Predictive Value of Edmonton Frailty Scale, ISAR, and PRISMA-7 for Short-Term Mortality in Older Adults Presenting to the Emergency Department

Frailty has emerged as a critical determinant of outcomes among older adults presenting to the emergency department (ED). However, limited evidence exists regarding the comparative prognostic performance of commonly used frailty screening tools. This study aimed to evaluate and compare the predictive accuracy of the Edmonton Frailty Scale (EFS), Identification of Seniors at Risk (ISAR), and PRISMA-7 for short-term mortality in the ED setting. This prospective observational study included patients aged ≥65 years admitted to a tertiary ED between January and July 2022. Frailty was assessed at admission using EFS, ISAR, and PRISMA-7. The primary outcome was 30-day all-cause mortality. Group comparisons were performed with Mann–Whitney U and chi-square tests. Prognostic accuracy was evaluated using receiver operating characteristic (ROC) curves, and optimal cut-offs were defined with the Youden Index. Among 103 patients (mean age 73.9±7.2 years), 16 (15.5%) died within 30 days. Non-survivors had higher frailty scores on all tools (EFS 11 vs. 7; ISAR 4 vs. 3; PRISMA-7 5 vs. 3; all p≤0.001). AUC values were 0.811 for EFS, 0.765 for ISAR, and 0.754 for PRISMA-7. At a cut-off of >7, EFS showed 100% sensitivity, while ISAR and PRISMA-7 provided a more balanced sensitivity–specificity profile. Frailty screening with EFS, ISAR, or PRISMA-7 yields valuable prognostic information in older ED patients. EFS offers maximal sensitivity, whereas ISAR and PRISMA-7 achieve greater balance, supporting complementary use in practice.