Can Patient Frailty Be Estimated from Inpatient Records? A Prospective Cohort Study

Abstract

Background: Frailty is a common condition in older people affecting around 1.8 million people in the UK and is independently associated with adverse outcomes. Frailty is commonly measured with the Clinical Frailty Scale (CFS) which involves a face to face assessment. There is evidence the CFS can be assigned retrospectively from information in patient records, but no research has assessed whether scores can be assigned using routine inpatient records. We aimed to assess whether a CFS could be accurately assigned using hospital inpatient records in a UK setting. Methods: Forty newly admitted patients aged 65 and over were prospectively recruited at Bradford Royal Infirmary. A CFS score was assigned to each patient using a face to face assessment. A CFS score was independently assigned to each patient solely using information in the inpatient records. A quadratically weighted Cohen's Kappa was used to estimate inter-rater reliability (IRR) between the assessments. Results: A Kappa of 0.84 was estimated for the IRR between the scores derived from a face to face assessment and those based solely on inpatient records, indicating good agreement. The Kappa score fell to 0.7 when a 4 category collapsed version of the CFS was used. The IRR appeared unaffected by the number of times a patient had been admitted recently. Conclusion: The CSF may accurately be determined from data routinely recorded in inpatient records. Retrospectively derived scores can, therefore, be used in analysis of patient outcomes of older people in research and service improvement.

Clinical Features, Inpatient Trajectories and Frailty in Older Inpatients with COVID-19: A Retrospective Observational Study

“…Additionally, only routinely collected data were available and some patients were not assessed by their treating team for frailty, necessitating scoring by the research team who may have been aware of the outcome in some cases. However, scoring was done by physicians experienced in frailty assessment at our centre and based only on information documented in the EHR on the patient's admission to hospital, a validated method [31]. Finally, more detailed information regarding Intensive Care Unit (ICU) admission, treatments and mechanical ventilation was not included, as this is currently being evaluated in a larger study at our institution.…”

“…All CFS scores were completed using information recorded in the EHR on the patient's admission to hospital and verified by a consultant or specialist registrar in Geriatric Medicine, experienced in the assessment of frailty using the CFS. CFS scores derived from manual review of inpatient records show good agreement with scores assigned after face to face assessment, with an estimated Kappa of 0.84 for inter-rater reliability [31]. All CFS scores were assigned as soon as possible after admission but it was not possible to blind researchers to the outcome if patients had already died, as users are automatically notified of this when the electronic patient record is accessed.…”

Clinical Features, Inpatient Trajectories and Frailty in Older Inpatients With COVID-19: A Retrospective Observational Study.

“…Additionally, only routinely collected data were available and some patients were not assessed by their treating team for frailty, necessitating scoring by the research team. However, this was done by physicians experienced in frailty assessment using information documented in the EHR on admission, a validated method [31]. Finally, more detailed information regarding Intensive Care Unit (ICU) admission, treatments and mechanical ventilation was not included, as this is currently being evaluated in a larger study at our institution.…”

“…All CFS scores were completed using patient information recorded in the EHR on admission to hospital and verified by a consultant or specialist registrar in Geriatric Medicine, experienced in the assessment of frailty using the CFS. This method has been validated previously [31].…”

Predicting 1 year mortality after traumatic injury using the Clinical Frailty Scale

“…The TARN database was used to extract patient demographics, injury pattern, and ISS. CFS was either retrospectively scored by a geriatrician from the hand-written notes which had been scanned on to the electronic patient record, 16 or prospectively scored and entered directly onto the database. All members of the G-POC team completed online CFS training to standardize scores.…”