External validation of the Hospital Frailty Risk Score in France

Abstract

Background: The Hospital Frailty Risk Score (HFRS) has made it possible internationally to identify subgroups of patients with characteristics of frailty from routinely collected hospital data.

Objective: To externally validate the HFRS in France.

Design: A retrospective analysis of the French medical information database.

Setting: 743 hospitals in Metropolitan France.

Subjects: All patients aged 75 years or older hospitalised as an emergency in 2017 (n = 1,042,234).

Methods: The HFRS was calculated for each patient based on the index stay and hospitalisations over the preceding 2 years. Main outcome measures were 30-day in-patient mortality, length of stay (LOS) >10 days and 30-day readmissions. Mixed logistic regression models were used to investigate the association between outcomes and HFRS score.

Results: Patients with high HFRS risk were associated with increased risk of mortality and prolonged LOS (adjusted odds ratio [aOR] = 1.38 [1.35-1.42] and 3.27 [3.22-3.32], c-statistics = 0.676 and 0.684, respectively), while it appeared less predictive of readmissions (aOR = 1.00 [0.98-1.02], c-statistic = 0.600). Model calibration was excellent. Restricting the score to data prior to index admission reduced discrimination of HFRS substantially.

Conclusions: HFRS can be used in France to determine risks of 30-day in-patient mortality and prolonged LOS, but not 30-day readmissions. Trial registration: Reference ID on clinicaltrials.gov: ID: NCT03905629.

Keywords: frailty; hospitalisation; length of stay; mortality; older people; risk assessment; statistics and numerical data.

Figure 1

Flowchart.

Figure 2

Calibration assessment for mixed logistic regression models. Crude (A, C, E) and adjusted models (B, D, F) for 30 day in-patient mortality, prolonged LOS > 10 days and 30-day readmissions, respectively.