Abstract
Background: Frailty is a common condition in older people affecting around 1.8 million people in the UK and is independently associated with adverse outcomes. Frailty is commonly measured with the Clinical Frailty Scale (CFS) which involves a face to face assessment. There is evidence the CFS can be assigned retrospectively from information in patient records, but no research has assessed whether scores can be assigned using routine inpatient records. We aimed to assess whether a CFS could be accurately assigned using hospital inpatient records in a UK setting. Methods: Forty newly admitted patients aged 65 and over were prospectively recruited at Bradford Royal Infirmary. A CFS score was assigned to each patient using a face to face assessment. A CFS score was independently assigned to each patient solely using information in the inpatient records. A quadratically weighted Cohen’s Kappa was used to estimate inter-rater reliability (IRR) between the assessments. Results: A Kappa of 0.84 was estimated for the IRR between the scores derived from a face to face assessment and those based solely on inpatient records, indicating good agreement. The Kappa score fell to 0.7 when a 4 category collapsed version of the CFS was used. The IRR appeared unaffected by the number of times a patient had been admitted recently. Conclusion: The CSF may accurately be determined from data routinely recorded in inpatient records. Retrospectively derived scores can, therefore, be used in analysis of patient outcomes of older people in research and service improvement.
Highlights
Frailty is a common condition in older people affecting around 1.8 million people in the UK and is independently associated with adverse outcomes
A prospective cross-sectional study was conducted on the acute older people’s medical admissions unit at Bradford Royal Infirmary between March and August 2019 to test agreement between a Clinical Frailty Scale (CFS) score derived from face to face assessment and a score derived solely from information contained within inpatient electronic health records (EHRs)
High levels of agreement were observed between CFS scores derived from face to face assessment compared to clinical notes review as well as high inter-rater reliability (IRR) between independent reviews of the clinical notes
Summary
Frailty is a common condition in older people affecting around 1.8 million people in the UK and is independently associated with adverse outcomes. Around half of older hospital inpatients have frailty, a condition characterised by loss of biological reserves across multiple organ systems and vulnerability to physiological decompensation after a stressor event [3]. It is an established prognostic factor in a range of conditions and outcomes, including mortality, nursing home admission, length of hospital stay, delirium and falls [4,5]. Many frailty assessment instruments are available, relatively few have been validated in the acute inpatient setting because acute illness can conflate frailty when a performance-based tool, such as gait speed, is used. Some studies have found that the CFS can be reliably assigned prospectively using a standardised algorithm and by a telephone assessment [18,19]
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