Agreement and predictive value of the Clinical Frailty Scale in hospitalised older patients

Abstract

Abstract Purpose: Our objective was to determine the agreement of the Clinical Frailty Scale (CFS) by comparing scores obtained by a senior geriatrician, a junior geriatrician, and by using a 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 senior and junior geriatricians based on clinical judgement. Another junior geriatrician, who did not have a treatment relationship with the patient, scored the CFS using the classification tree. Intraclass correlation coefficient (ICC) was calculated to assess agreement. A ROC curve and Cox regression model determined prognostic value. Results: In total, 97 patients with a mean age of 86 years (SD 5.2) were included. The reliability 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 senior geriatrician’s CFS was 0.774. 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 3.476, [1.531-7.888], p = 0.003). Conclusion: The CFS classification tree can help standardize CFS scoring, enhancing reliability when used by less experienced raters.