{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T16:50:24Z","timestamp":1761324624022,"version":"3.41.2"},"reference-count":79,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2025,7,16]],"date-time":"2025-07-16T00:00:00Z","timestamp":1752624000000},"content-version":"vor","delay-in-days":15,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Laboratory-based frailty indices (FI-Labs) offer potential adjuncts and alternatives to clinical assessments. Still, their optimal configuration and construct validity compared with nurse-assessed Clinical Frailty Scale (CFS) scores remain unclear.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In this retrospective cohort study, we evaluated five FI-Lab configurations against nurse-assessed CFS scores using data from 74\u00a0493 emergency department visits. We examined their association with clinical outcomes and assessed measurement reliability using mixed effects models.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>While nurse assessments demonstrated superior outcome discrimination (c-statistic 0.726 for 90-day mortality versus 0.718 for best FI-Lab), automated FI-Lab measures showed significantly greater between-visit reliability [intraclass correlation coefficient (ICC)\u2009=\u20090.51\u20130.76 versus 0.37 for nurse CFS]. The drug-adjusted FI-Lab demonstrated highest reliability (ICC\u2009=\u20090.76) but weaker age associations (\u03b2\u2009=\u20090.002, P\u2009=\u2009.08) compared to other configurations (\u03b2\u2009=\u20090.006\u20130.013, P\u2009&amp;lt;\u2009.001). In complex models adjusting for illness severity, nurse CFS scores showed stronger mortality associations (HR 1.55, 95% CI 1.45\u20131.66 per standard deviation) compared to FI-Lab configurations (HR range 1.19\u20131.29). Notably, all frailty measures showed effect sizes comparable to age (HR range 1.37\u20131.55 per SD).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Automated FI-Lab measures offer a reliability advantage over nurse-assessed CFS scores despite slightly lower predictive validity for mortality. Their comparable effect sizes to age suggest these automated measures capture clinically meaningful patient characteristics. This trade-off between reliability and predictive validity suggests that integrated approaches combining automated screening with targeted clinical assessment may provide optimal frailty identification in emergency settings.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ageing\/afaf192","type":"journal-article","created":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T08:02:40Z","timestamp":1751011360000},"source":"Crossref","is-referenced-by-count":2,"title":["Can laboratory test-based frailty indices contribute to frailty screening in emergency departments?"],"prefix":"10.1093","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6428-0158","authenticated-orcid":false,"given":"Hugh","family":"Logan Ellis","sequence":"first","affiliation":[{"name":"Department of Biostatistics & Health Informatics, Social Genetic and Developmental Psychiatry Centre, King\u2019s College London , Memory Lane, Southwark, London SE5 8AF ,","place":["UK"]},{"name":"Department of Medicine, Dalhousie University , Suite 1421-5955 Veterans\u2019 Memorial Lane, Halifax, Nova Scotia B3H 4R2 ,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4642-9334","authenticated-orcid":false,"given":"Liam","family":"Dunnell","sequence":"additional","affiliation":[{"name":"University Hospital Lewisham , Lewisham, London ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4109-9970","authenticated-orcid":false,"given":"Julie","family":"Whitney","sequence":"additional","affiliation":[{"name":"School of Life Course & Population Sciences, King\u2019s College London , London ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cara","family":"Jennings","sequence":"additional","affiliation":[{"name":"Emergency Department, King\u2019s College Hospital NHS Foundation Trust , London ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dan","family":"Wilson","sequence":"additional","affiliation":[{"name":"Department of Clinical Gerontology, King\u2019s College Hospital NHS Foundation Trust , Denmark Hill, London SE5 9RS ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jane","family":"Tippett","sequence":"additional","affiliation":[{"name":"Emergency Department, King\u2019s College Hospital NHS Foundation Trust , London ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6899-8319","authenticated-orcid":false,"given":"James","family":"Teo","sequence":"additional","affiliation":[{"name":"Neurology Department, King\u2019s College Hospital NHS Foundation Trust , London ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6203-2727","authenticated-orcid":false,"given":"Zina","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Department of Biostatistics & Health Informatics, King\u2019s College London , London ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6674-995X","authenticated-orcid":false,"given":"Kenneth","family":"Rockwood","sequence":"additional","affiliation":[{"name":"Department of Medicine, Dalhousie University , Suite 1421-5955 Veterans\u2019 Memorial Lane, Halifax, Nova Scotia B3H 4R2 ,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,7,16]]},"reference":[{"key":"2025071602212359300_ref1","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1503\/cmaj.050051","article-title":"A global clinical measure of fitness and frailty in elderly people","volume":"173","author":"Rockwood","year":"2005","journal-title":"Can Med Assoc J"},{"key":"2025071602212359300_ref2","doi-asserted-by":"publisher","first-page":"210","DOI":"10.5770\/cgj.23.463","article-title":"Using the Clinical Frailty Scale in allocating scarce health care resources","volume":"23","author":"Rockwood","year":"2020","journal-title":"Can Geriatr J"},{"key":"2025071602212359300_ref3","doi-asserted-by":"publisher","first-page":"2407","DOI":"10.1007\/s11739-022-03042-5","article-title":"Frailty assessment in emergency medicine using the Clinical Frailty Scale: a scoping review","volume":"17","author":"Fehlmann","year":"2022","journal-title":"Intern Emerg Med"},{"key":"2025071602212359300_ref4","doi-asserted-by":"publisher","first-page":"868","DOI":"10.1136\/emermed-2019-208633","article-title":"Agreement and predictive value of the Rockwood Clinical Frailty Scale at emergency department triage","volume":"38","author":"Shrier","year":"2021","journal-title":"Emerg Med J"},{"key":"2025071602212359300_ref5","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afaf093","article-title":"What can we learn from 68,000 Clinical Frailty Scale scores? 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