Surkan Megan, Rajabali Naheed, Bagshaw Sean M, Wang Xiaoming, Rolfson Darryl
Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB.
Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB.
Can Geriatr J. 2020 Sep 1;23(3):235-241. doi: 10.5770/cgj.23.398. eCollection 2020 Sep.
The Clinical Frailty Scale (CFS) is a commonly used frailty measure in intensive care unit (ICU) settings. We are interested in the test characteristics, especially interrater reliability, of the CFS in ICU by comparing the scores of intensivists to geriatricians.
We conducted a prospective cohort study on a convenience sample of newly admitted patients to an ICU in Edmonton, Canada. An intensivist and a resident in Geriatric Medicine (GM) independently assigned a CFS score on 158 adults within 72 hours of admission. A specialist in Geriatric Medicine assigned a CFS score independently of 20 of the 158 patients to assess agreement between the two raters trained in geriatrics. Predictive validity was captured using mortality and length of stay.
Agreement on CFS score was fair for intensivists vs. GM resident (kappa 0.32) and for intensivists vs. GM specialist (0.29), but substantial for GM resident vs. staff (0.79). Despite this, the CFS remained prognostically relevant, regardless of rater background. Frailty (CFS ≥ 5) as assessed by either intensivist or GM resident was a strong predictor of in-hospital mortality (odds ratio [OR] 3.6; 95% CI, 1.6-8.4, = .003 and OR 3.0; 95% CI 1.3-6.9; = .01, respectively). Frailty was also positively correlated with age, illness severity measured by APACHE II score, and length of hospital stay.
The interrater reliability of the CFS in ICU settings is fair for intensivists vs. geriatricians.
临床衰弱量表（CFS）是重症监护病房（ICU）环境中常用的衰弱测量工具。我们通过比较重症监护医生和老年病医生的评分，来研究ICU中CFS的测试特征，尤其是评分者间信度。
我们对加拿大埃德蒙顿一家ICU新入院患者的便利样本进行了一项前瞻性队列研究。一名重症监护医生和一名老年医学住院医师在患者入院72小时内独立为158名成年人评定CFS分数。一名老年医学专家独立为158名患者中的20名评定CFS分数，以评估两名接受老年医学培训的评分者之间的一致性。通过死亡率和住院时间来评估预测效度。
重症监护医生与老年医学住院医师之间以及重症监护医生与老年医学专家之间在CFS评分上的一致性一般（kappa值分别为0.32和0.29），但老年医学住院医师与工作人员之间的一致性较高（0.79）。尽管如此，无论评分者背景如何，CFS在预后方面仍然具有相关性。由重症监护医生或老年医学住院医师评估的衰弱（CFS≥5）是院内死亡率的有力预测指标（优势比[OR]分别为3.6；95%CI，1.6 - 8.4，P = 0.003和OR 3.0；95%CI 1.3 - 6.9；P = 0.01）。衰弱也与年龄、用急性生理学及慢性健康状况评分系统II（APACHE II）评分衡量的疾病严重程度以及住院时间呈正相关。
在ICU环境中，重症监护医生与老年病医生之间CFS的评分者间信度一般。
