Melissa Shears1, Alyson Takaoka1, Bram Rochwerg2, Sean M Bagshaw3, Jennie Johnstone4, Amanda Holding5, Surenthar Tharmalingam6, Tina Millen1, France Clarke1, Kenneth Rockwood7, Guowei Li8, Lehana Thabane8, John Muscedere9, Henry T Stelfox10, Deborah J Cook11. 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: debcook@mcmaster.ca.
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.
PURPOSE: To describe pre-ICU frailty in critically illpatients 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.
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