Assessing the Efficacy of the Modified SEGA Frailty (mSEGA) Screening Tool in Predicting 12-Month Morbidity and Mortality among Elderly Emergency Department Visitors

Abstract

Introduction: Rapid identification of frail elderly individuals upon admission to the emergency department is pivotal for enhancing their care and alleviating emergency room congestion. Objective: This pilot study aims to explore the relationship between morbidity, mortality, and frailty, as assessed by the mSEGA scale, among individuals aged 65 years or older in the emergency department. Methods: A retrospective cohort study was conducted at a single center. The pilot study included patients aged 65 and above who were admitted to Chaumont Hospital’s emergency unit (Haute-Marne department) for medical and/or surgical reasons between 1 July 2017 and 31 January 2018. Data encompassed socio-demographic characteristics, medical profiles, and emergency department visit details. Outcomes for patients one year post-admission were obtained through consultation with their respective general practitioners. Results: A total of 255 subjects participated, with a mean age of 82.1 ± 8.2 years. Primary admission reasons were falls (n = 51, 20.0%), digestive issues (excluding hemorrhage) (n = 30, 11.8%), and “other” causes (n = 61, 23.9%). Among participants, 78 (30.6%) scored ≤8 on the mSEGA frailty scale, 49 (19.2%) scored 9 to 11, and 125 (50.2%) scored ≥12. Concerning post-emergency department outcomes, 152 patients (59.6%) were hospitalized, while 103 (40.4%) were discharged. No deaths were reported during the study period, and vital status was known for all subjects at the one-year mark. At that point, 63 out of 255 patients had passed away, with 30 of them being readmitted to the emergency department either before or at the time of their one-year death. The 12-month survival rate analysis based on frailty status revealed a significant difference. Low-frailty patients exhibited a survival rate of 87.2% (95% CI; [77.5–92.9]), whereas frail/very frail patients had a survival rate of 70.0% (95% CI; [62.7–76.2]). Similarly, the 12-month readmission-free survival rate demonstrated statistically significant disparities. Low-frailty patients had a rate of 76.9% (95% CI; [65.9–84.8]), compared to 51.4% (95% CI; [43.8–58.5]) for very frail patients. Conclusion: Utilizing the mSEGA frailty scale in the Emergency Department could provide crucial prognostic insights, highlighting significant differences in 12-month survival and readmission-free survival rates based on frailty status.