odds ratios (aOR) showed that frailty was an independent risk factor for presenting any of the named adverse outcomes: aOR for CFS >4, 3.18 (95% CI, 2.02-5.01), P < .001; aOR for FIM > 2, 3.49 (95% CI, 2.15-5.66), P < .001; and aOR for ISAR >3, 2.46 (95% CI, 1.60-3.79), P < .001.


All 3 scales studied — the CFS, the FIM and the ISAR — are useful for identifying frail older patients at high risk of developing an adverse outcome (death, functional decline, hospitalization, or revisiting the ED) within 30 days after discharge.


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