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

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

Canadian Critical Care Trials Group

Research output: Contribution to journal › Article › peer-review

100 Citations (Scopus)

Abstract

Purpose: To describe pre-ICU frailty in critically ill patients using the Clinical Frailty Scale (CFS). Methods: We included patients ≥18 years 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.

Original language	English
Pages (from-to)	197-203
Number of pages	7
Journal	Journal of Critical Care
Volume	45
DOIs	https://doi.org/10.1016/j.jcrc.2018.02.004
Publication status	Published - Jun 2018

Bibliographical note

Funding Information:
This study was funded by the Canadian Frailty Network ( TG2015-20 ). J Muscedere as Scientific Director was not involved in the peer review of this grant.

Funding Information:
S Bagshaw is supported by a Canada Research Chair in Critical Care Nephrology from the Canadian Institutes of Health Research. K Rockwood is the Kathryn Allen Weldon Professor of Alzheimer Research at Dalhousie University. J Muscedere is the Scientific Director for the Canadian Frailty Network. HT Stelfox is supported by an Embedded Clinician Researcher Award from the Canadian Institutes of Health Research. D Cook holds a Canada Research Chair in Critical Care Knowledge Translation from the Canadian Institutes of Health Research.

Publisher Copyright:
© 2018 Elsevier Inc.

ASJC Scopus Subject Areas

Critical Care and Intensive Care Medicine

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10.1016/j.jcrc.2018.02.004

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@article{a0e15d50bfbd43be81cfd58e36811e5b,

title = "Assessing frailty in the intensive care unit: A reliability and validity study",

abstract = "Purpose: To describe pre-ICU frailty in critically ill patients using the Clinical Frailty Scale (CFS). Methods: We included patients ≥18 years 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.",

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

note = "Funding Information: This study was funded by the Canadian Frailty Network ( TG2015-20 ). J Muscedere as Scientific Director was not involved in the peer review of this grant. Funding Information: S Bagshaw is supported by a Canada Research Chair in Critical Care Nephrology from the Canadian Institutes of Health Research. K Rockwood is the Kathryn Allen Weldon Professor of Alzheimer Research at Dalhousie University. J Muscedere is the Scientific Director for the Canadian Frailty Network. HT Stelfox is supported by an Embedded Clinician Researcher Award from the Canadian Institutes of Health Research. D Cook holds a Canada Research Chair in Critical Care Knowledge Translation from the Canadian Institutes of Health Research. Publisher Copyright: {\textcopyright} 2018 Elsevier Inc.",

year = "2018",

month = jun,

doi = "10.1016/j.jcrc.2018.02.004",

language = "English",

volume = "45",

pages = "197--203",

journal = "Journal of Critical Care",

issn = "0883-9441",

publisher = "Elsevier BV",

}

TY - JOUR

T1 - Assessing frailty in the intensive care unit

T2 - A reliability and validity study

AU - Canadian Critical Care Trials Group

AU - Shears, Melissa

AU - Takaoka, Alyson

AU - Rochwerg, Bram

AU - Bagshaw, Sean M.

AU - Johnstone, Jennie

AU - Holding, Amanda

AU - Tharmalingam, Surenthar

AU - Millen, Tina

AU - Clarke, France

AU - Rockwood, Kenneth

AU - Li, Guowei

AU - Thabane, Lehana

AU - Muscedere, John

AU - Stelfox, Henry T.

AU - Cook, Deborah J.

N1 - Funding Information: This study was funded by the Canadian Frailty Network ( TG2015-20 ). J Muscedere as Scientific Director was not involved in the peer review of this grant. Funding Information: S Bagshaw is supported by a Canada Research Chair in Critical Care Nephrology from the Canadian Institutes of Health Research. K Rockwood is the Kathryn Allen Weldon Professor of Alzheimer Research at Dalhousie University. J Muscedere is the Scientific Director for the Canadian Frailty Network. HT Stelfox is supported by an Embedded Clinician Researcher Award from the Canadian Institutes of Health Research. D Cook holds a Canada Research Chair in Critical Care Knowledge Translation from the Canadian Institutes of Health Research. Publisher Copyright: © 2018 Elsevier Inc.

PY - 2018/6

Y1 - 2018/6

N2 - Purpose: To describe pre-ICU frailty in critically ill patients using the Clinical Frailty Scale (CFS). Methods: We included patients ≥18 years 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.

AB - Purpose: To describe pre-ICU frailty in critically ill patients using the Clinical Frailty Scale (CFS). Methods: We included patients ≥18 years 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.

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JO - Journal of Critical Care

JF - Journal of Critical Care

ER -

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

Abstract

Bibliographical note

ASJC Scopus Subject Areas

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