Abstract
Background: Data are limited on whether the causes of Emergency Department (ED) attendance and clinical outcomes vary by frailty status.
Methods: Using the Nationwide ED Sample, causes of attendance were stratified by Hospital Frailty Risk Score (HFRS). Logistic regression was used to determine adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) of ED and overall mortality.
Results: A total of 155,497,048 ED attendances were included, of which 125,809,960 (80.9%) had a low HFRS (<5), 27,205,257 (17.5%) had an intermediate HFRS (5-15) and 2,481,831 (1.6%) had a high HFRS (>15). The most common cause of ED attendance in the high HFRS group was infectious diseases (43.0%), followed by cardiovascular diseases (CVD) (24.0%) and respiratory diseases (10.2%). For the low HFRS group musculoskeletal disease was the most common cause (21.2%) followed by respiratory diseases (20.6%), and gastrointestinal diseases (18.5%). On adjusted analysis, high-risk patients had overall mortality (combined ED and in-hospital) across most attendance causes, compared to their low-risk counterparts (p<0.001). High HFRS patients with infectious diseases, CVD and respiratory diseases had an increased risk of overall mortality, compared to their low-risk counterparts (aOR 23.88 95% CI 23.42-24.34 for the infectious disease cohort, aOR 2.58 95% CI 2.55-2.61 for the CVD cohort and aOR 36.90 95% CI 36.18-37.62 for respiratory disease cohort).
Conclusions: Frailty is present in a significant proportion of ED attendances, with the cause varying by frailty status. Frailty is associated with decreased ED and increased overall mortality across most attendance causes.