Imaging in the last six months of life: associations with age, Clinical Frailty Scale and anticipatory care planning

Introduction: Patients with high Clinical Frailty Scale (CFS) scores are experiencing substantial radiological investigations in their final months of life. We quantified imaging use in the last six months of life, examined associations between age, CFS, and imaging frequency, and compared patients with and without an anticipatory clinical management plan (ACMP).

Methods: Retrospective cohort study (n=94) of randomly selected care home residents with CFS 5–9 admitted to a District General Hospital between January and December 2024. All had died before inclusion. Imaging data were retrieved from our Picture Archiving and Communication System (PACS), and the number of scans in the last six months of life was recorded.

Results: 94 patients were included; mean age at death was 83.6, sex split 46% (43/94) female. 522 scans were performed in the last six months of life (mean 5.6 per patient, median 4.5, range 0–23): 338 X-rays, 128 CTs, 37 ultrasounds, and 19 MRIs. Age correlated negatively with imaging frequency (Spearman’s ρ = –0.24, p = 0.016 for total scans; ρ = –0.30, p = 0.0036 for CT/MRI only), whereas CFS showed no association (ρ = 0.085, p = 0.42 for total scans; ρ = 0.084, p = 0.42 for CT/MRI only). 85/94 patients underwent a scan within 100 days of death; 12 underwent a scan within 1 day of death. Patients with an ACMP were less likely to experience >1 CT or MRI than those without, but the difference did not reach statistical significance (OR 0.24, 95% CI 0.05–1.13; p = 0.073).

Conclusions: Age correlated negatively with imaging frequency, whilst CFS did not. This pattern may suggest that imaging decisions are more closely aligned with chronological age than measured frailty. The high rate of investigations highlights the need for guidance to support patient-centred imaging at the end of life.