To Örebro University

INTRODUCTION: As people age, frailty becomes increasingly prevalent and is associated with adverse outcomes, including higher risks of hospitalisation, institutionalisation and mortality. Early identification of frailty in ambulance and emergency department (ED) settings may support clinical decision-making and help predict outcomes for older patients. However, there is currently no consensus on how frailty should be assessed in these settings, and the clinical usefulness of available tools remains uncertain. This protocol outlines the methods for a planned scoping review that aims to identify frailty screening tools used for older adults (age ≥65 years) in the ambulance and ED settings and to evaluate existing evidence on their clinical usefulness.

METHODS AND ANALYSIS: This protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Protocols, and the final review will follow the Joanna Briggs Institute methodology and is reported in accordance with the PRISMA extension for Scoping Reviews guidelines. Studies will be included if they examine the use of frailty screening or assessment tools in individuals aged 65 years or older in ambulance and/or ED settings and report on aspects of clinical usefulness, such as feasibility, predictive validity or influence on clinical decisions. A comprehensive literature search will be conducted in PubMed, Embase, CINAHL, Scopus and Web of Science for studies published in English between January 2014 and December 2025. To refine the search strategy, an initial systematic pre-search was performed in PubMed using Medical Subject Headings terms, followed by a pilot study. A sample pilot screening of 101 references identified in the pre-search was conducted as a support for finalising the search. Ten of the papers in the pre-screening were furthermore used as a support for testing and validating the data extraction variables and quality assessment procedures. In the full scoping review, study selection and data extraction will be independently conducted by two reviewers using the Covidence software (Veritas Health Innovation, Melbourne, Australia), with any discrepancies resolved by a third reviewer. Extracted data will be summarised in tabular format and analysed through narrative synthesis. The methodological quality of included studies will be evaluated using the quality assessment tool of the National Heart, Lung, and Blood Institute for cohort studies.

ETHICS AND DISSEMINATION: Ethical approval is not required as no primary data will be collected. Findings will be disseminated through publication in a peer-reviewed journal, conference presentations and summaries shared with relevant clinical and research-related stakeholders.