Angel Yoel, Eyal Or, Stavi Dekel, Adi Nimrod, Lichter Yael, Nevo Andrey, Moshkovits Itay, Aviram Daniel, Matot Idit, Gal Oz Amir
Department of Anesthesia, Pain Management and Intensive Care, Tel Aviv Sourasky Medical Center, the School of Medicine, Faculty of Medical and Health Science, Tel Aviv University, Weizmann 6, 6423906, Tel Aviv, Israel.
Critical Care Department, University College London Hospital NHS Foundation Trust, London, United Kingdom.
Intern Emerg Med. 2025 May 24. doi: 10.1007/s11739-025-03976-6.
Frailty is a common clinical syndrome associated with increased risks of morbidity, mortality and other adverse outcomes. It is often used by healthcare providers as a tool for estimating patients` condition and triaging for Intensive Care Unit (ICU) admission, as recommended by several national guidelines. This study aimed to evaluate the utility of observed frailty, a subjective clinical assessment by physicians, as an alternative to the validated Clinical Frailty Score (CFS) and Modified Frailty Index (MFI). Additionally, the study explored the association of these frailty scoring systems with 30 day mortality, mechanical ventilation duration, and ICU length of stay. This retrospective study analyzed 100 patients admitted to an ICU at a tertiary center between March 12 and April 30, 2019. Observed frailty was assessed on a 4-point scale by physicians at ICU admission. CFS (7-point scale) and MFI (11-point scale) were retrospectively calculated. Correlations between these frailty assessments and their relationships with clinical outcomes were examined. Observed frailty correlated moderately with the CFS (Spearman coefficient = 0.4, p < 0.001) but showed a weaker, non-significant correlation with the MFI (Spearman coefficient = 0.18, p = 0.07). Significant differences in 30 day survival were observed based on the 4-point observed frailty scale (p < 0.001). Subjective assessment of frailty using a 4-point scale by physicians at ICU admission correlates with the CFS and is significantly associated with 30 day mortality. This suggests that observed frailty may be a practical tool for clinical decision-making. Further prospective studies are required to validate its utility and prognostic implications.
衰弱是一种常见的临床综合征，与发病率、死亡率及其他不良后果风险增加相关。正如几项国家指南所推荐的，医疗服务提供者常将其用作评估患者病情及对重症监护病房（ICU）收治进行分诊的工具。本研究旨在评估医生的主观临床评估——观察性衰弱，作为经过验证的临床衰弱评分（CFS）和改良衰弱指数（MFI）的替代方法的效用。此外，该研究还探讨了这些衰弱评分系统与30天死亡率、机械通气时长及ICU住院时间的关联。这项回顾性研究分析了2019年3月12日至4月30日期间在一家三级中心ICU收治的100例患者。医生在患者入住ICU时采用4分制对观察性衰弱进行评估。回顾性计算CFS（7分制）和MFI（11分制）。检查了这些衰弱评估之间的相关性及其与临床结局的关系。观察性衰弱与CFS呈中度相关（斯皮尔曼系数 = 0.4，p < 0.001），但与MFI的相关性较弱且无统计学意义（斯皮尔曼系数 = 0.18，p = 0.07）。基于4分制的观察性衰弱量表观察到30天生存率存在显著差异（p < 0.001）。医生在ICU入院时采用4分制对衰弱进行主观评估与CFS相关，且与30天死亡率显著相关。这表明观察性衰弱可能是临床决策的实用工具。需要进一步的前瞻性研究来验证其效用及预后意义。
