Agreement and predictive value of the clinical frailty scale in hospitalized older patients.
Acute geriatric unit
Agreement
Classification tree
Clinical frailty scale
Mortality
Journal
European geriatric medicine
ISSN: 1878-7649
Titre abrégé: Eur Geriatr Med
Pays: Switzerland
ID NLM: 101533694
Informations de publication
Date de publication:
01 Aug 2024
01 Aug 2024
Historique:
received:
05
04
2024
accepted:
13
07
2024
medline:
1
8
2024
pubmed:
1
8
2024
entrez:
1
8
2024
Statut:
aheadofprint
Résumé
Our objective was to perform an external validity study of the clinical frailty scale (CFS) classification tree by determining the agreement of the CFS when attributed by a senior geriatrician, a junior geriatrician, or using the classification tree. Additionally, we evaluated the predictive value of the CFS for 6-month mortality after admission to an acute geriatric unit. This prospective study was conducted in two acute geriatric units in Belgium. The premorbid CFS was determined by a senior and a junior geriatrician based on clinical judgment within the first 72 h of admission. Another junior geriatrician, who did not have a treatment relationship with the patient, scored the CFS using the classification tree. Intra-class correlation coefficient (ICC) was calculated to assess agreement. A ROC curve and Cox regression model determined prognostic value. In total, 97 patients were included (mean age 86 ± 5.2; 66% female). Agreement of the CFS, when determined by the senior geriatrician and the classification tree, was moderate (ICC 0.526, 95% CI [0.366-0.656]). This is similar to the agreement between the senior and junior geriatricians' CFS (ICC 0.643, 95% CI [0.510-0.746]). The AUC for 6-month mortality based on the CFS by respectively the classification tree, the senior and junior geriatrician was 0.719, 95% CI [0.592-0.846]; 0.774, 95% CI [0.673-0.875]; 0.774, 95% CI [0.665-0.882]. Cox regression analysis indicated that severe or very severe frailty was associated with a higher risk of mortality compared to mild or moderate frailty (hazard ratio respectively 6.274, 95% CI [2.613-15.062] by the classification tree; 3.476, 95% CI [1.531-7.888] by the senior geriatrician; 4.851, 95% CI [1.891-12.442] by the junior geriatrician). Interrater agreement in CFS scoring on clinical judgment without Comprehensive Geriatric Assessment is moderate. The CFS classification tree can help standardize CFS scoring.
Identifiants
pubmed: 39088181
doi: 10.1007/s41999-024-01026-6
pii: 10.1007/s41999-024-01026-6
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s), under exclusive licence to European Geriatric Medicine Society.
Références
Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K (2013) Frailty in elderly people. Lancet 381(9868):752–762
doi: 10.1016/S0140-6736(12)62167-9
pubmed: 23395245
Falk Erhag H, Guðnadóttir G, Alfredsson J, Cederholm T, Ekerstad N, Religa D et al (2023) The association between the Clinical Frailty Scale and adverse health outcomes in older adults in acute clinical settings—a systematic review of the literature. Clin Interv Aging 18:249–261
doi: 10.2147/CIA.S388160
pubmed: 36843633
pmcid: 9946013
Hoogendijk EO, Afilalo J, Ensrud KE, Kowal P, Onder G, Fried LP (2019) Frailty: implications for clinical practice and public health. Lancet 394(10206):1365–1375
doi: 10.1016/S0140-6736(19)31786-6
pubmed: 31609228
Church S, Rogers E, Rockwood K, Theou O (2020) A scoping review of the Clinical Frailty Scale. BMC Geriatr 20(1):393
doi: 10.1186/s12877-020-01801-7
pubmed: 33028215
pmcid: 7540438
Bruno RR, Wernly B, Bagshaw SM, van den Boogaard M, Darvall JN, De Geer L et al (2023) The Clinical Frailty Scale for mortality prediction of old acutely admitted intensive care patients: a meta-analysis of individual patient-level data. Ann Intensive Care 13(1):37
doi: 10.1186/s13613-023-01132-x
pubmed: 37133796
pmcid: 10155148
Gordon EH, Hubbard RE (2022) Frailty: understanding the difference between age and ageing. Age Ageing 51(8):afac185
doi: 10.1093/ageing/afac185
