Inter‐rater Agreement Between Self‐rated and Staff‐rated Clinical Frailty Scale Scores in Older Emergency Department Patients: A Prospective Observational Study

Ringer, Thom; Thompson, Courtney; McLeod, Shelley; Melady, Don

doi:10.1111/acem.13907

Cited by 18 publications

(25 citation statements)

References 10 publications

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“…To our knowledge, this is the first report on CFS inter-rater reliability between a physician and nurses in a U.S. ED. Taken together with the Canadian study by Ringer et al 7 in patients age 75 and older, our study provides evidence supporting the inter-rater reliability between ED nurses and physicians of CFS to screening for frailty among older adults in the ED. Additionally, this study offers an analysis of the reliability associated with the CFS complementary to the analysis by Dresden et al, 6 which reported moderate reliability between physician-and patient-assigned CFS.…”

supporting

confidence: 85%

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Inter‐rater Reliability of Clinical Frailty Scores for Older Patients in the Emergency Department

Heinemann

Gray

et al. 2020

Academic Emergency Medicine

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O ver 50 million U.S. adults 65 years and older account for >20 million emergency department (ED) visits each year. 1 Increasing ED use by older adults is projected to exceed the capacity of U.S. EDs. 2 The traditional ED model of care is ill-equipped to address the many complex care needs of older adults. 2 To address these problems, an evolution of emergency care has developed as evidenced by consensus geriatric ED (GED) guidelines and the American College of Emergency Medicine's Geriatric Emergency Department Accreditation (GEDA) program (https://www.acep.org/geda/). 3 Although the GED guidelines recommend "routine screening for all geriatric patients for high-risk features," there are no screening tests that effectively predict poor outcomes among older patients who seek ED care. 4 The currently used screening tests measure risk of a composite of poor outcomes such as functional decline, death, and depression after an ED visit. Alternatively, frailty might be used to identify older adults who might benefit from specialized GED care. Frailty is a state of heightened vulnerability to stressors arising from impairments in multiple systems leading to declines in homeostatic reserve and resiliency. Frailty predicts poor outcomes for older adults after acute care. However, it is not a concept familiar to many ED clinicians.

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supporting

confidence: 85%

“…6 The inter-rater reliability of the CFS between ED nurses and ED physicians in the United States is unknown. Recently, Ringer et al 7 demonstrated good inter-rater reliability between nurses and physicians/advanced practice providers for patients age 75 and older in a Canadian ED. There is no criterion standard for identifying frailty in the ED.…”

mentioning

confidence: 99%

Inter‐rater Reliability of Clinical Frailty Scores for Older Patients in the Emergency Department

Heinemann

Gray

et al. 2020

Academic Emergency Medicine

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“…However, it is likely that this bias was limited as there are several studies indicating sufficient interrater reliability of the CFS. [29][30][31][32] Although there is still some variability in interrater agreement, the CFS is prognostically relevant. 30 The present study showed an important direction for future research.…”

Section: Discussionmentioning

confidence: 99%

Association between Clinical Frailty Scale score and hospital mortality in adult patients with COVID-19 (COMET): an international, multicentre, retrospective, observational cohort study

