This forthcoming article from the Canadian Journal of Emergency Medicine argues that, in allocating scarce resources, determining a patient’s potential to benefit from treatment should rely on a structured, evidence-based, and global assessment of frailty that accounts for more than simply the patient’s age.
The article notes that triage guidelines in Italy in response to COVID-19 were criticized as ageist for suggesting an age cutoff for intensive care, even though the guidelines were not based exclusively on age. While many comorbidities, such as diabetes, cardiovascular disease, and immunocompromising conditions associated with higher COVID-19 mortality are also correlated with age, the article notes that the correlation with age is imperfect because of the heterogeneity of aging.
In contrast to assessment based on age, the article describes the proposed use of screening based on frailty according to guidelines from the U.K.’s National Institute for Health and Care Excellence (NICE). The NICE guidelines use the Clinical Frailty Scale (CFS), though there are no universally accepted methods for assessing frailty. The CFS is a decision support tool that uses pictograms and brief descriptions to assist clinicians in placing patients along a 9-point scale from very fit to terminally ill. The article argues that this approach is practical for use in an overwhelmed hospital for triaging patients during COVID-19 case surge.