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Reliability of the clinical frailty scale in very elderly ICU patients : a prospective European study

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Abstract
Purpose Frailty is a valuable predictor for outcome in elderly ICU patients, and has been suggested to be used in various decision-making processes prior to and during an ICU admission. There are many instruments developed to assess frailty, but few of them can be used in emergency situations. In this setting the clinical frailty scale (CFS) is frequently used. The present study is a sub-study within a larger outcome study of elderly ICU patients in Europe (the VIP-2 study) in order to document the reliability of the CFS. Materials and methods From the VIP-2 study, 129 ICUs in 20 countries participated in this sub-study. The patients were acute admissions >= 80 years of age and frailty was assessed at admission by two independent observers using the CFS. Information was obtained from the patient, if not feasible, from the family/caregivers or from hospital files. The profession of the rater and source of data were recorded along with the score. Interrater variability was calculated using linear weighted kappa analysis. Results 1923 pairs of assessors were included and background data of patients were similar to the whole cohort (n = 3920). We found a very high inter-rater agreement (weighted kappa 0.86), also in subgroup analyses. The agreement when comparing information from family or hospital records was better than using only direct patient information, and pairs of raters from same profession performed better than from different professions. Conclusions Overall, we documented a high reliability using CFS in this setting. This frailty score could be used more frequently in elderly ICU patients in order to create a more holistic and realistic impression of the patient ' s condition prior to ICU admission.
Keywords
Critical Care and Intensive Care Medicine, Clinical frailty scale, Inter-rater variability, Intensive care, Octogenarians

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MLA
Flaatten, Hans, et al. “Reliability of the Clinical Frailty Scale in Very Elderly ICU Patients : A Prospective European Study.” ANNALS OF INTENSIVE CARE, vol. 11, no. 1, 2021, doi:10.1186/s13613-021-00815-7.
APA
Flaatten, H., the VIP2 Study Group, [missing], Guidet, B., Andersen, F. H., Artigas, A., Cecconi, M., … de Lange, D. W. (2021). Reliability of the clinical frailty scale in very elderly ICU patients : a prospective European study. ANNALS OF INTENSIVE CARE, 11(1). https://doi.org/10.1186/s13613-021-00815-7
Chicago author-date
Flaatten, Hans, [missing] the VIP2 Study Group, Bertrand Guidet, Finn H. Andersen, Antonio Artigas, Maurizio Cecconi, Ariane Boumendil, et al. 2021. “Reliability of the Clinical Frailty Scale in Very Elderly ICU Patients : A Prospective European Study.” ANNALS OF INTENSIVE CARE 11 (1). https://doi.org/10.1186/s13613-021-00815-7.
Chicago author-date (all authors)
Flaatten, Hans, [missing] the VIP2 Study Group, Bertrand Guidet, Finn H. Andersen, Antonio Artigas, Maurizio Cecconi, Ariane Boumendil, Muhammed Elhadi, Jesper Fjølner, Michael Joannidis, Christian Jung, Susannah Leaver, Brian Marsh, Rui Moreno, Sandra Oeyen, Yuriy Nalapko, Joerg C. Schefold, Wojciech Szczeklik, Sten Walther, Ximena Watson, Tilemachos Zafeiridis, and Dylan W. de Lange. 2021. “Reliability of the Clinical Frailty Scale in Very Elderly ICU Patients : A Prospective European Study.” ANNALS OF INTENSIVE CARE 11 (1). doi:10.1186/s13613-021-00815-7.
Vancouver
1.
Flaatten H, the VIP2 Study Group [missing], Guidet B, Andersen FH, Artigas A, Cecconi M, et al. Reliability of the clinical frailty scale in very elderly ICU patients : a prospective European study. ANNALS OF INTENSIVE CARE. 2021;11(1).
IEEE
[1]
H. Flaatten et al., “Reliability of the clinical frailty scale in very elderly ICU patients : a prospective European study,” ANNALS OF INTENSIVE CARE, vol. 11, no. 1, 2021.
@article{8692258,
  abstract     = {{Purpose Frailty is a valuable predictor for outcome in elderly ICU patients, and has been suggested to be used in various decision-making processes prior to and during an ICU admission. There are many instruments developed to assess frailty, but few of them can be used in emergency situations. In this setting the clinical frailty scale (CFS) is frequently used. The present study is a sub-study within a larger outcome study of elderly ICU patients in Europe (the VIP-2 study) in order to document the reliability of the CFS. Materials and methods From the VIP-2 study, 129 ICUs in 20 countries participated in this sub-study. The patients were acute admissions >= 80 years of age and frailty was assessed at admission by two independent observers using the CFS. Information was obtained from the patient, if not feasible, from the family/caregivers or from hospital files. The profession of the rater and source of data were recorded along with the score. Interrater variability was calculated using linear weighted kappa analysis. Results 1923 pairs of assessors were included and background data of patients were similar to the whole cohort (n = 3920). We found a very high inter-rater agreement (weighted kappa 0.86), also in subgroup analyses. The agreement when comparing information from family or hospital records was better than using only direct patient information, and pairs of raters from same profession performed better than from different professions. Conclusions Overall, we documented a high reliability using CFS in this setting. This frailty score could be used more frequently in elderly ICU patients in order to create a more holistic and realistic impression of the patient ' s condition prior to ICU admission.}},
  articleno    = {{22}},
  author       = {{Flaatten, Hans and the VIP2 Study Group, [missing] and Guidet, Bertrand and Andersen, Finn H. and Artigas, Antonio and Cecconi, Maurizio and Boumendil, Ariane and Elhadi, Muhammed and Fjølner, Jesper and Joannidis, Michael and Jung, Christian and Leaver, Susannah and Marsh, Brian and Moreno, Rui and Oeyen, Sandra and Nalapko, Yuriy and Schefold, Joerg C. and Szczeklik, Wojciech and Walther, Sten and Watson, Ximena and Zafeiridis, Tilemachos and de Lange, Dylan W.}},
  issn         = {{2110-5820}},
  journal      = {{ANNALS OF INTENSIVE CARE}},
  keywords     = {{Critical Care and Intensive Care Medicine,Clinical frailty scale,Inter-rater variability,Intensive care,Octogenarians}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{7}},
  title        = {{Reliability of the clinical frailty scale in very elderly ICU patients : a prospective European study}},
  url          = {{http://dx.doi.org/10.1186/s13613-021-00815-7}},
  volume       = {{11}},
  year         = {{2021}},
}

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