Clinical Frailty Scale is a better predictor for adverse post-operative complications and functional outcomes than Modified Frailty Index and Charlson Comorbidity Index after total knee arthroplasty.

PURPOSE: Studies have demonstrated correlations between frailty and comorbidity scores with adverse outcomes in total knee replacement (TKR). However, there is a lack of consensus on the most suitable pre-operative assessment tool. This study aims to compare Clinical Frailty Scale (CFS), Modified Frailty Index (MFI), and Charlson Comorbidity Index (CCI) in predicting adverse post-operative complications and functional outcomes following a unilateral TKR. METHODS: In total, 811 unilateral TKR patients from a tertiary hospital were identified. Pre-operative variables were age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) class, CFS, MFI, and CCI. Binary logistic regression analysis was performed to ascertain odd ratios of pre-operative variables on adverse post-operative complications (length of stay < LOS >, complications, ICU/HD admission, discharge location, 30-day readmission, 2-year reoperation). Multiple linear regression analyses were used to estimate the standardized effects of pre-operative variables on the Knee Society Functional Score (KSFS), Knee Society Knee Score (KSKS), Oxford Knee Score (OKS), and 36-Item Short Form Survey (SF-36). RESULTS: CFS is a strong predictor for LOS (OR 1.876, p < 0.001), complications (OR 1.83-4.97, p < 0.05), discharge location (OR 1.84, p < 0.001), and 2-year reoperation rate (OR 1.98, p < .001). ASA and MFI were predictors for ICU/HD admission (OR:4.04, p = 0.002; OR 1.58, p = 0.022, respectively). None of the scores was predictive for 30-day readmission. A higher CFS was associated with a worse outcome for 6-month KSS, 2-year KSS, 6-month OKS, 2-year OKS, and 6-month SF-36. CONCLUSION: CFS is a superior predictor for post-operative complications and functional outcomes than MFI and CCI in unilateral TKR patients. This suggests the importance of assessing pre-operative functional status when planning for TKR. LEVEL OF EVIDENCE: Diagnostic, II.

Reliability and validity of a frailty assessment tool in specialized burn care, a retrospective multicentre cohort study.

BACKGROUND: Frailty is a predictor of adverse outcomes in elderly patients. The Canadian Study of Health and Aging Clinical Frailty Scale (CFS) is an often-used frailty assessment instrument. However, the CFS's reliability and validity in patients with burn injuries are unknown. This study aimed to assess the CFS's inter-rater reliability and validity (predictive validity, known group validity and convergent validity) in patients with burn injuries treated to specialized burn care. METHODS: A retrospective multicentre cohort study was conducted in all three Dutch burn centres. Patients aged ≥ 50 years with burn injuries, with a primary admission in 2015-2018, were included. Based on information in the electronic patient files, a research team member scored the CFS retrospectively. Inter-rater reliability was calculated using Krippendorff's α. Validity was assessed using logistic regression analysis. Patients with a CFS ≥ 5 were considered frail. RESULTS: In total, 540 patients were included, with a mean age of 65.8 years (SD 11.5) and a Total Body Surface Area (TBSA) burned of 8.5%. The CFS was used to assess frailty in 540 patients and the reliability of the CFS was scored for 212 patients. Mean CFS was 3.4(SD 2.0). Inter-rater reliability was adequate, Krippendorff's α 0.69 (95%CI 0.62-0.74). A positive frailty screening was predictive of a non-home discharge location (OR 3.57, 95%CI 2.16-5.93), a higher in-hospital mortality rate (OR 1.06-8.77), and a higher mortality rate within 12 months after discharge (OR 4.61, 95%CI 1.99-10.65) after adjustment for age, TBSA, and inhalation injury. Frail patients were more likely to be older (for<70 vs. ≥70 years odds ratio 2.88, 95%CI 1.95-4.25) and their comorbidities were more severe (ASA ≥3 vs 1-2 OR 6.43, 95%CI 4.26-9.70) (known group validity). The CFS was significantly related (rSpearman=0.55) to the Dutch Safety Management System (DSMS) frailty screening, reflecting a fair-good correlation between the CFS and DSMS frailty screening outcomes. CONCLUSION: The Clinical Frailty scale is reliable and has shown its validity, including its association with adverse outcomes in patients with burn injury admitted to specialized burn care. Early frailty assessment with the CFS must be considered, to optimize early recognition and treatment of frailty.

