Liese Lanckmans, Olga Theou, Nele Van Den Noortgate, Ruth Piers
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Intra-class correlation coefficient (ICC) was calculated to assess agreement. A ROC curve and Cox regression model determined prognostic value.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>Interrater agreement in CFS scoring on clinical judgment without Comprehensive Geriatric Assessment is moderate. The CFS classification tree can help standardize CFS scoring.</p>","PeriodicalId":49287,"journal":{"name":"European Geriatric Medicine","volume":" ","pages":"1339-1345"},"PeriodicalIF":3.5000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Agreement and predictive value of the clinical frailty scale in hospitalized older patients.\",\"authors\":\"Liese Lanckmans, Olga Theou, Nele Van Den Noortgate, Ruth Piers\",\"doi\":\"10.1007/s41999-024-01026-6\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>Interrater agreement in CFS scoring on clinical judgment without Comprehensive Geriatric Assessment is moderate. The CFS classification tree can help standardize CFS scoring.</p>\",\"PeriodicalId\":49287,\"journal\":{\"name\":\"European Geriatric Medicine\",\"volume\":\" \",\"pages\":\"1339-1345\"},\"PeriodicalIF\":3.5000,\"publicationDate\":\"2024-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Geriatric Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s41999-024-01026-6\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/8/1 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"GERIATRICS & GERONTOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Geriatric Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s41999-024-01026-6","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/8/1 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"GERIATRICS & GERONTOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的：我们的目的是对临床虚弱程度量表（CFS）分类树进行外部有效性研究，确定由高级老年病学专家、初级老年病学专家或使用分类树进行归因时，CFS 的一致性。此外，我们还评估了老年虚弱量表对急性老年病科入院后 6 个月死亡率的预测价值：这项前瞻性研究在比利时的两家急诊老年病科进行。入院后 72 小时内，由一名高级和一名初级老年病学专家根据临床判断确定病前 CFS。另一名与患者没有治疗关系的初级老年病学专家则使用分类树对 CFS 进行评分。计算类内相关系数（ICC）以评估一致性。ROC 曲线和 Cox 回归模型确定了预后价值：共纳入 97 名患者（平均年龄为 86 ± 5.2 岁；66% 为女性）。由资深老年病学专家确定的 CFS 与分类树的一致性为中等（ICC 0.526，95% CI [0.366-0.656]）。这与高级和初级老年病学专家的 CFS 之间的一致性相似（ICC 0.643，95% CI [0.510-0.746]）。根据分类树、高级和初级老年病学家的 CFS 得出的 6 个月死亡率的 AUC 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，与轻度或中度虚弱相比，重度或极重度虚弱与较高的死亡风险相关（根据分类树，危险比分别为6.274，95% CI [2.613-15.062]；根据高级老年病学专家，危险比为3.476，95% CI [1.531-7.888]；根据初级老年病学专家，危险比为4.851，95% CI [1.891-12.442]）：结论：在没有进行老年病综合评估的情况下，根据临床判断对 CFS 进行评分的互译一致性为中等。CFS分类树有助于规范CFS评分。
Agreement and predictive value of the clinical frailty scale in hospitalized older patients.
Purpose: 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.
Methods: 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.
Results: 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).
Conclusion: Interrater agreement in CFS scoring on clinical judgment without Comprehensive Geriatric Assessment is moderate. The CFS classification tree can help standardize CFS scoring.
期刊介绍：
European Geriatric Medicine is the official journal of the European Geriatric Medicine Society (EUGMS). Launched in 2010, this journal aims to publish the highest quality material, both scientific and clinical, on all aspects of Geriatric Medicine.
The EUGMS is interested in the promotion of Geriatric Medicine in any setting (acute or subacute care, rehabilitation, nursing homes, primary care, fall clinics, ambulatory assessment, dementia clinics..), and also in functionality in old age, comprehensive geriatric assessment, geriatric syndromes, geriatric education, old age psychiatry, models of geriatric care in health services, and quality assurance.
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