Sablerolles¹,

Lafeber²,

Kempen³

et al. 2021

The Lancet Healthy Longevity

100

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Background During the COVID-19 pandemic, the scarcity of resources has necessitated triage of critical care for patients with the disease. In patients aged 65 years and older, triage decisions are regularly based on degree of frailty measured by the Clinical Frailty Scale (CFS). However, the CFS could also be useful in patients younger than 65 years. We aimed to examine the association between CFS score and hospital mortality and between CFS score and admission to intensive care in adult patients of all ages with COVID-19 across Europe. Methods This analysis was part of the COVID Medication (COMET) study, an international, multicentre, retrospective observational cohort study in 63 hospitals in 11 countries in Europe. Eligible patients were aged 18 years and older, had been admitted to hospital, and either tested positive by PCR for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or were judged to have a high clinical likelihood of having SARS-CoV-2 infection by the local COVID-19 expert team. CFS was used to assess level of frailty: fit (CFS 1-3), mildly frail (CFS 4-5), or frail (CFS 6-9). The primary outcome was hospital mortality. The secondary outcome was admission to intensive care. Data were analysed using a multivariable binary logistic regression model adjusted for covariates (age, sex, number of drugs prescribed, and type of drug class as a proxy for comorbidities). Findings Between March 30 and July 15, 2020, 2434 patients (median age 68 years [IQR 55-77]; 1480 [61%] men, 954 [30%] women) had CFS scores available and were included in the analyses. In the total sample and in patients aged 65 years and older, frail patients and mildly frail patients had a significantly higher risk of hospital mortality than fit patients (total sample: CFS 6-9 vs CFS 1-3 odds ratio [OR] 2•71 [95% CI 2•04-3•60], p<0•0001 and CFS 4-5 vs CFS 1-3 OR 1•54 [1•16-2•06], p=0•0030; age ≥65 years: CFS 6-9 vs CFS 1-3 OR 2•90 [2•12-3•97], p<0•0001 and CFS 4-5 vs CFS 1-3 OR 1•64 [1•20-2•25], p=0•0020). In patients younger than 65 years, an increased hospital mortality risk was only observed in frail patients (CFS 6-9 vs CFS 1-3 OR 2•22 [1•08-4•57], p=0•030; CFS 4-5 vs CFS 1-3 OR 1•08 [0•48-2•39], p=0•86). Frail patients had a higher incidence of admission to intensive care than fit patients (CFS 6-9 vs CFS 1-3 OR 1•54 [1•21-1•97], p=0•0010), whereas mildly frail patients had a lower incidence than fit patients (CFS 4-5 vs CFS 1-3 OR 0•71 [0•55-0•92], p=0•0090). Among patients younger than 65 years, frail patients had an increased incidence of admission to intensive care (CFS 6-9 vs CFS 1-3 OR 2•96 [1•98-4•43], p<0•0001), whereas mildly frail patients had no significant difference in incidence compared with fit patients (CFS 4-5 vs CFS 1-3 OR 0•93 [0•63-1•38], p=0•72). Among patients aged 65 years and older, frail patients had no significant difference in the incidence of admission to intensive care compared with fit patients (CFS 6-9 vs CFS 1-3 OR 1•27 [0•92-1•75], p=0•14), whereas mildly frail patients had a lower incide...

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“…This was done using the Clinical Frailty Scale (CFS), a 9-point global frailty scale that evaluates baseline mobility, energy, physical activity, and function (before consultation or discharge) 8 (Supplemental Figure 1), and has been applied in the ED with good inter-rater reliability. 9 Consistent with previous research, a CFS ≥ 5 was used to identify the presence of frailty. Patients with a CFS of 9 were excluded due to the high likelihood of short-term mortality.…”

Section: Identifying Frailtymentioning

confidence: 99%

Frailty and associated prognosis among older emergency department patients with suspected infection: A prospective, observational cohort study

Fernando

Guo

Lukasik

et al. 2020

CJEM

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Background Prognosis and disposition among older emergency department (ED) patients with suspected infection remains challenging. Frailty is increasingly recognized as a predictor of poor prognosis among critically ill patients; however, its association with clinical outcomes among older ED patients with suspected infection is unknown. Methods We conducted a multicenter prospective cohort study at two tertiary care EDs. We included older ED patients (≥75 years) with suspected infection. Frailty at baseline (before index illness) was explicitly measured for all patients by the treating physicians using the Clinical Frailty Scale (CFS). We defined frailty as a CFS 5–8. The primary outcome was 30-day mortality. We used multivariable logistic regression to adjust for known confounders. We also compared the prognostic accuracy of frailty with the Systemic Inflammatory Response Syndrome (SIRS) and Quick Sequential Organ Failure Assessment (qSOFA) criteria. Results We enrolled 203 patients, of whom 117 (57.6%) were frail. Frail patients were more likely to develop septic shock (adjusted odds ratio [aOR], 1.83; 95% confidence interval [CI], 1.08–2.51) and more likely to die within 30 days of ED presentation (aOR 2.05; 95% CI, 1.02–5.24). Sensitivity for mortality was highest among the CFS (73.1%; 95% CI, 52.2–88.4), compared with SIRS ≥ 2 (65.4%; 95% CI, 44.3–82.8) or qSOFA ≥ 2 (38.4; 95% CI, 20.2–59.4). Conclusions Frailty is a highly prevalent prognostic factor that can be used to risk-stratify older ED patients with suspected infection. ED clinicians should consider screening for frailty to optimize disposition in this population.

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Inter‐rater Agreement Between Self‐rated and Staff‐rated Clinical Frailty Scale Scores in Older Emergency Department Patients: A Prospective Observational Study

Cited by 18 publications

References 10 publications

Inter‐rater Reliability of Clinical Frailty Scores for Older Patients in the Emergency Department

Inter‐rater Reliability of Clinical Frailty Scores for Older Patients in the Emergency Department

Association between Clinical Frailty Scale score and hospital mortality in adult patients with COVID-19 (COMET): an international, multicentre, retrospective, observational cohort study

Frailty and associated prognosis among older emergency department patients with suspected infection: A prospective, observational cohort study

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