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Validating a Standardised Approach in Administration of the Clinical Frailty Scale in Hospitalised Older Adults.
Ann Acad Med Singap. 2019 Apr; 48(4):115-124.AA

Abstract

INTRODUCTION

We developed a Clinical Frailty Scale algorithm (CFS-A) to minimise inter-rater variability and to facilitate wider application across clinical settings. We compared the agreement, diagnostic performance and predictive utility of CFS-A against standard CFS.

MATERIALS AND METHODS

We retrospectively analysed data of 210 hospitalised older adults (mean age, 89.4 years). Two independent raters assessed frailty using CFS-A. Agreement between CFS-A raters and with previously completed CFS was determined using Cohen's Kappa. Area under receiver operator characteristic curves (AUC) for both measures were compared against the Frailty Index (FI). Independent associations between these measures and adverse outcomes were examined using logistic regression.

RESULTS

Frailty prevalence were 81% in CFS and 96% in CFS-A. Inter-rater agreement between CFS-A raters was excellent (kappa 0.90, P <0.001) and there was moderate agreement between CFS-A and standard CFS (kappa 0.42, P <0.001). We found no difference in AUC against FI between CFS (0.91; 95% CI, 0.86-0.95) and CFS-A (0.89; 95% CI, 0.84-0.95; P <0.001). Both CFS (OR, 3.59; 95% CI, 2.28-5.67; P <0.001) and CFS-A (OR, 4.31; 95% CI, 2.41-7.69; P <0.001) were good predictors of mortality at 12 months. Similarly, CFS (OR, 2.59; 95% CI, 1.81-3.69; P <0.001) and CFS-A (OR, 3.58; 95% CI, 2.13-6.02; P <0.001) were also good predictors of institutionalisation and/or mortality after adjusting for age, sex and illness severity.

CONCLUSION

Our study corroborated the results on inter-rater reliability, diagnostic performance and predictive validity of CFS-A which has the potential for consistent and efficient administration of CFS in acute care settings.

Authors+Show Affiliations

Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Validation Study

Language

eng

PubMed ID

31131383

Citation

Chong, Edward, et al. "Validating a Standardised Approach in Administration of the Clinical Frailty Scale in Hospitalised Older Adults." Annals of the Academy of Medicine, Singapore, vol. 48, no. 4, 2019, pp. 115-124.
Chong E, Chia JQ, Law F, et al. Validating a Standardised Approach in Administration of the Clinical Frailty Scale in Hospitalised Older Adults. Ann Acad Med Singap. 2019;48(4):115-124.
Chong, E., Chia, J. Q., Law, F., Chew, J., Chan, M., & Lim, W. S. (2019). Validating a Standardised Approach in Administration of the Clinical Frailty Scale in Hospitalised Older Adults. Annals of the Academy of Medicine, Singapore, 48(4), 115-124.
Chong E, et al. Validating a Standardised Approach in Administration of the Clinical Frailty Scale in Hospitalised Older Adults. Ann Acad Med Singap. 2019;48(4):115-124. PubMed PMID: 31131383.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Validating a Standardised Approach in Administration of the Clinical Frailty Scale in Hospitalised Older Adults. AU - Chong,Edward, AU - Chia,Jia Qian, AU - Law,Felicia, AU - Chew,Justin, AU - Chan,Mark, AU - Lim,Wee Shiong, PY - 2019/5/28/entrez PY - 2019/5/28/pubmed PY - 2019/12/18/medline SP - 115 EP - 124 JF - Annals of the Academy of Medicine, Singapore JO - Ann Acad Med Singap VL - 48 IS - 4 N2 - INTRODUCTION: We developed a Clinical Frailty Scale algorithm (CFS-A) to minimise inter-rater variability and to facilitate wider application across clinical settings. We compared the agreement, diagnostic performance and predictive utility of CFS-A against standard CFS. MATERIALS AND METHODS: We retrospectively analysed data of 210 hospitalised older adults (mean age, 89.4 years). Two independent raters assessed frailty using CFS-A. Agreement between CFS-A raters and with previously completed CFS was determined using Cohen's Kappa. Area under receiver operator characteristic curves (AUC) for both measures were compared against the Frailty Index (FI). Independent associations between these measures and adverse outcomes were examined using logistic regression. RESULTS: Frailty prevalence were 81% in CFS and 96% in CFS-A. Inter-rater agreement between CFS-A raters was excellent (kappa 0.90, P <0.001) and there was moderate agreement between CFS-A and standard CFS (kappa 0.42, P <0.001). We found no difference in AUC against FI between CFS (0.91; 95% CI, 0.86-0.95) and CFS-A (0.89; 95% CI, 0.84-0.95; P <0.001). Both CFS (OR, 3.59; 95% CI, 2.28-5.67; P <0.001) and CFS-A (OR, 4.31; 95% CI, 2.41-7.69; P <0.001) were good predictors of mortality at 12 months. Similarly, CFS (OR, 2.59; 95% CI, 1.81-3.69; P <0.001) and CFS-A (OR, 3.58; 95% CI, 2.13-6.02; P <0.001) were also good predictors of institutionalisation and/or mortality after adjusting for age, sex and illness severity. CONCLUSION: Our study corroborated the results on inter-rater reliability, diagnostic performance and predictive validity of CFS-A which has the potential for consistent and efficient administration of CFS in acute care settings. SN - 0304-4602 UR - https://www.unboundmedicine.com/medline/citation/31131383/Validating_a_Standardised_Approach_in_Administration_of_the_Clinical_Frailty_Scale_in_Hospitalised_Older_Adults_ L2 - http://www.annals.edu.sg/pastIssue.cfm?pastMonth=4&amp;pastYear=2019 DB - PRIME DP - Unbound Medicine ER -