Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland.
Department of Emergency Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
Ann Emerg Med. 2020 Sep;76(3):291-300. doi: 10.1016/j.annemergmed.2020.03.028. Epub 2020 Apr 24.
We validate the Clinical Frailty Scale by examining its independent predictive validity for 30-day mortality, ICU admission, and hospitalization and by determining its reliability. We also determine frailty prevalence in our emergency department (ED) as measured with the Clinical Frailty Scale.
This was a prospective observational study including consecutive ED patients aged 65 years or older, from a single tertiary care center during a 9-week period. To examine predictive validity, association with mortality was investigated through a Cox proportional hazards regression; hospitalization and ICU transfer were investigated through multivariable logistic regression. We assessed reliability by calculating Cohen's weighted κ for agreement of experts who independently assigned Clinical Frailty Scale levels, compared with trained study assistants. Frailty was defined as a Clinical Frailty Scale score of 5 and higher.
A total of 2,393 patients were analyzed in this study, of whom 128 died. Higher frailty levels were associated with higher hazards for death independent of age, sex, and condition (medical versus surgical). The area under the curve for 30-day mortality prediction was 0.81 (95% confidence interval [CI] 0.77 to 0.85), for hospitalization 0.72 (95% CI 0.70 to 0.74), and for ICU admission 0.69 (95% CI 0.66 to 0.73). Interrater reliability between the reference standard and the study team was good (weighted Cohen's κ was 0.74; 95% CI 0.64 to 0.85). Frailty prevalence was 36.8% (n=880).
The Clinical Frailty Scale appears to be a valid and reliable instrument to identify frailty in the ED. It might provide ED clinicians with useful information for decisionmaking in regard to triage, disposition, and treatment.
通过考察临床虚弱量表对 30 天死亡率、重症监护病房（ICU）入院和住院的独立预测效度，并确定其可靠性，对该量表进行验证。我们还通过临床虚弱量表来确定我们急诊科（ED）的虚弱发生率。
这是一项前瞻性观察性研究，纳入了在为期 9 周内来自一家三级护理中心的年龄在 65 岁及以上的连续 ED 患者。为了考察预测效度，我们通过 Cox 比例风险回归来研究与死亡率的相关性；通过多变量逻辑回归来研究与住院和 ICU 转移的相关性。我们通过计算专家独立分配临床虚弱量表等级与经过培训的研究助理之间的一致性的 Cohen 加权κ来评估可靠性。虚弱被定义为临床虚弱量表评分为 5 分及以上。
本研究共分析了 2393 例患者，其中 128 例死亡。较高的虚弱程度与独立于年龄、性别和病情（内科与外科）的死亡风险增加相关。30 天死亡率预测的曲线下面积为 0.81（95%置信区间 [CI] 0.77 至 0.85），住院率为 0.72（95% CI 0.70 至 0.74），ICU 入院率为 0.69（95% CI 0.66 至 0.73）。参考标准与研究团队之间的观察者间信度良好（加权 Cohen's κ 为 0.74；95% CI 0.64 至 0.85）。虚弱的发生率为 36.8%（n=880）。
临床虚弱量表似乎是一种在 ED 中识别虚弱的有效且可靠的工具。它可能为 ED 临床医生提供有用的信息，以便在分诊、处置和治疗方面做出决策。
