
==== Front
Clin Interv Aging
Clin Interv Aging
cia
Clinical Interventions in Aging
1176-9092
1178-1998
Dove

490961
10.2147/CIA.S490961
Letter
The Clinical Frailty Scale is the Significant Predictor for in-Hospital Mortality of Older Patients in the Emergency Department [Letter]
Wu and Shen
Wu and Shen
Wu Ji 1
Shen Xiping 1
1 Department of General Surgery, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu Province, People’s Republic of China
Correspondence: Xiping Shen, Department of General Surgery, Suzhou Ninth Hospital Affiliated to Soochow University, Ludang Road, Wujiang District, Suzhou, Jiangsu Province, 2666, People’s Republic of China, Tel +86 0512-82881248, Email shenxiping2022@163.com
04 9 2024
2024
19 15071508
10 8 2024
02 9 2024
© 2024 Wu and Shen.
2024
Wu and Shen.
https://creativecommons.org/licenses/by-nc/3.0/ This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
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pmcDear editor

We have read a recent article titled “The Association Between Frailty Evaluated by Clinical Frailty Scale and Mortality of Older Patients in the Emergency Department: A Prospective Cohort Study”, with great interest.1 This study is significant, as it provides insights into the factors that predict adverse outcomes in older patients in the emergency department (ED). This article highlights the importance of the Clinical Frailty Scale (CFS) score. These findings have important implications for early prediction of unfavorable outcomes in the older ED population. While recognizing the value of this study, we would like to make the following comments.

Firstly, although the logistic regression model is widely acknowledged for its utility, it may inadvertently lead to risk overestimation in scenarios beset with potential competing risks. Consequently, for the mortality risk assessment explored in this paper, especially when systemic diseases (such as heart failure and pulmonary edema) are potentially interrelated, employing a competing risks model appears more fitting. Traditional survival analysis techniques might not adequately account for the influence of secondary events on the primary study outcome, whereas the competing risks model affords a more holistic analytical viewpoint.2

Secondly, the authors’ inclusion of important information such as demographic information and laboratory tests to adjust for potential covariates is commendable. However, we suggest a further expansion of the scope of covariates such as Charlson Comorbidity Index.3 Additionally, factors such as organ failure assessment and physical activity should also be considered for a more comprehensive assessment of the stability and reliability of the results.4

Last but not least, this article primarily explores the relationship between the CFS score and clinical outcome. Considering previous studies on the delays to admission from ED and in-hospital mortality, conducting subgroup analyses might enhance the applicability and universality of these findings.5 Furthermore, recommending stratified analyses for patients with complications could deepen the understanding and evaluate the impact of these factors on research outcomes.

Disclosure

The authors declare no potential conflicts of interest in this communication.
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References

1. Lin JW, Lin PY, Wang TY, et al. The association between frailty evaluated by clinical frailty scale and mortality of older patients in the emergency department: a prospective cohort study. Clin Interv Aging. 2024;19 :1383–1392.39081832
2. Damen JA, Hooft L, Schuit E, et al. Prediction models for cardiovascular disease risk in the general population: systematic review. BMJ. 2016;353 :i2416.27184143
3. Charlson ME, Carrozzino D, Guidi J, et al. Charlson comorbidity index: a critical review of clinimetric properties. Psychoth Psychosom. 2022;91 (1 ):8–35. doi:10.1159/000521288
4. Moreno R, Rhodes A, Piquilloud L, et al. The Sequential Organ Failure Assessment (SOFA) Score: has the time come for an update? Critical Care. 2023;27 (1 ):15. doi:10.1186/s13054-022-04290-9 36639780
5. Jones S, Moulton C, Swift S, et al. Association between delays to patient admission from the emergency department and all-cause 30-day mortality. Emerg Med J. 2022;39 (3 ):168–173. doi:10.1136/emermed-2021-211572 35042695
