Routine frailty screening may help predict risk for poor outcomes in critically ill patients

In a study of 175 ICUs in Australia and New Zealand, patients who were frail at ICU admission had an in-hospital mortality rate of 16% compared to 5% in those who were not. Frail patients also had longer lengths of stay in the ICU and hospital.

Frailty screening on a population level at ICU admission may help predict which patients are likely to have negative outcomes, according to a recent study in Australia and New Zealand.

Researchers performed a prospective cohort study of critically ill adult patients admitted between July 1, 2018, and June 30, 2020, to 175 ICUs in Australia and New Zealand. Frailty at ICU admission was classified according to the 9-point Clinical Frailty Scale (higher scores indicate greater frailty). The study's primary outcome was in-hospital mortality, while secondary outcomes were length of stay, discharge destination, complications (delirium, pressure injury), and duration of survival. The study results were published June 2 by Chest.

Overall, 234,568 critically ill patients with complete frailty data were included in the study. Of these, 45,245 (19%) were determined to have frailty before ICU admission. Rates of in-hospital mortality (16% vs. 5%) and delirium (10% vs. 4%) were higher in patients with frailty than in those without (P<0.001 for both comparisons). Patients with frailty also had longer length of stay in the ICU and hospital and were more likely to be discharged to a new chronic care facility (3% vs. 1%; P<0.001). In patients with very severe frailty versus patients classified as very fit at admission, 39% versus 2% died in the hospital (odds ratio, 7.83 [95% CI, 6.39 to 9.59]; P<0.001). Frailty remained highly significantly predictive of mortality after adjustment for illness severity, including in patients younger than age 50 years.

The authors noted that some frailty scores were missing and that method of frailty assessment (i.e., record review or patient/surrogate interview) was not recorded. They concluded that it is possible to perform large-scale population screening for degree of frailty in critically ill patients and that doing so can help predict prognosis, since outcomes appear to be worse in patients with a Clinical Frailty Scale score of 6 or greater. This higher-risk group, once identified, can be targeted for future potential interventions, the authors wrote.