FrailtyNCT06869148
Evaluation of Prioritized Assessment for Older Patients Living With Frailty Presenting to the Emergency Department
An observational study of Frailty and Length of Stay, run by University Hospital, Linkoeping at 1 site in Sweden.
Trial summary
The older population is getting older and growing in size worldwide. This requires healthcare to adapt to meet the complex medical and nursing needs of the older patient group. As older patients have varying health conditions with different levels of functions, their premise to handle acute, unexpected illness differs… Read more about this study
- Who is it for?
- Ages 65 years and olderHealthy volunteers can take part
- Conditions the study is for
- Frailty, Length of Stay, Emergency Department Visit
- What is being tested?
- Prioritized assessment for older patients living with frailty
- How many people
- 1,217 participants
- Where
- 1 siteSweden
- Study dates
- 27 Jan 2025to 31 Jul 2025
- Phase
- Observational
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 65 years and older
- All sexes
- Healthy volunteers accepted
- Older adult
Study population: Patients visiting the ED in Linköping in the age of 65 years or older who have been assessed by CFS
Who may be able to join
- 65 years of age or older
- Assessed by CFS with the score being documented in the electronic journal
Who cannot join
- Under the age of 65 years of age
- Not assessed by CFS
- Refusal of participation in the study
Trial locations and contacts
1 site in 1 country.
Sweden1 site
Department of Emergency Medicine, University hospital
Linköping, Östergötland County, 581 85
About this study
The older population is getting older and growing in size worldwide. This requires healthcare to adapt to meet the complex medical and nursing needs of the older patient group. As older patients have varying health conditions with different levels of functions, their premise to handle acute, unexpected illness differs as well. This complicates matters for healthcare, especially emergency departments (ED) where resource allocation and identifying patients that are at greatest risk of negative health outcomes must be prioritized in a limited time.
When patients present to the ED, initial triage information such as vital signs and reason for visit determines the triage acuity for the patient. In Linköping, and large parts of Sweden, the triage tool RETTS (Rapid Emergency Triage and Treatment System) is used, where the highest priority is red (priority 1), then orange (priority 2), yellow (priority 3), green (priority 4) and blue (priority 5). However, this can be misleading when assessing older patients due to altered physiology with natural ageing and older patients are known to be under-triaged with existing triage systems.
Read more
The variation in functional capacity in older patients does not necessarily correlate with comorbidities and age and has been condensed to the term 'frailty'. It has been proposed that the frailty level corresponds more to biological age rather than chronological age. Frailty increases the risk of adverse outcomes such as falls, the need of in-hospital care, institutionalization, and mortality in which the risk is increased even in low acuity illnesses.
Frailty can be assessed by various means and based on the theory of cumulative deficit, frailty assessment instruments have been developed where frailty level increases with the amount of help needed from others. Different instruments have been compared in the ED and the Clinical Frailty Scale (CFS) have been deemed fit due to it being practical in a busy environment. The scale consists of 9 points where 9 is the highest level of frailty and the scale is usually dichotomized into "robust" and "living with frailty" where 5 points or above constitutes frailty. The prognostic value of CFS has previously been studied in the ED of University hospital of Linköping in Sweden with results indicating that the instrument should be used as an additional risk assessment in the ED.
Older patients often present with vague and complex symptoms to th ED, which could lead to prolonged ED stay due to the need of extensive medical workup or therapy. Long ED stays have been shown to increase both morbidity and mortality in older patients as well as risk of delirium and complications relating to care, especially in individuals living with frailty. In order to decrease the adverse events, aim to shorten ED length of stay (ED LOS) should therefore be a reasonable goal in clinical improvement work. Early identification of frailty in the ED may lead to rapid assessments and streaming of care for older patients which have shown to statistically significantly decrease ED LOS, which is why an early assessment by a physician potentially could decrease overall ED LOS. However, it is unknown how early assessed frailty could affect the ED visit itself.
In the beginning of 2025, the Emergency department of University hospital of Linköping launched a local guideline which recommended that patients aged 65 years or older visiting the ED should be assessed with CFS as early as possible, preferably in connection to triage. If the patients were assessed as living with frailty, the frailty score should be stated in the electronical overview of ED patients. The patient's needs of care should be induvidualized according to frailty level and the responsible clinical team should aim to decrease the ED length of stay for older patients living with frailty.
