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Validation of the Clinical Frailty Scale for retrospective use in acute care

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Key summary points

AbstractSection Aim

We assessed agreement, accuracy, precision, and reliability of retrospectively compared with prospectively and separately attained, retrospective Clinical Frailty Scale (CFS) scoring, respectively.

AbstractSection Findings

Compared to both prospectively and separately retrospectively attained CFS, retrospective CFS scores demonstrated high agreement, accuracy, precision, and reliability in 110 hospitalized patients aged ≥ 80 years.

AbstractSection Message

The retrospectively attained CFS score is a valid diagnostic instrument to measure frailty in older hospitalized patients.

Abstract

Purpose

There is a considerable need to measure frailty retrospectively in clinical practice and research. We assessed agreement, accuracy, precision, and reliability of retrospectively compared with prospectively, and separately attained, retrospective Clinical Frailty Scale (CFS) scoring, respectively.

Methods

We studied 110 hospitalized patients aged ≥ 80 years, consisting of 70.9% females. Agreement was assessed by bias, accuracy by root mean square error (RMSE) and the percentages of one CFS scores within 20% and 30% of each other (P20 and P30), precision by interquartile ranges of the bias, and reliability by weighted Cohen’s kappa (κ).

Results

Comparison of retrospective and prospective CFS scores demonstrated a modest bias of 0.26. Classification as robust, prefrail, or frail was generally correct in retrospectively compared to prospectively CFS scores. RMSE was low (0.28), while P20 and P30 values were high (90.0% and 96.6%, respectively). Precision of retrospective to predict prospective CFS scores was high with narrow interquartile ranges of 0 and 1. Reliability of retrospective with prospective CFS scores was high (κ = 0.89). Comparing two separately attained retrospective CFS scores demonstrated low bias (0.05) and RMSE (0.24), and a high P30 value (90.0%). Precision and interrater reliability of the comparison of retrospective CFS scores were high with narrow interquartile ranges and κ = 0.85.

Conclusion

The retrospectively attained CFS score is a valid diagnostic instrument to measure frailty in older hospitalized patients with high agreement, accuracy, precision, and reliability compared to both prospective and separately attained CFS scores.

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Acknowledgements

The study was funded by the Dr. Werner Jackstädt Foundation.

Funding

The study was funded by the Dr. Werner Jackstädt Foundation. The funding source was informed about the design and conduct and regularly updated on the status of the study but had no role in the analysis, writing, or submission of this report.

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Authors and Affiliations

  1. Department of Medicine, Rotes Kreuz Krankenhaus, St.-Pauli-Deich 24, 28199, Bremen, Germany

    Kolja Stille, Nancy Temmel, Jessica Hepp & Stefan Herget-Rosenthal

Authors
  1. Kolja Stille
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  2. Nancy Temmel
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  3. Jessica Hepp
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  4. Stefan Herget-Rosenthal
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Contributions

All the authors contributed to the study conception and design. Data collection was performed by all the authors, data analysis by KS and SH-R. The first draft of the manuscript was written by SH-R and further versions were revised by all the authors. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Stefan Herget-Rosenthal.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

All procedures performed in these studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments. The study protocol was approved by the local ethics committee (Medical council Bremen, reference number RA/RE-578).

Consent to participate

The requirement of obtaining informed consent to participate was waived by the local ethics committee as assessment of frailty with the CFS contains information which are routinely gathered on admission in our institution.

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Stille, K., Temmel, N., Hepp, J. et al. Validation of the Clinical Frailty Scale for retrospective use in acute care. Eur Geriatr Med 11, 1009–1015 (2020). https://doi.org/10.1007/s41999-020-00370-7

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  • DOI: https://doi.org/10.1007/s41999-020-00370-7

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