Reliability of the Clinical Frailty Scale in very elderly ICU patients: a prospective European study

Abstract

Purpose Frailty is a valuable predictor for outcome in elderly ICU patients, and has been suggested to be used in various decision-making processes prior to and during an ICU admission. There are many instruments developed to assess frailty, but few of them can be used in emergency situations. In this setting the clinical frailty scale (CFS) is frequently used. The present study is a sub-study within a larger outcome study of elderly ICU patients in Europe (the VIP-2 study) in order to document the reliability of the CFS. Materials and methods From the VIP-2 study, 129 ICUs in 20 countries participated in this sub-study. The patients were acute admissions ≥ 80 years of age and frailty was assessed at admission by two independent observers using the CFS. Information was obtained from the patient, if not feasible, from the family/caregivers or from hospital files. The profession of the rater and source of data were recorded along with the score. Interrater variability was calculated using linear weighted kappa analysis. Results 1923 pairs of assessors were included and background data of patients were similar to the whole cohort (n = 3920). We found a very high inter-rater agreement (weighted kappa 0.86), also in subgroup analyses. The agreement when comparing information from family or hospital records was better than using only direct patient information, and pairs of raters from same profession performed better than from different professions. Conclusions Overall, we documented a high reliability using CFS in this setting. This frailty score could be used more frequently in elderly ICU patients in order to create a more holistic and realistic impression of the patient´s condition prior to ICU admission.

Relationship between the Clinical Frailty Scale and short-term mortality in patients ≥ 80 years old acutely admitted to the ICU: a prospective cohort study

“…The Clinical Frailty Scale (CFS) is a widely used frailty assessment tool which has gained recognition in a variety of clinical settings over the past decade [ 13 ]. Unlike many other instruments describing the degree of frailty, the CFS score was shown to be reliable in the highly dynamic context of acute admission to the ICU in patients ≥ 80 years old [ 14 , 15 ]. Frailty is most often defined as a CFS score greater than or equal to 5, with a CFS score of 4 labelled as pre-frailty (vulnerability, living with mild frailty) and CFS scores between 1 and 3 referred to as fitness.…”

Frailty and survival in elderly intensive care patients in Norway

“…Such a process is often referred to as the "ICU triage.” Furthermore, we cannot rule out information bias regarding misclassifications of the scores. However, a recent sub‐study of the VIP2 study showed a high reliability in the scoring of CFS 35 . Secondly, we have no data on decisions on treatment limitation after the intensive care unit.…”

Association between clinical frailty, illness severity and post-discharge survival: a prospective cohort study of older medical inpatients in Norway

“…It should be noted that the CFS translation used herein lacks a formal validation study. The Norwegian CFS translation was, however, performed according to the validated method described by French CFS translators [ 22 ] and has shown to have good inter-rater reliability when used in ICU patients [ 23 ]. Further, the present results show that data obtained by the Norwegian CFS version associate with a range of clinical endpoints and strongly correlate with a validated frailty index, giving support to its continued use in Norway.…”