Performance of 3 frailty scales for predicting adverse outcomes at 30 days in older patients discharged from emergency departments. / Rendimiento de tres escalas de fragilidad para predecir resultados adversos a 30 días en los pacientes mayores dados de alta en los servicios de urgencias.

OBJECTIVES: To compare the ability of 3 frailty scales (the Clinical Frailty Scale [CFS], the Functional Index - eMergency [FIM], and the Identification of Seniors at Risk [ISAR] scale) to predict adverse outcomes at 30 days in older patients discharged from hospital emergency departments (EDs). MATERIAL AND METHODS: Secondary analysis of data from the FRAIL-Madrid registry of patients aged 75 years or older who were discharged from Madrid EDs over a period of 3 months in 2018 and 2019. Frailty was defined by a CFS score over 4, a FIM score over 2, or an ISAR score over 3. The outcome variables were revisits to an ED, hospitalization, functional decline, death, and a composite variable of finding any of the previously named variables within 30 days of discharge. RESULTS: A total of 619 patients were studied. The mean (SD) age was 84 (7) years, and 59.1% were women. The CFS identified as frail a total of 339 patients (54.8%), the FIM 386 (62.4%), and the ISAR 301 (48.6%). An adverse outcome occurred within 30 days in 226 patients (36.5%): 21.5% revisited, 12.6% were hospitalized, 18.4% experienced functional decline, and 3.6% died. The areas under the receiver operating characteristic curves were as follows: CFS, 0.66 (95% CI, 0.62-0.70; P = .022); FIM, 0.67 (95% CI, 0.62-0.71; P = .021), and ISAR, 0.64 (95% CI, 0.60-0.69; P = .023). Adjusted odds ratios (aOR) showed that frailty was an independent risk factor for presenting any of the named adverse outcomes: aOR for CFS >4, 3.18 (95% CI, 2.02-5.01), P .001; aOR for FIM > 2, 3.49 (95% CI, 2.15-5.66), P .001; and aOR for ISAR >3, 2.46 (95% CI, 1.60-3.79), P .001. CONCLUSION: All 3 scales studied - the CFS, the FIM and the ISAR - are useful for identifying frail older patients at high risk of developing an adverse outcome (death, functional decline, hospitalization, or revisiting the ED) within 30 days after discharge.

OBJETIVO: Comparar la capacidad de tres escalas de fragilidad, Clinical Frailty Scale (CFS), Functional Index ­ eMergency (FIM) e Identification Senior at Risk (ISAR), para predecir resultados adversos (RA) a 30 días en los pacientes mayores dados de alta desde el servicio de urgencias hospitalario (SUH). METODO: Análisis secundario del registro FRAIL-Madrid que incluyó pacientes 75 años dados de alta de 10 SUH de Madrid durante un periodo de 3 meses entre 2018 y 2019. Se definió fragilidad como CFS 4, FIM 2 e ISAR 3. Las variables de resultado fueron revisita en urgencias, hospitalización, deterioro funcional, muerte y la variable compuesta por algún RA de los anteriores en los 30 días posteriores al alta del SUH. RESULTADOS: Se incluyeron 619 pacientes, la edad media fue de 84 años (DE 7), 59,1% eran mujeres. Hubo 339 pacientes (54,8%) identificados como frágiles en el SUH según CFS 4, 386 (62,4%) según FIM 2 y 301 (48,6%) según ISAR 3. Hubo 226 pacientes (36,5%) que presentaron algún RA a los 30 días tras el alta (21,5% revisita, 12,6% hospitalización,18,4% deterioro funcional y 3,6% muerte). El área bajo la curva (ABC) de la escala CFS fue de 0,66 (0,62-0,70; p = 0,022), de FIM 0,67 (0,62-0,71; p = 0,021) y de ISAR 0,64 (0,60-0,69; p = 0,023). La presencia de fragilidad fue un factor independiente de presentar algún RA a los 30 días tras el alta (CFS 4 ORa 3,18 [IC 95% 2,02-5,01, p 0,001], FIM 2 ORa 3,49 [IC 95% 2,15-5,66, p 0,001] e ISAR 3 ORa 2,46 [IC 95% 1,60-3,79, p 0,001]). CONCLUSIONES: Las tres escalas estudiadas ­CFS, FIM, ISAR­ son útiles y tienen una capacidad similar para identificar al paciente mayor frágil dado de alta del SUH con alto riesgo de presentar RA (muerte, deterioro funcional, hospitalización o revisita al SUH) a los 30 días.