pubmed: 35973066
Shrier W, Dewar C, Parrella P, Hunt D, Hodgson LE (2021) Agreement and predictive value of the Rockwood Clinical Frailty Scale at emergency department triage. Emerg Med J 38(12):868–873
doi: 10.1136/emermed-2019-208633
pubmed: 33172880
Theou O, Squires E, Mallery K, Lee JS, Fay S, Goldstein J et al (2018) What do we know about frailty in the acute care setting? A scoping review. BMC Geriatr 18(1):139
doi: 10.1186/s12877-018-0823-2
pubmed: 29898673
pmcid: 6000922
Montero-Odasso M, Hogan DB, Lam R, Madden K, MacKnight C, Molnar F et al (2020) Age alone is not adequate to determine health-care resource allocation during the COVID-19 pandemic. Can Geriatr J 23(1):152–154
doi: 10.5770/cgj.23.452
pubmed: 32550953
pmcid: 7279701
Lewis EG, Breckons M, Lee RP, Dotchin C, Walker R (2021) Rationing care by frailty during the COVID-19 pandemic. Age Ageing 50(1):7–10
doi: 10.1093/ageing/afaa171
pubmed: 32725156
Piers R, Janssens W, Cobbaert K, Pattyn I, Westhovens I, Martens H et al (2021) Letter to the Editor: Premorbid frailty is a better prognostic indicator than age in oldest-old hospitalized with COVID-19. J Am Med Dir Assoc 22(3):514–516
doi: 10.1016/j.jamda.2021.01.059
pubmed: 33484639
pmcid: 7816969
Dou Q, Wang W, Wang H, Ma Y, Hai S, Lin X et al (2019) Prognostic value of frailty in elderly patients with acute coronary syndrome: a systematic review and meta-analysis. BMC Geriatr 19(1):222
doi: 10.1186/s12877-019-1242-8
pubmed: 31416442
pmcid: 6694517
Yan B, Sun W, Wang W, Wu J, Wang G, Dou Q (2022) Prognostic significance of frailty in older patients with hip fracture: a systematic review and meta-analysis. Int Orthop 46(12):2939–2952
doi: 10.1007/s00264-022-05605-9
pubmed: 36227383
Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I et al (2005) A global clinical measure of fitness and frailty in elderly people. CMAJ 173(5):489–495
doi: 10.1503/cmaj.050051
pubmed: 16129869
pmcid: 1188185
Kaeppeli T, Rueegg M, Dreher-Hummel T, Brabrand M, Kabell-Nissen S, Carpenter CR et al (2020) Validation of the Clinical Frailty Scale for prediction of thirty-day mortality in the emergency department. Ann Emerg Med 76(3):291–300
doi: 10.1016/j.annemergmed.2020.03.028
pubmed: 32336486
Surkan M, Rajabali N, Bagshaw SM, Wang X, Rolfson D (2020) Interrater reliability of the Clinical Frailty Scale by geriatrician and intensivist in patients admitted to the intensive care unit. Can Geriatr J 23(3):235–241
doi: 10.5770/cgj.23.398
pubmed: 32904800
pmcid: 7458598
Pugh RJ, Battle CE, Thorpe C, Lynch C, Williams JP, Campbell A et al (2019) Reliability of frailty assessment in the critically ill: a multicentre prospective observational study. Anaesthesia 74(6):758–764
doi: 10.1111/anae.14596
pubmed: 30793278
Theou O, Pérez-Zepeda MU, van der Valk AM, Searle SD, Howlett SE, Rockwood K (2021) A classification tree to assist with routine scoring of the Clinical Frailty Scale. Age Ageing 50(4):1406–1411
doi: 10.1093/ageing/afab006
pubmed: 33605412
pmcid: 7929455
Koo TK, Li MY (2016) A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 15(2):155–163
doi: 10.1016/j.jcm.2016.02.012
pubmed: 27330520
pmcid: 4913118
Fronczek J, Polok K, de Lange DW, Jung C, Beil M, Rhodes A et al (2021) Relationship between the Clinical Frailty Scale and short-term mortality in patients ≥ 80 years old acutely admitted to the ICU: a prospective cohort study. Crit Care 25(1):231
doi: 10.1186/s13054-021-03632-3
pubmed: 34210358
pmcid: 8247215
Darvall JN, Bellomo R, Bailey M, Paul E, Young PJ, Rockwood K et al (2020) Frailty and outcomes from pneumonia in critical illness: a population-based cohort study. Br J Anaesth 125(5):730–738
doi: 10.1016/j.bja.2020.07.049
pubmed: 32891413
Rottler M, Ocskay K, Sipos Z, Görbe A, Virág M, Hegyi P et al (2022) Clinical Frailty Scale (CFS) indicated frailty is associated with increased in-hospital and 30-day mortality in COVID-19 patients: a systematic review and meta-analysis. Ann Intensive Care 12(1):17
doi: 10.1186/s13613-021-00977-4
pubmed: 35184215
pmcid: 8858439