Assessing frailty in the intensive care unit: A reliability and validity study
Assessing frailty in the intensive care unit: A reliability and validity study
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DOI：
10.1016/j.jcrc.2018.02.004
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发表时间：
2018-06-01
影响因子：
3.7
通讯作者：
Cook, Deborah J.
中科院分区：
文献类型：
--
作者：
Shears, Melissa;Takaoka, Alyson;Cook, Deborah J.
目的：使用临床虚弱量表（CFS）描述重症患者ICU前虚弱。方法：我们纳入了在加拿大汉密尔顿入住2个ICU的18岁患者。ICU研究协调员（RC）使用以下方法生成3个CFS评分：1）病历审查，2）家庭访谈，3）患者访谈。随后，在最终评分中获得了总体印象。计算平均差异以评估RC、职业治疗师（OT）和老年病住院医师（GR）对图表审查的RC评定者内可靠性和评定者间可靠性。还比较了年轻患者和老年患者的评分。结果：我们前瞻性地纳入了150例患者（平均年龄63.8（SD 15.3）岁，APACHE II评分21（SD 73））。RC、OT和GR图表审查之间的CFS相似（所有比较p > 0.05）。RC图表审查和RC最终评分之间或RC患者访谈和RC最终评分之间无差异。RC家庭访谈后的评分和RC最终评分有显著差异（-024，95%CI-0.38，-0.09，p < 0.01）。RC最终CFS评分每增加1分与ICU死亡率弱相关（比值比1.18，95%CI 0.84-1.66，p = 0.33）和医院死亡率（OR 1.19，95% CI 0.89，-1.59，p = 024）。CFS评分可以使用病历审查生成，并可以由ICU临床医生和研究人员可靠地完成。(C)2018爱思唯尔公司All rights reserved.
Purpose: To describe pre-ICU frailty in critically ill patients using the Clinical Frailty Scale (CFS).Methods: We included patients 18 years admitted to 2 ICUs in Hamilton, Canada. The ICU Research Coordinator (RC) generated 3 CFS scores using: 1) chart review, 2) family interview, 3) patient interview. Subsequently, an overall impression was captured in a final score. Mean differences were calculated to assess the RC intra-rater reliability and inter-rater reliability of chart reviews by the RC, Occupational Therapist (OT), and Geriatrics Resident (GR). Scores were also compared between younger and older patients. We also analyzed the relationship between CFS scores and mortality.Results: We prospectively enrolled 150 patients (mean age 63.8 (SD 15.3] years, APACHE Il score 21 (SD 73]). CFS were similar between RC, OT, and GR chart reviews (p > 0.05 for all comparisons). There was no difference between RC chart review and RC final score, or between RC patient interview and RC final score. Scores following the RC family interview and the RC final score were significantly different (-024, 95% CI -0.38, -0.09, p < 0.01). Each 1-point increase in the final CFS scored by the RC was weakly associated with ICU mortality (odds ratio 1.18, 95% CI 0.84-1.66, p = 0.33), and hospital mortality (OR 1.19, 95% CI 0.89, -1.59, p = 024).Conclusions: CFS scores can be generated using medical chart review and can be reliably completed by ICU clinicians and research staff. (C) 2018 Elsevier Inc. All rights reserved.