Frailty in elderly ICU patients in Greece: a prospective, observational study.

BACKGROUND: Of particular interest is the study of frailty syndrome in older patients in recent years. This syndrome is characterized by weight loss and muscle mass, a change in eating habits, movement and endurance, and a decline in cognitive function. The purpose of the study was the prevalence of frailty syndrome in subjects aged 65 years who were hospitalized in an intensive care unit (ICU) in Greece. METHODS: This is a prospective, observational study. The study sample consisted of families or carers of 36 patients over 65 years of age. The study was conducted in a General Hospital in Greece, over a period of 1 year. The Clinical Frailty Scale (CFS) and the 5 criterions frailty phenotype were used. In addition, the severity of the patients with the APACHE II, SAPS II and SOFA scales was assessed. For the analysis of the data, the SPSS 19 for windows statistical package was used and more specifically descriptive statistics and correlations with parametric methods were performed. RESULTS: Thirty-six severely ill patients aged 65 years and over (22 women, 14 men) were studied. 25% of the patients had a positive frailty phenotype, 44% were at an early stage, while 30.6% had a frailty negative phenotype. A significant correlation between CFS and APACHE (P=0.041), age (P=0.033), sex (P=0.049) and ADL mobility index (P=0.001) was found to be significant. Concerning mortality, 36.1% of patients died in ICU, 11.1% died within the next 6 months and 38.9% were alive. CONCLUSIONS: The findings of the study highlighted the onset of frailty syndrome in ICU patients. The objective assessment of the frailty syndrome of the seriously ill patient as well as the prognostic markers provides a clearer picture of its out-of-hospital condition and contributes to the collection of information on the outcomes of the in-hospital treatment.

Impact of frailty markers on outcomes after transcatheter aortic valve replacement: insights from a Japanese multicenter registry.

There are no standardized criteria for measuring patients' frailty. We examined prognosis based on four frailty markers [serum albumin level, grip strength, gait speed, and clinical frailty scale (CFS)] in patients who underwent transcatheter aortic valve replacement (TAVR) between October 2013 and April 2016 and were recorded in the Optimized CathEter vAlvular iNtervention (OCEAN) Japanese multicenter registry. Serum albumin level was assessed by dividing patients into two groups: hypoalbuminemia or non-hypoalbuminemia according to their serum albumin level. Clinical outcomes including all-cause, cardiovascular and non-cardiovascular mortality rates after TAVR were compared. During the follow-up period cumulative all-cause, cardiovascular and non-cardiovascular mortality rates were significantly higher in the hypoalbuminemia group than in the non-hypoalbuminemia group. This result remained unchanged even after a propensity-matched model was used in terms of cumulative all-cause and non-cardiovascular mortality; however, differences in cardiovascular mortality rates were attenuated. To consider the impact of grip strength patients were divided into a low or high peak grip strength group based on classification and regression tree (CART) survival analysis. The clinical outcomes for each sex were compared between the two groups. In both sexes the cumulative 1-year mortality rates were significantly different between the two groups. To investigate gait speed patients were classified into two gait speed groups (low or high gait speed group) based on CART survival analysis. Clinical outcomes were compared between the two groups. The cumulative 1-year mortality rate was significantly different between the two gait speed groups. The effect of CFS on prognosis after TAVR was assessed. Patients were categorized into five groups based on the following CFS scores: CFS1-3, CFS4, CFS5, CFS6, and CFS ≥7. We evaluated the relationship between the CFS score and other indicators of frailty markers. We also assessed the mid-term mortality among the five groups. The CFS score had a significant correlation with other frailty markers. The cumulative 1-year mortality increased with an increasing CFS score. In the Cox regression multivariable analysis, the CFS score was an independent predictive factor of an increased late cumulative mortality risk. In conclusion, the results suggest that serum albumin level, grip strength, gait speed, and CFS score are all useful indicators when considering the optimal indications and risk stratification for TAVR.

