School of Allied Health, University of Limerick, Limerick, Ireland
Department of Ageing and Therapeutics, Univeristy Hospital Limerick, Limerick, Ireland.
BMJ Open. 2021 Jan 20;11(1):e040765. doi: 10.1136/bmjopen-2020-040765.
Frailty is a common condition affecting older adults and is associated with increased mortality and adverse outcomes. Identification of older adults at risk of adverse outcomes is central to subsequent resource planning and targeted interventions. This systematic review and meta-analysis will examine the: (1) diagnostic accuracy of the Clinical Frailty Scale (CFS) in identifying hospitalised adults ≥65 years with frailty and a medical diagnosis compared with the reference standard Frailty Index or Frailty Phenotype and (2) predictive value of the CFS in determining those at increased risk of subsequent adverse outcomes.
We will include cross-sectional, retrospective and prospective cohort studies, and randomised controlled trials that assess either the diagnostic accuracy of the CFS when compared with the reference standard Frailty Index/Frailty Phenotype or the predictive validity of the CFS to predict subsequent adverse outcomes in hospitalised adults over 65 years with medical complaints. Adverse outcomes include falls, functional decline, unplanned Emergency Department attendance, emergency rehospitalisation, nursing home admission or death. A systematic search will be conducted in Embase, AMED, MEDLINE (Ebsco, Ovid, Pubmed), CINAHL, PsycINFO, Cochrane Library. Studies will be limited to those published from 2005 to 30 October 2019. Two independent reviewers will screen all titles and abstracts to identify relevant studies. The methodological quality of studies will be independently assessed using the Quality Assessment of Diagnostic Accuracy Studies-2. A CFS score of >4 will be used to identify frailty. We will construct 2×2 tables and determine true positives, true negatives, false positives and false negatives for each study when compared with the reference standard and for each adverse outcome. A bivariate random effects model will be applied to generate pooled summary estimates of sensitivity and specificity.
Ethical approval is not required for this systematic review. We will disseminate our findings through a peer-reviewed journal.
衰弱是一种常见的老年病，与死亡率增加和不良结局相关。识别有不良结局风险的老年人是后续资源规划和有针对性干预的核心。本系统评价和荟萃分析将检查：（1）临床虚弱量表（CFS）在识别与参考标准虚弱指数或虚弱表型相比患有衰弱和医疗诊断的住院成年人（≥65 岁）的诊断准确性，以及（2）CFS 在确定那些有更高风险的后续不良结局的预测价值。
我们将包括横断面、回顾性和前瞻性队列研究，以及随机对照试验，评估 CFS 与参考标准虚弱指数/虚弱表型相比的诊断准确性，或 CFS 预测 65 岁以上有医疗投诉的住院成年人后续不良结局的预测价值。不良结局包括跌倒、功能下降、非计划性急诊科就诊、紧急再住院、疗养院入院或死亡。将在 Embase、AMED、MEDLINE（Ebsco、Ovid、Pubmed）、CINAHL、PsycINFO、Cochrane Library 中进行系统搜索。研究将限于 2005 年至 2019 年 10 月 30 日发表的研究。两名独立审查员将筛选所有标题和摘要以确定相关研究。使用诊断准确性研究质量评估-2 独立评估研究的方法学质量。CFS 评分>4 将用于识别衰弱。我们将为每个研究构建 2×2 表，并确定与参考标准相比的真阳性、真阴性、假阳性和假阴性，以及每个不良结局。将应用双变量随机效应模型生成敏感性和特异性的汇总估计值。
本系统评价不需要伦理批准。我们将通过同行评审期刊传播我们的研究结果。
