Validation of the Clinical Frailty Score (CFS) in French language

Abstract

Background Very old critical ill patients are a rapid expanding group in the ICU. To better understand the magnitude of the challenges involved in intensive care practice for an ageing population and discuss a rational allocation of resources (admission, triage and level of care) for such patients, healthcare practitioners need a reliable evaluation of frailty. In order to promote the adequate use of the clinical frailty Scale (CFS) in a wider panel of countries, we aimed to develop, validate and characterise a French (FR) version from the originale English (EN) CFS. Results Inter-rater reliability was 0.87 (95%CI: 0.76-0.93) between doctors for the original CFS version and 0.76 (95%CI: 0.57-0.87) between nurses for the FR version. Inter-rater variability between doctor and nurse was 0.75 (95%CI: 0.56-0.87) for the original version, and 0.73 (95%CI: 0.52-0.85) for the FR version. Test-retest (stability) with the original vs the FR version was 0.86 (95%CI: 0.72-0.93) for doctors and 0.87 (95%CI: 0.76-0.93) for nurses. Differences between the evaluations of the CFS-EN and CSF-FR were not different from 0, with a mean difference of 0.06 (95%CI -0.24, 0.36) for the EN version and -0.03 (95%CI -0.47, 0.41) for the FR version. Agreement between the FR and the EN version for doctors was similar. Average original version ratings were slightly lower than FR version ratings, though this difference did not reach significance: -0.29 (95%CI -0.54, 0.04). There were no significant differences in the CFS scores between participants who died within 30 days and participants who survived for either the original (median survived: 4.7, median died: 4.0, p=0.52) or FR (median survived: 4.7, median died: 4.5, p=0.56) versions Conclusion In this prospective cohort of very old intensive care participants we developed and tested the basic psychometric properties (internal consistency, reproducibility) of a French version of the CFS. This manuscript provides clinically meaningful psychometric properties that have not been previously reported in any other language, including in the original EN version. The French cultural adaptation of this CFS has adequate psychometric properties for doctors or nurses to evaluate frailty in very old intensive care patients.