• Carmen S van Dam, Marijke C Trappenburg, Marieke M Ter Wee, Emiel O Hoogendijk, Riekie de Vet, Yvo M Smulders, Prabath B Nanayakkara, Majon Muller, and Mike L Peters.
• Department of Internal Medicine and Geriatrics, Amsterdam Cardiovascular Sciences research institute, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands. Electronic address: c.vandam@amsterdamumc.nl.
• Ann Emerg Med. 2022 Nov 1; 80 (5): 422431422-431.

Study ObjectiveTo compare the prognostic accuracy of clinical judgment for frailty in older patients at the emergency department with a validated screening instrument and patient-perceived frailty.MethodsA prospective cohort study in patients 70 years of age and older in 2 Dutch EDs with a follow-up of 3 months. A dichotomous question was asked to the physician and patient: "Do you consider the patient / yourself to be frail?" The Identification of Seniors At Risk-Hospitalized Patients (ISAR-HP) was used as a validated screening instrument. The primary composite outcome consisted of either functional decline, institutionalization, or mortality.ResultsA total of 736 patients were included. The physician identified 59% as frail, compared with 49% by ISAR-HP and 43% by patients themselves. The level of agreement was fair (Fleiss Kappa, 0.31). After 3 months, 31% of the patients experienced at least 1 adverse health outcome. The sensitivity was 79% for the physician, 72% for ISAR-HP, 61% for the patient, and 48% for all 3 combined. The specificity was 50% for the physician, 63% for ISAR-HP, 66% for the patient, and 85% for all 3 positive. The highest positive likelihood ratio was 3.03 (physician, ISAR-HP, patient combined), and the lowest negative likelihood ratio was 0.42 (physician). The areas under the receiver operating curves were all poor: 0.68 at best for ISAR-HP.ConclusionClinical judgment for frailty showed fair agreement with a validated screening instrument and patient-perceived frailty. All 3 instruments have poor prognostic accuracy, which does not improve when combined. These findings illustrate the limited prognostic value of clinical judgment as a frailty screener in older patients at the ED.Copyright © 2022 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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