This study focuses on the outcomes of this newly implemented routine and aims to answer if recommended prioritization of older ED patients living with frailty leads to decreased ED LOS. Furthermore the study investigates if the clinical guidelines have an impact on time to the first assessment by a physician, admission rate, in-hospital length of stay, and mortality at 90 days
- Conditions
- Frailty, Length of Stay, Emergency Department Visit, Older Patients
- Being tested
- Prioritized assessment for older patients living with frailty
- Keywords
- Clinical frailty scale, CFS, Frailty assessment, Triage, Emergency department, Length of stay, physician prioritization, physician prioritisation
- Medical subject headings
- Frailty, Emergencies
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Prioritized assessment for older patients living with frailtyOther
Also called Local guidelines regarding frailty in the Emergency Department
In the beginning of 2025, the Emergency department of University hospital of Linköping launched a clinical guideline which stated that patients aged 65 years or older should be assessed with CFS as early as possible, preferably in connection to triage. If the patients were assessed as living with frailty, the frailty score should be stated in the electronical overview of ED patients. The patient's needs of care should be met according to frailty level and the responsible clinical team should aim to decrease the ED length of stay for older patients living with frailty.
| Study group | Role | What they receive |
|---|---|---|
| Control group | Patients aged 65 years or older visisting the ED who have been assessed for frailty. The control group were included before implementation of the local guidelines. | |
| Intervention group | Patients aged 65 years or older visisting the ED who have been assessed for frailty. The intervention group were included after the implementation of the local guidelines. Receives: Other: Prioritized assessment for older patients living with frailty |
What is being measured
The primary outcome is the main question the study is designed to answer.
ED length of stay
Length of stay in the ED measured in hours and minutes (data will be collected from the electronic health record)
Measured: From enrollment until end of inclusion, approximately 4-8 weeks for each group
Secondary outcomes (5)
Time to the first assessment by a physician
Time to the first assessment by a physician (measured in minutes)
Measured: From enrollment until end of inclusion, approximately 4 weeks for each group
Admission rate
Proportion of patients in each group that were admitted, measured in amount of patients and percentage.
Measured: From enrollment until end of inclusion, approximately 4-8 weeks for each group
In-hospital length of stay
Length of in-hospital stay, measured in days.
Measured: From enrollment until end of inclusion, approximately 4-8 weeks for each group
Mortality up to 90 days
Proportion of patients who deceased up to 90 days post ED-visit, including mortality at ED and in-hospital mortality. Measured in amount of patients and percentage.
Measured: From enrollment until end of inclusion, approximately 4-8 weeks for each group
Difference in ED length of stay between patients in different triage categories
Difference in ED length of stay between patients in different triage categories, measured in hours and minutes. The triage categories are: Red (priority 1), orange (priority 2), yellow (priority 3), green (priority 4), and blue (priority 5).
Measured: From enrollment until end of inclusion, approximately 4-8 weeks for each group
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted11 Mar 2025
- Study start27 Jan 2025
- Primary completion31 Jul 2025
- Study completion31 Jul 2025
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (3)Papers the sponsor has linked to this study.
- Other trials for FrailtyStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Retrospective
- Enrolment
- 1,217 participants (actual)
Sponsor and investigators
- Lead sponsor
- University Hospital, Linkoeping
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Daniel Wilhelms, University Hospital, Linkoeping
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06869148
- Sponsor's protocol ID
- 2024-05740-01
- Status last verified
- Mar 2025
- First submitted
- 3 Mar 2025
- Last updated
- 26 Aug 2025
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Undecided
Publications
Wretborn J, Munir-Ehrlington S, Horlin E, Wilhelms DB. Addition of the clinical frailty scale to triage tools and early warning scores improves mortality prognostication at 30 days: A prospective observational multicenter study. J Am Coll Emerg Physicians Open. 2024 Sep 9;5(5):e13244. doi: 10.1002/emp2.13244. eCollection 2024 Oct.
