Frailty as a Prognostic Indicator in Intensive Care.

Aged, 80 and over Critical Care Female Frailty / diagnosis Germany / epidemiology Humans Intensive Care Units Prognosis Reproducibility of Results

Journal

Deutsches Arzteblatt international
ISSN: 1866-0452
Titre abrégé: Dtsch Arztebl Int
Pays: Germany
ID NLM: 101475967

Informations de publication

Date de publication:
02 Oct 2020
Historique:
received: 31 03 2020
revised: 31 03 2020
accepted: 09 06 2020
entrez: 28 12 2020
pubmed: 29 12 2020
medline: 2 2 2021
Statut: ppublish

Résumé

The percentage of patients in intensive care who are 80 years old or older is continually increasing. Such patients already made up more than 20% of all patients in intensive care in Germany in the years 2007-2011. Meanwhile, effective treatments that support the organs of the body and keep severely ill patients alive are also being continually developed and refined. Frailty is a key prognostic parameter. The scientifically based assessment of frailty can be highly useful in intensive care medicine with regard to consented decision-making, individualized prognostication, treatment planning, and aftercare. Pertinent publications were retrieved by a selective search in the PubMed database. On the basis of the literature assessment, a variety of screening instruments were used to assess frailty and its significance for very old, critically ill patients in German intensive care units. Only a small number of screening instruments are suitable for routine use in German intensive care units. The scores vary in diagnostic precision. The Clinical Frailty Scale (CFS) enables highly accurate prognostication; it considers the patient in relation to his or her social environment, and to the reference population. Categorization is achieved by means of pictograms that are supplemented with brief written descriptions. The CFS can be used prospectively and is easy to learn. Its interrater reliability is high (weighted Cohen's κ: 0.85 [0.84; 0.87]), and it has been validated for routine use in intensive care units in Germany. None of the available scores enable perfect prognostication. In Germany, frailty in intensive-care patients is currently best assessed on a simple visual scale (CFS).

Sections du résumé

BACKGROUND BACKGROUND
The percentage of patients in intensive care who are 80 years old or older is continually increasing. Such patients already made up more than 20% of all patients in intensive care in Germany in the years 2007-2011. Meanwhile, effective treatments that support the organs of the body and keep severely ill patients alive are also being continually developed and refined. Frailty is a key prognostic parameter. The scientifically based assessment of frailty can be highly useful in intensive care medicine with regard to consented decision-making, individualized prognostication, treatment planning, and aftercare.
METHODS METHODS
Pertinent publications were retrieved by a selective search in the PubMed database. On the basis of the literature assessment, a variety of screening instruments were used to assess frailty and its significance for very old, critically ill patients in German intensive care units.
RESULTS RESULTS
Only a small number of screening instruments are suitable for routine use in German intensive care units. The scores vary in diagnostic precision. The Clinical Frailty Scale (CFS) enables highly accurate prognostication; it considers the patient in relation to his or her social environment, and to the reference population. Categorization is achieved by means of pictograms that are supplemented with brief written descriptions. The CFS can be used prospectively and is easy to learn. Its interrater reliability is high (weighted Cohen's κ: 0.85 [0.84; 0.87]), and it has been validated for routine use in intensive care units in Germany.
CONCLUSION CONCLUSIONS
None of the available scores enable perfect prognostication. In Germany, frailty in intensive-care patients is currently best assessed on a simple visual scale (CFS).

Identifiants

DOI: 10.3238/arztebl.2020.0668 PMID: 33357351 PMC: PMC7838379
pubmed: 33357351
pii: arztebl.2020.0668
doi: 10.3238/arztebl.2020.0668
pmc: PMC7838379
doi:
pii:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

668-673

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Auteurs

Christian Jung (C)

Department of Cardiology, Pulmonary Diseases and Vascular Medicine, Faculty of Medicine, Düsseldorf University Hospital; Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Department of Intensive Care Medicine, Hadassah-Hebrew University Hospital, Jerusalem, Israel; Cardiovascular Research Institute Düsseldorf (CARID).

Raphael Romano Bruno (RR)

Bernhard Wernly (B)

Georg Wolff (G)

Michael Beil (M)

Malte Kelm (M)

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Sujet âgé de 80 ans ou plus › Frailty as a Prognostic Indicator in Intensive Care.
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Soins de réanimation › Frailty as a Prognostic Indicator in Intensive Care.
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Fragilité › Frailty as a Prognostic Indicator in Intensive Care.
questionsmedicales.fr › Régions géographiques › Europe › Allemagne › Frailty as a Prognostic Indicator in Intensive Care.
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Frailty as a Prognostic Indicator in Intensive Care.
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Établissements de santé › Unités hospitalières › Unités de soins intensifs › Frailty as a Prognostic Indicator in Intensive Care.
questionsmedicales.fr › Diagnostic › Pronostic › Frailty as a Prognostic Indicator in Intensive Care.
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Méthodologie en recherche épidémiologique › Reproductibilité des résultats › Frailty as a Prognostic Indicator in Intensive Care.