Comparison of two electronic medical record-
based frailty assessment tools and their

association with adverse outcomes in older
hospitalized patients with urgent admissions

Comparison of two electronic medical record-
based frailty assessment tools and their

association with adverse outcomes in older
hospitalized patients with urgent admissions

Canadian Institute for Health Information-Hospital Frailty Risk Measure, United Kingdom-Hospital Frailty
Risk Score, Urgent admission, Older, Adverse outcome

Frailty assessment is crucial for predicting outcomes in acute care settings; however, its application
remains challenging. Therefore, this study aims to evaluate and compare two electronic medical record-based tools—
the Canadian Institute for Health Information Hospital Frailty Risk Measure (CIHI-HFRM) and the United Kingdom
Hospital Frailty Risk Score (UK-HFRS)—in older patients requiring urgent admission.
Methods In this retrospective cohort study, we analyzed 35,564 patients aged 65 or older from the MIMIC-IV 2.0

database. Frailty was assessed using CIHI-HFRM and UK-HFRS. Primary outcomes included in-hospital mortality, one-
year post-discharge mortality, post-discharge care needs, timely hospital discharge, and one-year readmission rates.

Logistic regression, Cox regression, and competing risk models were used for analysis.
Results The CIHI-HFRM and UK-HFRS were significantly associated with in-hospital mortality [odds ratio (OR) per

point: CIHI-HFRM 1.10 (95% confidence interval (CI) 1.07–1.13); UK-HFRS 1.06 (95% CI 1.05–1.07)] and one-year post-
discharge mortality [hazard ratio (HR) per point: CIHI-HFRM 1.08 (95% CI 1.06–1.09); UK-HFRS 1.05 (95% CI 1.04–1.05)].

Both measures were associated with prolonged hospital stays and post-discharge care needs, while only CIHI-HFRM
was linked to one-year readmission risk.
Conclusion The CIHI-HFRM and UK-HFRS effectively stratify adverse outcomes risk in older patients requiring urgent
admission. They may be considered alongside traditional measures as part of a pragmatic multimodal pathway, which
represents a potential direction for clinical application.
Keywords Canadian Institute for Health Information-Hospital Frailty Risk Measure, United Kingdom-Hospital Frailty
Risk Score, Urgent admission, Older, Adverse outcome

Benchuan Hao1†, Yifei Xu2†, Huimin Yang3†, Liangchen Li4

, Zhong Zhang1

, Huihui Xia1

, Dapeng Song1
,

Chaosheng Du1

, Zhenzhen Yang1

and Bei Zhao1*

https://doi.org/10.1186/s12245-025-01061-5

2026

peri irawan

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