The hospital frailty risk score is of limited value in intensive care unit patients

Bruno, Raphael Romano; Wernly, Bernhard; Schölzel, Fabian; Kelm, Malte; Jung, Christian

doi:10.1186/s13054-019-2520-8

Cited by 33 publications

(29 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The result of the assessment should help to predict the patient's clinical course. Redfern et al confirmed previously published studies showing that the HFRS does not predict mortality in critically ill patients [5]. On the contrary, the CFS has been shown to estimate intra-hospital survival [2].…”

Section: Dear Editormentioning

confidence: 58%

Frailty assessment in very old intensive care patients: the Hospital Frailty Risk Score answers another question

et al. 2020

Self Cite

View full text Add to dashboard Cite

Section: Dear Editormentioning

confidence: 58%

Frailty assessment in very old intensive care patients: the Hospital Frailty Risk Score answers another question

et al. 2020

Self Cite

View full text Add to dashboard Cite

“…Gilbert et al [4] have proposed an alternative frailty measure (the Hospital Frailty Risk Score, HFRS) that can be calculated using diagnostic coding within the electronic patient record (EPR). The HFRS is associated with higher mortality in hospitalised patients, although this might not extend to the critical care population [4,5]. We hypothesised that, even if frailty is not explicitly measured, a comparable assessment would form part of the decision to admit patients to the Intensive Care Unit (ICU).…”

Section: Lettermentioning

confidence: 99%

Frailty and unplanned admissions to the intensive care unit: a retrospective cohort study in the UK

et al. 2020

View full text Add to dashboard Cite

“…The HFRS has been widely adopted, but diagnostic information from past admissions is inconsistently used. 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 At face value, using more information is always better, increasing the likelihood that the HFRS captures the true effect of frailty risk on patient outcomes. However, obtaining historical data might incur costs and, even if these costs were marginal, they might not be worth incurring if the extra data do not offer substantial additional information.…”

Section: Introductionmentioning

confidence: 99%

“…Some studies apply a 2-year window, 3 , 4 , 5 , 6 as recommended by Gilbert and colleagues. 2 Some studies use information from the current admission alone, 7 , 8 , 9 , 10 whereas others look back over the preceding 3 months, 11 , 12 the preceding year, 13 , 14 and even up to the preceding 15 years. 15 , 16 In some studies, the look-back period is not specified.…”

Section: Introductionmentioning

confidence: 99%

The use of linked routine data to optimise calculation of the Hospital Frailty Risk Score on the basis of previous hospital admissions: a retrospective observational cohort study

Street

Maynou

Gilbert

et al. 2021

The Lancet Healthy Longevity

View full text Add to dashboard Cite

Summary Background The Hospital Frailty Risk Score (HFRS) has been widely but inconsistently applied in published studies, particularly in how diagnostic information recorded in previous hospital admissions is used in its construction. We aimed to assess how many previous admissions should be considered when constructing the HFRS and the influence of frailty risk on long length of stay, in-hospital mortality, and 30-day readmission. Methods This is a retrospective observational cohort study of patients aged 75 years or older who had at least one emergency admission to any of 49 hospital sites in the Yorkshire and Humber region of England, UK. We constructed multiple versions of the HFRS for each patient, each form incorporating diagnostic data from progressively more previous admissions in its construction within a 1-year or 2-year window. We assessed the ability of each form of the HFRS to predict long length of stay (>10 days), in-hospital death, and 30-day readmission. Findings Between April 1, 2013, and March 31, 2017, 282 091 patients had 675 155 hospital admissions. Regression analyses assessing the different constructions of HFRS showed that the form constructed with diagnostic information recorded in the current and previous two admissions within the preceding 2 years performed best for predicting all three outcomes. Under this construction, 263 432 (39·0%) of 674 615 patient admissions were classified as having low frailty risk, for whom 33 333 (12·7%) had a long length of stay, 10 145 (3·9%) died in hospital, and 45 226 (17·2%) were readmitted within 30 days. By contrast with those patients with low frailty risk, for those with intermediate frailty risk, the probability was 2·5-times higher (95% CI 2·4 to 2·6) for long length of stay, 2·17-times higher (2·1 to 2·2) for in-hospital death, and 0·7% higher (0·5 to 1) for readmission. For patients with high frailty risk, the probability was 4·3-times higher (4·2 to 4·5) for long length of stay, 2·48-times higher (2·4 to 2·6) for in-hospital death, and −1% (−1·2 to −0·5) lower for readmission than those with low frailty risk. The intermediate and high frailty risk categories were more important predictors of long length of stay than any of the other rich set of control variables included in our analysis. These categories also proved to be important predictors of in-hospital mortality, with only the Charlson Comorbidity Index offering greater predictive power. Interpretation We recommend constructing the HFRS with diagnostic information from the current admission and from the previous two admissions in the preceding 2 years. This HFRS form was a powerful predictor of long length of stay and in-hospital mortality, but less so of emergency readmissions. Funding National Institute of Health Research.

show abstract

The hospital frailty risk score is of limited value in intensive care unit patients

Cited by 33 publications

References 5 publications

Frailty assessment in very old intensive care patients: the Hospital Frailty Risk Score answers another question

Frailty assessment in very old intensive care patients: the Hospital Frailty Risk Score answers another question

Frailty and unplanned admissions to the intensive care unit: a retrospective cohort study in the UK

The use of linked routine data to optimise calculation of the Hospital Frailty Risk Score on the basis of previous hospital admissions: a retrospective observational cohort study

Contact Info

Product

Resources

About