Comparison of predictability on adverse events among different assessment tools in elderly discharged inpatients

Objective To investigate the predictability on adverse events(re-hospitalization and death)in elderly discharged inpatients among frailty phenotype(FP), frail scale(FS)and clinical frailty scale(CFS), in order to screen the simple and feasible frailty assessment tools for elderly discharged inpatients. Methods Elderly discharged inpatients aged 65 years and over were recruited for this prospective cohort study.And they underwent frailty assessment by using FP, FS and CFS, respectively.Patients were followed up for more than 6 months after discharge, and adverse events including re-hospitalization or death after discharge were recorded.Cox regression model was adopted to evaluate the relationship between frailty and death or re-hospitalization.Predictive effects of three assessment methods on adverse events were compared by using receiver operating characteristic(ROC). Results A total of 527 elderly patients aged(84.1±6.0)years with males of 61.9%(326/527)were successfully followed up.The detection rate of frailty by FP and FS evaluation tools was 26.0%(137/527)and 26.0%(137/527), respectively.The detection rate of moderate and severe frailty by CFS was 25.2%(133/527). The Cox regression model showed that the mortality was significantly higher in frailty patients by FP, FS, and CFS than in the non-frailty patients(HR=3.72, 2.95 and 3.90, P=0.017, 0.016 and 0.002)after adjusting for age, smoking, co-morbidity and other variable; and that the re-hospitalization rate was significant higher in frailty patients by FP and CFS than in the non-frailty patients(HR=1.81 and 1.69, P=0.000 and 0.002). The areas under the receiver operating characteristic curve(AUC)of FP, FS and CFS for predicting death and re-hospitalization were 0.691, 0.645, 0.728 on death, and 0.570, 0.579, 0.602 on re-hospitalization(all P<0.01), respectively. Conclusions All three assessment tools of FP, FS and CFS have predictive effects on death in elderly inpatients with frailty, and CFS has better predictive effect than the other two tools.But FP, FS and CFS have poor predictive effect on re-hospitalization. Key words: Frailty; Risk assessment; Death; Patient readmission