Table- Based Clinical Frailty Scale—agreement Between Ed Physicians, Patients and Caregivers
Abstract
Frailty predicts adverse health outcomes, and the Clinical Frailty Scale (CFS) has been validated internationally to predict adverse outcomes and mortality. Emergency Departments (ED) are challenged to assess frailty due to a lack of training and limited time. We studied the agreement between ED physicians and patient self-assessments using a tablet-based CFS that includes graphics and short descriptors for each of 9 frailty categories. We conducted a prospective observational cohort study of people >65 years seen in the ED of 3 Canadian academic centers. We excluded patients who were critically ill, visually impaired, or unable to communicate in English or French. We compared agreement on the tablet-based CFS between 4 categories of assessors: Patients, ED physicians, trained research assistants and caregivers using the kappa statistic. We enrolled 274/380 eligible patients who provided complete data (72.1%). Their average age was 75.8 years, and 48.9% were female. Their median MOCA score was 23/30 (IQR = 17 – 26) and their median OARS was 26/28 (IQR 22–28). Agreement between physicians and research assistants was good (κ=0.60, 95% CI 0.50 – 0.70), as was physician-caregiver agreement and patient-caregiver agreement (κ=0.66, 95% CI 0.40 – 0.93). Agreement between ED physicians and patients was only moderate (κ =0.47, 95% CI 0.36 – 0.58).ED physicians more often rated patients as frail (40% vs 29%, p<0.001). There was less agreement between ED physicians and patient self-assessments for the CFS compared to physicians-research assistant agreement and care-giver patient assessments. Future research should validate whether patient or physician assessments have higher predictive validity of frailty.
Authors: J.S. Lee, Judah Goldstein, Mary Catherine Tierney, Marie‐Josée Sirois, Mark Chignell, Michael Nolan, Kenneth J. Rockwood, Marcel Émond
Published in: Innovation in Aging (2017)