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SARC-F at the Emergency Department: Diagnostic Performance for Frailty and Predictive Performance for Reattendances and Acute Hospitalizations

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The journal of nutrition, health & aging

Abstract

Objectives

Sarcopenia is associated with adverse health outcomes including mortality, functional loss, falls, and poorer quality of life. However, the value of screening sarcopenia at the Emergency Department (ED) remains unclear. We aimed to examine the SARC-F questionnaire for its (1) diagnostic ability in identifying frailty, and (2) predictive ability for adverse health outcomes.

Design

A secondary analysis of a quasi-experimental study. Setting: An ED within a 1700-bed tertiary hospital.

Participants

ED patients aged ≥85 years (mean age 90.0 years) recruited into the Emergency Department Interventions of Frailty (EDIFY) study.

Measurements

Data of demographics, premorbid function, frailty status [Frailty Index (FI), Clinical Frailty Scale (CFS), FRAIL], comorbidities, medications, and cognitive status were gathered. We also captured outcomes of mortality, acute hospitalization, and ED reattendance at 3-, and 6-month. We then compared area under the operating characteristic curves (AUCs) for the abovementioned measures against the FI (reference) for diagnosis of frailty. Lastly, we performed univariate analyses and logistic regression to compare SARC-F and other measures against the adverse outcomes of interest. RESULTS: Amongst the various instruments, the SARC-F (AUC 0.92, 95% Confidence Interval (CI) 0.86-0.98, P<0.001; Sensitivity 79.0%, and Specificity 88.9%) performed best for frailty detection as defined by FI. Optimal cutoff was ≥3 (Sensitivity 91.4%, Specificity 83.3%, and Negative Predictive Value 68.2%). Only SARC-F was predictive of acute hospitalization [Adjusted Odds Ratio (OR) 4.00, 95% CI 1.47-10.94, P=0.007] and ED-reattendance [Adjusted OR 3.29, 95% CI 1.26-8.56, P=0.015] at 3-month.

Conclusions

The SARC-F demonstrated excellent diagnostic ability for frailty detection and predictive validity for ED reattendance and acute hospitalization at 3 months. Lowering cutoff score to ≥3 may improve case-finding at the ED to facilitate early identification and management of sarcopenia. Further studies are required to validate the diagnostic and predictive performance of SARC-F at ED settings.

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Acknowledgments

The authors wish to express their gratitude to the staff of the Emergency Department of Tan Tock Seng Hospital for their unwavering support in the EDIFY program. We also thank the staff of the Institute of Geriatrics and Active Ageing and the Health Services and Outcomes Research for ensuring the quality and integrity of the study were upheld at all times. Last but not least, we thank Ms B.Y. Ooi, Ms A. Ho, and Ms Y.C. Yeoh for playing a vital role in the success of the EDIFY program.

Funding

This work was supported by the Ng Teng Fong Healthcare Innovation Programme [Project Code: NTF_JUL2017_I_C2_CQR_02], National Healthcare Group, Singapore. The sponsor had no role in the design and conduct of the study; in the collection, analysis, and interpretation of data; in the preparation of the manuscript; or in the review or approval of the manuscript.

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Authors and Affiliations

  1. Department of Geriatric Medicine & Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore, Singapore

    Edward Chong, M. Bao & W. S. Lim

  2. Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore

    Edward Chong, E. F. Goh & W. S. Lim

Authors
  1. Edward Chong
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  2. M. Bao
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  3. E. F. Goh
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  4. W. S. Lim
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Corresponding author

Correspondence to Edward Chong.

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Ethics approval was granted by the Domain Specific Review Board of the National Healthcare Group, Singapore (DSRB reference 2017/01076).

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All authors declare no conflicts of interest.

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Chong, E., Bao, M., Goh, E.F. et al. SARC-F at the Emergency Department: Diagnostic Performance for Frailty and Predictive Performance for Reattendances and Acute Hospitalizations. J Nutr Health Aging 25, 1084–1089 (2021). https://doi.org/10.1007/s12603-021-1676-5

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  • DOI: https://doi.org/10.1007/s12603-021-1676-5

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