Interrater Reliability of the Clinical Frailty Scale by Geriatrician and Intensivist in Patients Admitted to the Intensive Care Unit

  • Megan Surkan University of Alberta
  • Naheed Rajabali University of Alberta
  • Sean M. Bagshaw University of Alberta
  • Xiaoming Wang Alberta Health Services
  • Darryl Rolfson University of Alberta http://orcid.org/0000-0002-9412-0737
Keywords: Frailty, Critical Illness, Measurement, interrater reliability

Abstract

Background

The Clinical Frailty Scale (CFS) is a commonly used frailty measure in intensive care unit (ICU) settings. We are inter­ested in the test characteristics, especially interrater reliability, of the CFS in ICU by comparing the scores of intensivists to geriatricians.

Methods

We conducted a prospective cohort study on a convenience sample of newly admitted patients to an ICU in Edmonton, Canada. An intensivist and a resident in Geriatric Medicine (GM) independently assigned a CFS score on 158 adults within 72 hours of admission. A specialist in Geriatric Medi­cine assigned a CFS score independently of 20 of the 158 patients to assess agreement between the two raters trained in geriatrics. Predictive validity was captured using mortality and length of stay.

Results

Agreement on CFS score was fair for intensivists vs. GM resident (kappa 0.32) and for intensivists vs. GM specialist (0.29), but substantial for GM resident vs. staff (0.79). Despite this, the CFS remained prognostically relevant, regardless of rater background. Frailty (CFS ≥ 5) as assessed by either intensivist or GM resident was a strong predictor of in-hospital mortality (odds ratio [OR] 3.6; 95% CI, 1.6-8.4, p = .003 and OR 3.0; 95% CI 1.3-6.9; p = .01, respectively). Frailty was also positively correlated with age, illness severity measured by APACHE II score, and length of hospital stay.

Conclusions

The interrater reliability of the CFS in ICU settings is fair for intensivists vs. geriatricians.

Author Biographies

Megan Surkan, University of Alberta

Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine and Dentistry

Naheed Rajabali, University of Alberta

Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine and Dentistry

Sean M. Bagshaw, University of Alberta

Department of Critical Care Medicine, Faculty of Medicine and Dentistry

Xiaoming Wang, Alberta Health Services

Research Facilitation, Data Integration, Management and Reporting (DIMR)

Darryl Rolfson, University of Alberta

Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine and Dentistry

Published
2020-09-01
How to Cite
Surkan, M., Rajabali, N., Bagshaw, S. M., Wang, X., & Rolfson, D. (2020). Interrater Reliability of the Clinical Frailty Scale by Geriatrician and Intensivist in Patients Admitted to the Intensive Care Unit. Canadian Geriatrics Journal, 23(3), 223-229. https://doi.org/10.5770/cgj.23.398
Section
Original Research