Rendimiento de tres escalas de fragilidad para predecir resultados adversos a 30 días en los pacientes mayores dados de alta en los servicios de urgencias / Performance of 3 frailty scales for predicting adverse outcomes at 30 days in older patients discharged from emergency departments

Objetivo: Comparar la capacidad de tres escalas de fragilidad, Clinical Frailty Scale (CFS), Functional Index eMergency (FIM) e Identification Senior at Risk (ISAR), para predecir resultados adversos (RA) a 30 días en los pacientes mayores dados de alta desde el servicio de urgencias hospitalario (SUH). Método: Análisis secundario del registro FRAIL-Madrid que incluyó pacientes $ 75 años dados de alta de 10 SUH de Madrid durante un periodo de 3 meses entre 2018 y 2019. Se definió fragilidad como CFS $ 4, FIM $ 2 e ISAR $ 3. Las variables de resultado fueron revisita en urgencias, hospitalización, deterioro funcional, muerte y la variable compuesta por algún RA de los anteriores en los 30 días posteriores al alta del SUH. Resultados: Se incluyeron 619 pacientes, la edad media fue de 84 años (DE 7), 59,1% eran mujeres. Hubo 339 pacientes (54,8%) identificados como frágiles en el SUH según CFS $ 4, 386 (62,4%) según FIM $ 2 y 301 (48,6%) según ISAR $ 3. Hubo 226 pacientes (36,5%) que presentaron algún RA a los 30 días tras el alta (21,5% revisita, 12,6% hospitalización, 18,4% deterioro funcional y 3,6% muerte). El área bajo la curva (ABC) de la escala CFS fue de 0,66 (0,62-0,70; p = 0,022), de FIM 0,67 (0,62-0,71; p = 0,021) y de ISAR 0,64 (0,60-0,69; p = 0,023). La presencia de fragilidad fue un factor independiente de presentar algún RA a los 30 días tras el alta (CFS $ 4 ORa 3,18 [IC 95% 2,02-5,01, p < 0,001], FIM $ 2 ORa 3,49 [IC 95% 2,15-5,66, p < 0,001] e ISAR $ 3 ORa 2,46 [IC 95% 1,60-3,79, p < 0,001]). Conclusiones: Las tres escalas estudiadas –CFS, FIM, ISAR– son útiles y tienen una capacidad similar para identificar al paciente mayor frágil dado de alta del SUH con alto riesgo de presentar RA (muerte, deterioro funcional, hospitalización o revisita al SUH) a los 30 días. (AU)

Objective: To compare the ability of 3 frailty scales (the Clinical Frailty Scale [CFS], the Functional Index – eMergency [FIM], and the Identification of Seniors at Risk [ISAR] scale) to predict adverse outcomes at 30 days in older patients discharged from hospital emergency departments (EDs). Methods: Secondary analysis of data from the FRAIL-Madrid registry of patients aged 75 years or older who were discharged from Madrid EDs over a period of 3 months in 2018 and 2019. Frailty was defined by a CFS score over 4, a FIM score over 2, or an ISAR score over 3. The outcome variables were revisits to an ED, hospitalization, functionaldecline, death, and a composite variable of finding any of the previously named variables within 30 days of discharge. Results: A total of 619 patients were studied. The mean (SD) age was 84 (7) years, and 59.1% were women. The CFS identified as frail a total of 339 patients (54.8%), the FIM 386 (62.4%), and the ISAR 301 (48.6%). An adverse outcome occurred within 30 days in 226 patients (36.5%): 21.5% revisited, 12.6% were hospitalized, 18.4% experienced functional decline, and 3.6% died. The areas under the receiver operating characteristic curves were as follows: CFS, 0.66 (95% CI, 0.62-0.70; P = .022); FIM, 0.67 (95% CI, 0.62-0.71; P = .021), and ISAR, 0.64 (95% CI, 0.60-0.69; P = .023). Adjusted odds ratios (aOR) showed that frailty was an independent risk factor for presenting anyof the named adverse outcomes: aOR for CFS >4, 3.18 (95% CI, 2.02-5.01), P < .001; aOR for FIM > 2, 3.49 (95% CI, 2.15-5.66), P < .001; and aOR for ISAR >3, 2.46 (95% CI, 1.60-3.79), P < .001. Conclusions: All 3 scales studied — the CFS, the FIM and the ISAR — are useful for identifying frail older patients at high risk of developing an adverse outcome (death, functional decline, hospitalization, or revisiting the ED) within 30 days after discharge. (AU)