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Agreement and predictive value of the clinical frailty scale in hospitalized older patients

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Key summary points

AbstractSection Aim

External validation of the clinical frailty scale (CFS) classification tree by determining the agreement and predictive value of the CFS when attributed by a senior geriatrician, a junior geriatrician, or using the classification tree.

AbstractSection Findings

The CFS classification tree demonstrates moderate agreement with the senior geriatrician CFS and has predictive value for 6-month mortality in patients admitted to an acute geriatric unit.

AbstractSection Message

These findings suggest that the classification tree can help standardize CFS scoring, thereby improving reliability when used by less-experienced raters.

Abstract

Purpose

Our objective was to perform an external validity study of the clinical frailty scale (CFS) classification tree by determining the agreement of the CFS when attributed by a senior geriatrician, a junior geriatrician, or using the classification tree. Additionally, we evaluated the predictive value of the CFS for 6-month mortality after admission to an acute geriatric unit.

Methods

This prospective study was conducted in two acute geriatric units in Belgium. The premorbid CFS was determined by a senior and a junior geriatrician based on clinical judgment within the first 72 h of admission. Another junior geriatrician, who did not have a treatment relationship with the patient, scored the CFS using the classification tree. Intra-class correlation coefficient (ICC) was calculated to assess agreement. A ROC curve and Cox regression model determined prognostic value.

Results

In total, 97 patients were included (mean age 86 ± 5.2; 66% female). Agreement of the CFS, when determined by the senior geriatrician and the classification tree, was moderate (ICC 0.526, 95% CI [0.366–0.656]). This is similar to the agreement between the senior and junior geriatricians’ CFS (ICC 0.643, 95% CI [0.510–0.746]). The AUC for 6-month mortality based on the CFS by respectively the classification tree, the senior and junior geriatrician was 0.719, 95% CI [0.592–0.846]; 0.774, 95% CI [0.673–0.875]; 0.774, 95% CI [0.665–0.882]. Cox regression analysis indicated that severe or very severe frailty was associated with a higher risk of mortality compared to mild or moderate frailty (hazard ratio respectively 6.274, 95% CI [2.613–15.062] by the classification tree; 3.476, 95% CI [1.531–7.888] by the senior geriatrician; 4.851, 95% CI [1.891–12.442] by the junior geriatrician).

Conclusion

Interrater agreement in CFS scoring on clinical judgment without Comprehensive Geriatric Assessment is moderate. The CFS classification tree can help standardize CFS scoring.

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Data availability

All data relevant to the study can be attained through reasonable request from the corresponding author (Ruth.Piers@uzgent.be).

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Acknowledgements

We would like to acknowledge Soetkin De Raedt, Marie De Groote, Han Martens, and Raf Van Hoeyweghen for their contribution in patient recruitment and data collection.

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Authors and Affiliations

  1. Department of Geriatrics, Ghent University Hospital, Ghent, Belgium

    Liese Lanckmans, Nele Van Den Noortgate & Ruth Piers

  2. School of Physiotherapy, Dalhousie University, Halifax, NS, Canada

    Olga Theou

  3. Geriatric Medicine, Dalhousie University, Halifax, NS, Canada

    Olga Theou

Authors
  1. Liese Lanckmans
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  2. Olga Theou
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  3. Nele Van Den Noortgate
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  4. Ruth Piers
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Contributions

Study concept and design were developed by Olga Theou and Ruth Piers. Liese Lanckmans conducted material preparation and data collection. Data analysis and interpretation were performed by Liese Lanckmans, Ruth Piers, and Nele Van Den Noortgate. Liese Lanckmans drafted the initial manuscript, and all authors provided feedback on previous versions. All authors reviewed and approved the final manuscript.

Corresponding author

Correspondence to Ruth Piers.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Ethics approval

The study protocol was approved by the Ghent University Hospital Ethical Committee (reference number THE-2023-0187). The study was performed in accordance with the Declaration of Helsinki.

Consent

Before enrollment, all included patients or their legal representative provided written informed consent.

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Lanckmans, L., Theou, O., Van Den Noortgate, N. et al. Agreement and predictive value of the clinical frailty scale in hospitalized older patients. Eur Geriatr Med 15, 1339–1345 (2024). https://doi.org/10.1007/s41999-024-01026-6

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  • DOI: https://doi.org/10.1007/s41999-024-01026-6

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