PROGNOSTIC ACCURACY OF FRAILTY & VULNERABILITY SCREENING IN OLDER ED PATIENTS - A SYSTEMATIC REVIEW & META-ANALYSIS

Sep 29, 2026

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Frailty in older adults is linked to higher mortality and morbidity, creating a need for effective emergency department (ED) screening; however, the best prognostic instrument remains unclear. This systematic review asks which frailty and vulnerability screening tool shows the highest prognostic accuracy for adverse outcomes in older ED patients. Included studies enrolled patients aged ≥60, used validated instruments, and reported sensitivity, specificity, and AUC. Searches ran through January 25, 2025, using MEDLINE, EMBASE, Cochrane, CINAHL, and CNKI, with quality assessed by QUIPS. Across 62 studies and 40 instruments, most tools had high sensitivity but low specificity. Meta-analysis was feasible for ISAR and TRST, with ISAR showing higher AUC for in-hospital mortality than for ED revisits. ED frailty screening tools demonstrate sensitivity-limited specificity, restricting clinical utility. Future research should improve specificity by adding domains beyond geriatric conditions and incorporating established prognostic indicators in large studies.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Purpose and research question

Eligibility criteria and outcomes

Search strategy and study quality

Instruments used and overall findings

Sensitivity vs specificity pattern

Meta-analysis results for ISAR and TRST

Implications and future directions

Innovation in Aging, 2025, Vol. 9, No. S2 697 Abstract citation ID: igaf122.2378 PROGNOSTIC ACCURACY OF FRAILTY & VULNERABILITY SCREENING IN OLDER ED PATIENTS: A SYSTEMATIC REVIEW & META-ANALYSIS Nai-Wen Ku1, Yu-Chi Hsu2, Jasmine Mudhur1, Lusine Abrahamyan1, Chu-Lin Tsai2, Alibhai Shabbir3, and Martine Puts1, 1. University of Toronto, Toronto, Ontario, Canada, 2. National Taiwan University Hospital, Taipei, Taipei, Taiwan (Republic of China), 3. University Health Network, Toronto, Ontario, Canada Frailty is associated with increased mortality and morbidity in older adults, highlighting the need for effective screening in emergency departments (EDs) . However, the optimal tool for predicting adverse outcomes remains uncertain. Therefore, our review’s question is: which frailty and vulnerability screening instrument has the highest prognostic accuracy for adverse outcomes in older adults visiting EDs? Studies were eligible for inclusion if they included patients aged ≥60 admitted to the ED, used frailty or vulnerability instruments, and reported sensitivity, specificity, and area under the curve (AUC) . Databases searched until January 25, 2025, included MEDLINE, EMBASE, Cochrane Library, CINAHL, and CNKI. Study quality was assessed using 698 Innovation in Aging, 2025, Vol. 9, No. S2 the updated Quality in Prognosis Studies (QUIPS) tool. Two investigators independently reviewed abstracts and full-texts. A meta-analysis was conducted for tools with consistent cutoffsin ≥ 4 studies. Sixty-seven papers described 62 studies using 40 screening instruments. The Identification of Seniors at Risk (ISAR) was the most frequently used (n = 25), followed by the Clinical Frailty Scale (CFS) (n = 15) and the Triage Risk Screening Tool (TRST)(n = 11) . Most instruments showed high sensitivity but low specificity. Meta-analysis was feasible for ISAR and TRST. ISAR’s pooled sensitivity, specificity, and AUC for in-hospital mortality were 92%(95% CI, 88-95), 26%(95% CI, 21-33), and 0.82. For ED revisits, ISAR’s AUC was 0.64, while TRST’s was 0.60. Frailty screening instruments in EDs exhibit high sensitivity but low specificity, limiting clinical utility. Future research should enhance specificity by incorporating domains beyond geriatric conditions and known prognostic indicators into frailty instruments in large-scale studies.

FAQs

Which frailty or vulnerability screening tools were most commonly used in the included studies?

The Identification of Seniors at Risk (ISAR) was most frequently used (n=25), followed by the Clinical Frailty Scale (CFS) (n=15) and the Triage Risk Screening Tool (TRST) (n=11).

What overall performance pattern did most screening instruments show?

Most instruments demonstrated high sensitivity but low specificity, which limits practical clinical usefulness.

For which tools was meta-analysis feasible, and what were the key AUC findings for ED revisits?

Meta-analysis was feasible for ISAR and TRST. For ED revisits, ISAR’s AUC was 0.64 and TRST’s AUC was 0.60.

Sep 29, 2026

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