PubMed 39253302Munir Ehrlington S, Horlin E, Toll John R, Wretborn J, Wilhelms D. Frailty is associated with 30-day mortality: a multicentre study of Swedish emergency departments. Emerg Med J. 2024 Aug 21;41(9):514-519. doi: 10.1136/emermed-2023-213444.
PubMed 39053972Ehrlington SM, Wretborn J, Wilhelms D. Frailty Alerts Reduce Waiting Time and Length of Stay in the Emergency Department. Acad Emerg Med. 2026 Feb;33(2):e70239. doi: 10.1111/acem.70239.
PubMed 41645916
Study at a glance
From the registry record, last updated by the sponsor on 26 Aug 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Evaluation of Prioritized Assessment for Older Patients Living With Frailty Presenting to the Emergency Department
- ClinicalTrials.gov ID
- NCT06869148
- Acronym / sponsor ID
- 2024-05740-01
- Conditions
- Frailty, Length of Stay, Emergency Department Visit, Older Patients
- Keywords
- Clinical frailty scale, CFS, Frailty assessment, Triage, Emergency department, Length of stay, physician prioritization, physician prioritisation
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 1,217 participants (actual)
- Lead sponsor
- University Hospital, LinkoepingUniversity, hospital or other
- Study start
- 27 Jan 2025 (actual)
- Primary completion
- 31 Jul 2025 (actual)
- Study completion
- 31 Jul 2025 (actual)
- First posted
- 11 Mar 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The older population is getting older and growing in size worldwide. This requires healthcare to adapt to meet the complex medical and nursing needs of the older patient group. As older patients have varying health conditions with different levels of functions, their premise to handle acute, unexpected illness differs as well. This complicates matters for healthcare, especially emergency departments (ED) where resource allocation and identifying patients that are at greatest risk of negative health outcomes must be prioritized in a limited time.
When patients present to the ED, initial triage information such as vital signs and reason for visit determines the triage acuity for the patient. In Linköping, and large parts of Sweden, the triage tool RETTS (Rapid Emergency Triage and Treatment System) is used, where the highest priority is red (priority 1), then orange (priority 2), yellow (priority 3), green (priority 4) and blue (priority 5). However, this can be misleading when assessing older patients due to altered physiology with natural ageing and older patients are known to be under-triaged with existing triage systems.
The variation in functional capacity in older patients does not necessarily correlate with comorbidities and age and has been condensed to the term 'frailty'. It has been proposed that the frailty level corresponds more to biological age rather than chronological age. Frailty increases the risk of adverse outcomes such as falls, the need of in-hospital care, institutionalization, and mortality in which the risk is increased even in low acuity illnesses.
Frailty can be assessed by various means and based on the theory of cumulative deficit, frailty assessment instruments have been developed where frailty level increases with the amount of help needed from others. Different instruments have been compared in the ED and the Clinical Frailty Scale (CFS) have been deemed fit due to it being practical in a busy environment. The scale consists of 9 points where 9 is the highest level of frailty and the scale is usually dichotomized into "robust" and "living with frailty" where 5 points or above constitutes frailty. The prognostic value of CFS has previously been studied in the ED of University hospital of Linköping in Sweden with results indicating that the instrument should be used as an additional risk assessment in the ED.
Older patients often present with vague and complex symptoms to th ED, which could lead to prolonged ED stay due to the need of extensive medical workup or therapy. Long ED stays have been shown to increase both morbidity and mortality in older patients as well as risk of delirium and complications relating to care, especially in individuals living with frailty. In order to decrease the adverse events, aim to shorten ED length of stay (ED LOS) should therefore be a reasonable goal in clinical improvement work. Early identification of frailty in the ED may lead to rapid assessments and streaming of care for older patients which have shown to statistically significantly decrease ED LOS, which is why an early assessment by a physician potentially could decrease overall ED LOS. However, it is unknown how early assessed frailty could affect the ED visit itself.
