Emergency department attendance stratified by cause and frailty status: A national retrospective cohort study

Sokhal, Balamrit Singh; Matetić, Andrija; Protheroe, Joanne; Helliwell, Toby; Myint, Phyo K.; Paul, Timir K.; Mallen, Christian D.; Mamas, Mamas A.

Abstract

Aim: The aim of this study was to determine 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 (aORs) and 95% confidence intervals (95% CIs) 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‐HFRS attendances had increased overall mortality (combined ED and in‐hospital) across most attendance causes, compared with their low‐risk counterparts (P < 0.001). High‐HFRS attendances with infectious diseases, CVD, and respiratory diseases had an increased risk of overall mortality, compared with 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 the 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. Geriatr Gerontol Int 2025; ••: ••–••.

Citation

Sokhal, B. S., Matetić, A., Protheroe, J., Helliwell, T., Myint, P. K., Paul, T. K., Mallen, C. D., & Mamas, M. A. (in press). Emergency department attendance stratified by cause and frailty status: A national retrospective cohort study. Geriatrics and Gerontology International, https://doi.org/10.1111/ggi.70153

• Journal Article Type: Article
• Acceptance Date: Aug 16, 2025
• Online Publication Date: Aug 28, 2025
• Deposit Date: Sep 1, 2025
• Journal: Geriatrics & Gerontology International
• Print ISSN: 1444-1586
• Electronic ISSN: 1447-0594
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1111/ggi.70153
• Keywords: emergency department, risk factors, frailty, outcomes, mortality
• Public URL: https://keele-repository.worktribe.com/output/1372421
• Publisher URL: https://onlinelibrary.wiley.com/doi/10.1111/ggi.70153