A classification tree to assist with routine scoring of the Clinical Frailty Scale

Abstract

Background the Clinical Frailty Scale (CFS) was originally developed to summarise a Comprehensive Geriatric Assessment and yield a care plan. Especially since COVID-19, the CFS is being used widely by health care professionals without training in frailty care as a resource allocation tool and for care rationing. CFS scoring by inexperienced raters might not always reflect expert judgement. For these raters, we developed a new classification tree to assist with routine CFS scoring. Here, we test that tree against clinical scoring. Objective/Methods we examined agreement between the CFS classification tree and CFS scoring by novice raters (clerks/residents), and the CFS classification tree and CFS scoring by experienced raters (geriatricians) in 115 older adults (mean age 78.0 ± 7.3; 47% females) from a single centre. Results the intraclass correlation coefficient (ICC) for the CFS classification tree was 0.833 (95% CI: 0.768–0.882) when compared with the geriatricians’ CFS scoring. In 93%, the classification tree rating was the same or differed by at most one level with the expert geriatrician ratings. The ICC was 0.805 (0.685–0.883) when CFS scores from the classification tree were compared with the clerk/resident scores; 88.5% of the ratings were the same or ±1 level. Conclusions a classification tree for scoring the CFS can help with reliable scoring by relatively inexperienced raters. Though an incomplete remedy, a classification tree is a useful support to decision-making and could be used to aid routine scoring of the CFS.

Informing patterns of health and social care utilisation in Irish older people according to the Clinical Frailty Scale

“…The CFS was operationalised at waves 1-5 of TILDA according to the published CFS Decision Tree 24 . Six items were used in the decision tree to distinguish between CFS classes as follows: (i) number of basic activities of daily living requiring help (BADL); (ii) number of instrumental activities of daily living requiring help (IADL); (iii) number of chronic conditions (28 chronic and cardiovascular conditions shown in Table 1 ); (iv) self-rated health – excellent, very good, good, fair or poor; (v) one item from the Center for Epidemiological Studies Depression scale: during the past week how often have you felt that everything that you did was an effort – rarely or none of the time, some or a little of the time, occasionally or a moderate amount of time, all of the time; and (vi) moderate or vigorous activity on ≥1 days in the past week as assessed using the International Physical Activity Questionnaire Short Form (IPAQ-SF) 26 .…”

“…Despite the rolling out of dedicated training modules for more accurate CFS scoring 22 , 23 , a criticism of the CFS has been the possible subjectivity in the scoring, bringing the possible danger of lack of scoring consistency between individuals and across agencies. However, to address those concerns, the authors of the CFS have published a classification tree method to assist with routine scoring of the CFS 24 . This also allows the retrospective implementation of the CFS in a dataset when the required CFS decision tree variables have been collected.…”

“…In the opinion of the reviewer, this study provides 4 very relevant contributions: As far as the reviewer knows, the CFS Decision Tree recently published by Theou et al (doi: 10.1093/ageing/afab006) 1 is used for the first time in a large database, demonstrating its usefulness in retrospective data analysis. A particularly relevant element of this study is the assessment of both the use of health and social services.…”

“…As far as the reviewer knows, the CFS Decision Tree recently published by Theou et al (doi: 10.1093/ageing/afab006) 1 is used for the first time in a large database, demonstrating its usefulness in retrospective data analysis.…”

Response to: Modified Rockwood frailty index is predictive of adverse outcomes in elderly populations undergoing major abdominal surgery: is it a practical tool though?

“…Although we advocate for the use of mRFI as a screening tool for frailty since it has been externally validated in prior studies [2], we agree that it should be used in conjunction with other tools to obtain an integral preoperative assessment. To our knowledge, the Rockwood clinical frailty scale that is cited by the author has not been externally validated in the preoperative setting to this date, and its diagnostic performance is known to give inaccurate scores when applied by providers with limited experience in frailty care [3,4]. Interestingly, a recently published multicenter prospective observational study by Pugh et al demonstrated good levels of agreement while using this scale; however, factors that independently associated with higher ratings were also detected, indicating that personal bias existed [5].…”