In the beginning of 2025, the Emergency department of University hospital of Linköping launched a local guideline which recommended that patients aged 65 years or older visiting the ED should be assessed with CFS as early as possible, preferably in connection to triage. If the patients were assessed as living with frailty, the frailty score should be stated in the electronical overview of ED patients. The patient's needs of care should be induvidualized according to frailty level and the responsible clinical team should aim to decrease the ED length of stay for older patients living with frailty.
This study focuses on the outcomes of this newly implemented routine and aims to answer if recommended prioritization of older ED patients living with frailty leads to decreased ED LOS. Furthermore the study investigates if the clinical guidelines have an impact on time to the first assessment by a physician, admission rate, in-hospital length of stay, and mortality at 90 days
Study design
- Observational model
- Cohort
- Time perspective
- Retrospective
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Control group | – | –Patients aged 65 years or older visisting the ED who have been assessed for frailty. The control group were included before implementation of the local guidelines. |
| Intervention group | – | Other: Prioritized assessment for older patients living with frailtyPatients aged 65 years or older visisting the ED who have been assessed for frailty. The intervention group were included after the implementation of the local guidelines. |
Who may qualify
- Ages
- 65 years and older
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Older adult
- Study population
- Patients visiting the ED in Linköping in the age of 65 years or older who have been assessed by CFS
Key inclusion criteria (2 listed)
- 65 years of age or older
- Assessed by CFS with the score being documented in the electronic journal
Key exclusion criteria (3 listed)
- Under the age of 65 years of age
- Not assessed by CFS
- Refusal of participation in the study
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Prioritized assessment for older patients living with frailtyAlso: Local guidelines regarding frailty in the Emergency DepartmentIn the beginning of 2025, the Emergency department of University hospital of Linköping launched a clinical guideline which stated that patients aged 65 years or older should be assessed with CFS as early as possible, preferably in connection to triage. If the patients were assessed as living with frailty, the frailty score should be stated in the electronical overview of ED patients. The patient's needs of care should be met according to frailty level and the responsible clinical team should aim to decrease the ED length of stay for older patients living with frailty. | Other | Intervention group |
Primary outcome
ED length of stay
Time frame: From enrollment until end of inclusion, approximately 4-8 weeks for each group
Length of stay in the ED measured in hours and minutes (data will be collected from the electronic health record)
5 secondary outcomes
Time to the first assessment by a physician
Time frame: From enrollment until end of inclusion, approximately 4 weeks for each group
Admission rate
Time frame: From enrollment until end of inclusion, approximately 4-8 weeks for each group
In-hospital length of stay
Time frame: From enrollment until end of inclusion, approximately 4-8 weeks for each group
Mortality up to 90 days
Time frame: From enrollment until end of inclusion, approximately 4-8 weeks for each group
Difference in ED length of stay between patients in different triage categories
Time frame: From enrollment until end of inclusion, approximately 4-8 weeks for each group
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 26 Aug 2025.
- Results publication: PubMed 39253302Wretborn J, Munir-Ehrlington S, Horlin E, Wilhelms DB. Addition of the clinical frailty scale to triage tools and early warning scores improves mortality prognostication at 30 days: A prospective observational multicenter study. J Am Coll Emerg Physicians Open. 2024 Sep 9;5(5):e13244. doi: 10.1002/emp2.13244. eCollection 2024 Oct.
- Results publication: PubMed 39053972Munir Ehrlington S, Horlin E, Toll John R, Wretborn J, Wilhelms D. Frailty is associated with 30-day mortality: a multicentre study of Swedish emergency departments. Emerg Med J. 2024 Aug 21;41(9):514-519. doi: 10.1136/emermed-2023-213444.
- Derived from this study: PubMed 41645916Ehrlington SM, Wretborn J, Wilhelms D. Frailty Alerts Reduce Waiting Time and Length of Stay in the Emergency Department. Acad Emerg Med. 2026 Feb;33(2):e70239. doi: 10.1111/acem.70239.
- Individual participant dataSharing planned: Undecided
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Frailty and Length of Stay, run by University Hospital, Linkoeping at 1 site in Sweden.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 2 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 26 Aug 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Sweden. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
ED length of stay (time frame: From enrollment until end of inclusion, approximately 4-8 weeks for each group). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT06869148, which also lists 3 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 26 Aug 2025.