Assessment of frailty by paramedics using the clinical frailty scale - an inter-rater reliability and accuracy study

Abstract

Background Frailty assessment by paramedics in the prehospital setting is understudied. The goals of this study were to assess the inter-rater reliability and accuracy of frailty assessment by paramedics using the Clinical Frailty Scale (CFS). Methods This was a cross-sectional study with paramedics exposed to 30 clinical vignettes created from real-life situations. There was no teaching intervention prior to the study and paramedics were only provided with the French version of the CFS (definitions and pictograms). The primary outcome was the inter-rater reliability of the assessment. The secondary outcome was the accuracy, compared with the expert-based assessment. Reliability was determined by calculating an intraclass correlation coefficient (ICC). Accuracy was assessed through a mixed effects logistic regression model. A sensitivity analysis was carried out by considering that an assessment was still accurate if the score differed from no more than 1 level. Results A total of 56 paramedics completed the assessment. The overall assessment was found to have good inter-rater reliability (ICC = 0.87 [95%CI 0.81–0.93]). The overall accuracy was moderate at 60.6% (95%CI 54.9–66.1) when considering the full scale. It was however much higher (94.8% [95%CI 92.0–96.7] when close assessments were considered as accurate. The only factor associated with accurate assessment was field experience. Conclusion The assessment of frailty by paramedics was reliable in this vignette-based study. However, the accuracy deserved to be improved. Future research should focus on the clinical impact of these results and on the association of prehospital frailty assessment with patient outcomes. Registration This study was registered on the Open Science Framework registries (https://doi.org/10.17605/OSF.IO/VDUZY).

Cross-cultural adaption and inter-rater reliability of the Swedish version of the updated clinical frailty scale 2.0

“…[ 29 ]. On the other hand, the method of testing reliability using case vignettes is an established technique [ 29 , 45 , 46 ]. In order to optimise the generalisability of the results of our study, the case vignettes were constructed to reflect real-world patients in our daily clinical practice, and to represent all nine levels of the CFS.…”

“…Overall, a comparison between studies on the reliability of CFS rating based on clinical case vignettes (e.g. Nissen 2020 [ 29 ] = “excellent”, Young 2020 [ 45 ] = “broad agreement”, Fehlmann 2023 [ 46 ] = “good” and our study = “excellent”) with studies on the reliability of CFS rating of real-world patients (e.g. Abraham 2019 [ 31 ] = “good to excellent”, Vrettos 2021 [ 47 ] = “good”, Flaatten 2021 [ 48 ] = “high to very high”) indicates that the degree of reliability tends to be slightly attenuated with real-world cases.…”

Do-Not-ResuscitateDecision-Making during the COVID-19 Pandemic in a Teaching Hospital: Lessons Learned for the Future

“…The Clinical Frailty Scale (CFS) is a reliable tool used to estimate the risk of poor outcome in elderly people in different chronic settings (patients with liver cirrhosis, oncological patients, patients with a geriatric profile, etc.) [ 6 – 10 ]. The CFS includes a clinical assessment of the patient's daily functioning, divided into nine categories (from 1 “very fit” to 9 “terminally ill”) [ 11 , 12 ].…”