Lanckmans Liese, Theou Olga, Van Den Noortgate Nele, Piers Ruth
Department of Geriatrics, Ghent University Hospital, Ghent, Belgium.
School of Physiotherapy, Dalhousie University, Halifax, NS, Canada.
Eur Geriatr Med. 2024 Oct;15(5):1339-1345. doi: 10.1007/s41999-024-01026-6. Epub 2024 Aug 1.
Our objective was to perform an external validity study of the clinical frailty scale (CFS) classification tree by determining the agreement of the CFS when attributed by a senior geriatrician, a junior geriatrician, or using the classification tree. Additionally, we evaluated the predictive value of the CFS for 6-month mortality after admission to an acute geriatric unit.
This prospective study was conducted in two acute geriatric units in Belgium. The premorbid CFS was determined by a senior and a junior geriatrician based on clinical judgment within the first 72 h of admission. Another junior geriatrician, who did not have a treatment relationship with the patient, scored the CFS using the classification tree. Intra-class correlation coefficient (ICC) was calculated to assess agreement. A ROC curve and Cox regression model determined prognostic value.
In total, 97 patients were included (mean age 86 ± 5.2; 66% female). Agreement 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 CFS by respectively the classification tree, the senior and junior geriatrician was 0.719, 95% CI [0.592-0.846]; 0.774, 95% CI [0.673-0.875]; 0.774, 95% CI [0.665-0.882]. 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 respectively 6.274, 95% CI [2.613-15.062] by the classification tree; 3.476, 95% CI [1.531-7.888] by the senior geriatrician; 4.851, 95% CI [1.891-12.442] by the junior geriatrician).
Interrater agreement in CFS scoring on clinical judgment without Comprehensive Geriatric Assessment is moderate. The CFS classification tree can help standardize CFS scoring.
我们的目标是通过确定由老年科主任医师、老年科住院医师或使用分类树来判定临床衰弱量表（CFS）时的一致性，对CFS分类树进行外部效度研究。此外，我们评估了CFS对入住急性老年病科后6个月死亡率的预测价值。
这项前瞻性研究在比利时的两个急性老年病科开展。病前CFS由一位老年科主任医师和一位老年科住院医师在入院后的头72小时内根据临床判断来确定。另一位与患者没有治疗关系的老年科住院医师使用分类树对CFS进行评分。计算组内相关系数（ICC）以评估一致性。通过ROC曲线和Cox回归模型确定预后价值。
总共纳入了97例患者（平均年龄86±5.2岁；66%为女性）。由老年科主任医师和分类树判定的CFS一致性为中等（ICC 0.526，95% CI [0.366 - 0.656]）。这与老年科主任医师和老年科住院医师判定的CFS之间的一致性相似（ICC 0.643，95% CI [0.510 - 0.746]）。基于CFS的6个月死亡率的AUC，分类树、老年科主任医师和老年科住院医师分别为0.719，95% CI [0.592 - 0.846]；0.774，95% CI [0.673 - 0.875]；0.774，95% CI [0.665 - 0.882]。Cox回归分析表明，与轻度或中度衰弱相比，重度或极重度衰弱与更高的死亡风险相关（分类树判定的风险比分别为6.274，95% CI [2.613 - 15.062]；老年科主任医师判定的为3.476，95% CI [1.531 - 7.888]；老年科住院医师判定的为4.851，95% CI [1.891 - 12.442]）。
在没有综合老年评估的情况下，基于临床判断的CFS评分的评分者间一致性为中等。CFS分类树有助于使CFS评分标准化。
