Department of Emergency Medicine and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
Acad Emerg Med. 2022 Dec;29(12):1431-1437. doi: 10.1111/acem.14603. Epub 2022 Oct 19.
As frailty among the elderly is receiving increasing attention in emergency departments (EDs) around the world, the use of frailty assessment tools is growing. An often used such tool is the Clinical Frailty Scale (CFS), whose inter-rater reliability has been sparingly investigated in ED settings. No inter-rater reliability study regarding CFS has previously been performed within the Scandinavian ED context. The primary aim of this study was to evaluate the inter-rater reliability of the CFS in a Swedish ED setting.
This was a prospective observational study conducted at three Swedish EDs. Patients ≥65 years were independently assessed with CFS by their responsible physician, registered nurse, and assistant nurse. Demographic information for each assessor was collected, along with frailty status (frail/not frail) on the basis of clinical judgment. Inter-rater reliability was calculated using intraclass correlation coefficient (ICC), whereas agreement of frailty assessed by CFS (dichotomized between frail/not frail, cutoff at ≥5 points) versus solely by clinical judgment was calculated by using cross-tabulation.
One-hundred patients were included. We found inter-rater reliability to be moderate to good (ICC 0.78, 95% confidence interval [CI] 0.72-0.84), regardless of whether the care team included an emergency physician (ICC 0.74, 95% CI 0.62-0.83) or an intern/resident from another specialty (ICC 0.83, 95% CI 0.74-0.89). The agreement of clinically judged frailty compared to frailty according to CFS was 84%. In the opposing cases, staff tended to assess patients as frail to a higher extent using clinical judgment than by applying CFS on the same patient.
The CFS appears to have a moderate to good inter-rater reliability when used in a clinical ED setting. When guiding clinical decisions, we advise that the CFS score should be discussed within the team. Further research needs to be performed on the accuracy of clinical judgment to identify frailty in ED patients.
随着衰弱在全球各地的急诊科（ED）受到越来越多的关注，衰弱评估工具的使用也在不断增加。一种常用的工具是临床虚弱量表（CFS），但其在 ED 环境中的组内信度研究甚少。以前在斯堪的纳维亚 ED 环境中没有进行过关于 CFS 的组内信度研究。本研究的主要目的是评估 CFS 在瑞典 ED 环境中的组内信度。
这是一项在瑞典的三家 ED 进行的前瞻性观察性研究。由主治医生、注册护士和助理护士分别对年龄≥65 岁的患者进行 CFS 评估。收集每位评估者的人口统计学信息，以及根据临床判断得出的虚弱状态（虚弱/非虚弱）。使用组内相关系数（ICC）计算组内信度，而使用交叉表计算 CFS 评估的虚弱（分为虚弱/非虚弱，截定点为≥5 分）与仅基于临床判断的虚弱之间的一致性。
共纳入 100 例患者。我们发现，无论护理团队是否包括急诊医生（ICC 0.74，95%置信区间 [CI] 0.62-0.83）或来自其他专业的实习医生/住院医生（ICC 0.83，95% CI 0.74-0.89），组内信度均为中度至高度。与根据 CFS 评估的虚弱相比，临床判断的虚弱一致性为 84%。在相反的情况下，工作人员倾向于根据临床判断评估患者的虚弱程度比根据同一患者的 CFS 更高。
CFS 在临床 ED 环境中使用时具有中度至高度的组内信度。在指导临床决策时，我们建议应在团队中讨论 CFS 评分。需要进一步研究 ED 患者临床判断识别虚弱的准确性。
