Does the Clinical Frailty Scale at Triage Predict Outcomes From Emergency Care for Older People?

STUDY OBJECTIVE: We determine whether the Clinical Frailty Scale applied at emergency department (ED) triage is associated with important service- and patient-related outcomes. METHODS: We undertook a single-center, retrospective cohort study examining hospital-related outcomes and their associations with frailty scores assessed at ED triage. Participants were aged 65 years or older, registered on their first ED presentation during the study period at a single, centralized ED in the United Kingdom. Baseline data included age, sex, Clinical Frailty Scale score, National Early Warning Score-2 and the Charlson Comorbidity Index score; outcomes included length of stay, readmissions (any future admissions), and mortality (inhospital or out of hospital) up to 2 years after ED presentation. Survival analysis methods (standard and competing risks) were applied to assess associations between ED triage frailty scores and outcomes. Unadjusted incidence curves and adjusted hazard ratios are presented. RESULTS: A total of 52,562 individuals representing 138,328 ED attendances were included; participants' mean age was 78.0 years, and 55% were women. Initial admission rates generally increased with frailty. Mean length of stay after 30- or 180-day follow-up was relatively low; all Clinical Frailty Scale categories included patients who experienced zero days' length of stay (ie, ambulatory care) and patients with relatively high numbers of inhospital days. Overall, 46% of study participants were readmitted by the 2-year follow-up. Readmissions increased with Clinical Frailty Scale score up until a score of 6 and then attenuated. Mortality rates increased with increasing frailty; the adjusted hazard ratio was 3.6 for Clinical Frailty Scale score 7 to 8 compared with score 1 to 3. CONCLUSION: Frailty assessed at ED triage (with the Clinical Frailty Scale) is associated with adverse outcomes in older people. Its use in ED triage might aid immediate clinical decisionmaking and service configuration.

Cough syncope whilst driving - An unusual yet serious presentation.

Cough is a common symptom of cardiorespiratory pathology, yet its vasomotor effects are underappreciated. We report a case of a 45-year-old male who had a Cough Syncopal event resulting in a road traffic collision. Although he was unhurt and fully recovered, we believe there is need for greater understanding of this unusual sequence of events.

Mesenteric angina through superior mesenteric venous thrombosis.

We present the case of a 67-year-old male with mesenteric venous thrombosis resulting in mesenteric angina, where early diagnosis made a favourable outcome possible through prompt anticoagulation and bowel rest. Mesenteric venous thrombosis is a relatively rare but important cause of bowel ischaemia, as a delay in diagnosis is associated with high morbidity and mortality. Early diagnosis through computed tomography scanning and subsequent treatment resulted in resolution of the thrombus with no long term sequelae.