Assessing frailty in the intensive care unit: A reliability and validity study

Melissa Shears; Alyson Takaoka; Bram Rochwerg; Sean M Bagshaw; Jennie Johnstone; Amanda Holding; Surenthar Tharmalingam; Tina Millen; France Clarke; Kenneth Rockwood; Guowei Li; Lehana Thabane; John Muscedere; Henry T Stelfox; Deborah J Cook; Canadian Critical Care Trials Group

doi:10.1016/j.jcrc.2018.02.004

Assessing frailty in the intensive care unit: A reliability and validity study

J Crit Care. 2018 Jun:45:197-203. doi: 10.1016/j.jcrc.2018.02.004. Epub 2018 Feb 8.

Authors

Affiliations

¹ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.
² Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada; Departments of Medicine, McMaster University, Hamilton, Canada.
³ Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
⁴ Public Health Ontario, Toronto, Ontario, Canada; Ontario and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
⁵ Department of Occupational Therapy, St. Joseph's Healthcare, Hamilton, Canada.
⁶ Department of Geriatric Medicine, McMaster University, Hamilton, Canada.
⁷ Department of Medicine, Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
⁸ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada; Biostatistics Unit, St Joseph's Healthcare, Hamilton, ON, Canada.
⁹ Department of Critical Care Medicine, Queens University, Kingston, Ontario, Canada.
¹⁰ Department of Critical Care Medicine, O'Brien Institute for Public Health, University of Calgary, Calgary, Canada.
¹¹ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada; Departments of Medicine, McMaster University, Hamilton, Canada. Electronic address: [email protected].

PMID: 29574340
DOI: 10.1016/j.jcrc.2018.02.004

Abstract

Purpose: To describe pre-ICU frailty in critically ill patients using the Clinical Frailty Scale (CFS).

Methods: We included patients ≥18years admitted to 2 ICUs in Hamilton, Canada. The ICU Research Coordinator (RC) generated 3 CFS scores using: 1) chart review, 2) family interview, 3) patient interview. Subsequently, an overall impression was captured in a final score. Mean differences were calculated to assess the RC intra-rater reliability and inter-rater reliability of chart reviews by the RC, Occupational Therapist (OT), and Geriatrics Resident (GR). Scores were also compared between younger and older patients. We also analyzed the relationship between CFS scores and mortality.

Results: We prospectively enrolled 150 patients (mean age 63.8 [SD 15.3] years, APACHE II score 21 [SD 7.3]). CFS were similar between RC, OT, and GR chart reviews (p>0.05 for all comparisons). There was no difference between RC chart review and RC final score, or between RC patient interview and RC final score. Scores following the RC family interview and the RC final score were significantly different (-0.24, 95% CI -0.38, -0.09, p<0.01). Each 1-point increase in the final CFS scored by the RC was weakly associated with ICU mortality (odds ratio 1.18, 95% CI 0.84-1.66, p=0.33), and hospital mortality (OR 1.19, 95% CI 0.89, -1.59, p=0.24).

Conclusions: CFS scores can be generated using medical chart review and can be reliably completed by ICU clinicians and research staff.

Keywords: Clinical research; Critical care; Frailty; Geriatrician; Intensive care unit; Occupational therapy.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't
Validation Study

MeSH terms

APACHE
Aged
Critical Care
Critical Illness / mortality*
Female
Frailty*
Geriatric Assessment*
Hospital Mortality
Humans
Intensive Care Units
Male
Middle Aged
Ontario
Prospective Studies
Reproducibility of Results

Grants and funding

CIHR/Canada