The Prognostic Value of Chart Review-Based Clinical Frailty Scale Scores in the Intensive Care Unit
CCCF ePoster library. Takaoka A. Oct 4, 2017; 198120; 98
Ms. Alyson Takaoka
Ms. Alyson Takaoka
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The Prognostic Value of Chart Review-Based Clinical Frailty Scale Scores in the Intensive Care Unit

Takaoka A, Alyson A1; Shears B, Melissa B2; Millen C, Tina C3; Holding D, Amanda D4; Clarke E, France E5; Tharmalingam F, Surenthar F6; Li G, Guowei G7; Thabane H, Lehana H8; Rochwerg I, Bram I9; Bagshaw J, Sean J10; Rockwood K Kenneth K11; Stelfox L, Tom L12; Muscedere M, John M13; Johnstone N, Jennie N14; Cook O, Deborah O15



1 Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada; 2 School of Medicine, Queens University, Kingston, Canada; 3 Intensive Care Unit, Juravinski Hospital ,Hamilton, Canada; 4 Occupational Therapy, St. Joseph's Healthcare Hamilton, Hamilton, Canada; 5 Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada; 6 Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada; 7 Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada; 8 Clinical Epidemiology and Biostatistics, McMaster University, Hamilton Canada; 9 Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada; 10 Faculty of Medicine and Dentistry, University of Alberta, Calgary, Canada;  11 Department of Medicine, Dalhousie University, Halifax, Canada; 14 Dalla Lana School of Public Health, University of Toronto, Toronto; Canada; 15 Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada


Introduction: Frailty denotes the loss of functional reserve capacity and is prevalent in approximately 30% of patients admitted to the Intensive Care Unit (ICU). Frailty is a multidimensional construct with important prognostic implications, but may be difficult to capture and measure in critically ill patients. The 9-point judgement-based Clinical Frailty Scale (CFS) is a validated clinical tool that has been used in many settings to screen for frailty. The CFS may be a useful risk stratification instrument that can help to predict the chance of adverse outcomes for critically ill patients. In 2 ICU studies, frailty has been associated with an increased risk of mortality, increased length of hospital stay and adverse hospital outcomes.

Objectives: The objective of this study was to evaluate the prognostic value of CFS scores generated by research coordinators (RC) via chart review for critically ill patients. We used the CFS as a dichotomous variable, whereby frail was defined as a CFS score > 5 and non-frail was defined as a CFS score <5.

Methods: In a prospective 2-center cohort study, we enrolled patients ≥18 years of age admitted to 2 ICUs in Hamilton, Canada for <24h. The RC generated CFS scores using 3 steps: 1) chart review, 2) family interview (if possible), and 3) patient interview (if possible). Subsequently, based on all accumulated data, the RC generated an overall impression captured in a Final CFS. Length of stay and vital status for both ICU and hospital discharge were recorded for all patients.

Results: Of 336 patients screened, 150 patients were enrolled. 70 patients (46.7%) were identified as having pre-hospital frailty based on the initial chart review. The mean age of the frail cohort was significantly greater than those who were not frail (68.0 ± 11.8 v. 60.1 ±17.2, p=0.002). Both frail and non-frail patients had similar mean acute physiology and chronic health evaluation (APACHE) II scores (22.5 ± 7.7 v. 20.4 ± 6.9, p=0.09). In the frail cohort, 50% (n=35) of the patients were female, compared to 31% in the non-frail cohort (n=25).  Frailty was not associated with a significantly increased length of ICU stay (1.01 days, p=0.58) or hospital stay (3.60 days, p=0.24) using median regression analyses. Frailty was associated with a trend toward increased risk of ICU mortality (hazard ratio (HR) 1.29, 95% CI: 0.60-2.78, p=0.51) and in hospital mortality (HR 1.12, 95% CI: 0.58-2.17, p=0.073), after adjusting for APACHE II score, use of mechanical ventilation and inotropes.
 
Conclusion:
Although not statistically significant, frail patients had a higher risk of ICU and hospital mortality compared to their non-frail counterparts, after adjusting for illness severity.  These preliminary data suggest that CFS scores used in an ICU setting may provide useful information that could help to guide conversations with families of critically ill patients, as well as being useful for clinical ICU research.

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