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Intrarater and interrater reliability of the Clinical Frailty Scale-Es and FRAIL-Es in critically ill patients
Susana Arias-Rivera1, María Mar Sánchez-Sánchez2, Raquel Jareño-Collado2
1Programa de Doctorado en Enfermería y Salud, Facultad de Enfermería, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; Departamento de Investigación de Enfermería, Hospital Universitario de Getafe, Getafe, Madrid, Spain.
Objective:
To evaluate the intrarater and interrater reliability of the Clinical Frailty Scale-Spain (CFS-España) and FRAIL-España and the internal consistency of the FRAIL-España when implemented in critically ill patients by intensive care nurses and physicians.
Design:
Descriptive, observational and metric study.
Setting:
intensive care unit (ICU) of Spain.
Patients:
Patients >18 years, with >48 UCI hours.
Intervention:
None.
Main Variables Of Interest:
On admission, frailty with CFS-España and FRAIL-España (by 3 nurses and 2 intensive care physicians), sex, age, comorbidities and severity.
Results:
1045 assessments were performed in 206 patients. Not frail patients on admission: 53% according to the CFS-Spain and 34% according to the FRAIL-Spain. The intraclass correlation coefficient (ICC) shows almost perfect intrarater concordance (>0.80 for CFS-España and >0.90 for FRAIL-España). Agreement by frailty strata (non-fragile, pre-fragile and fragile patients) was substantial or almost perfect, with no major differences in ratings between nurses and physicians. Interprofessional concordance shows an almost perfect ICC for both scales. The lowest agreement was obtained for the FRAIL-España ratings among physicians. In the frailty strata analysis, agreement was moderate. The highest agreement for the CFS-España was considering level 4 patients as frail. High reliability of the FRAIL-España and strong correlation of all dimensions with the global assessment were obtained, except for the comorbidities dimension, with a weak correlation.
Conclusion:
The CFS-España and FRAIL-España scales are reliable for assessing frailty in critically ill patients by nurses and/or intensive care physicians.
