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Feasibility and reliability of frailty assessment in the critically ill: a systematic review

BACKGROUND: For healthcare systems, an ageing population poses challenges in the delivery of equitable and effective care. Frailty assessment has the potential to improve care in the intensive care setting, but applying assessment tools in critical illness may be problematic. The aim of this systema...

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Autores principales: Pugh, Richard J., Ellison, Amy, Pye, Kate, Subbe, Christian P., Thorpe, Chris M., Lone, Nazir I., Clegg, Andrew
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6389132/
https://www.ncbi.nlm.nih.gov/pubmed/29478414
http://dx.doi.org/10.1186/s13054-018-1953-9
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author Pugh, Richard J.
Ellison, Amy
Pye, Kate
Subbe, Christian P.
Thorpe, Chris M.
Lone, Nazir I.
Clegg, Andrew
author_facet Pugh, Richard J.
Ellison, Amy
Pye, Kate
Subbe, Christian P.
Thorpe, Chris M.
Lone, Nazir I.
Clegg, Andrew
author_sort Pugh, Richard J.
collection PubMed
description BACKGROUND: For healthcare systems, an ageing population poses challenges in the delivery of equitable and effective care. Frailty assessment has the potential to improve care in the intensive care setting, but applying assessment tools in critical illness may be problematic. The aim of this systematic review was to evaluate evidence for the feasibility and reliability of frailty assessment in critical care. METHODS: Our primary search was conducted in Medline, Medline In-process, EMBASE, CINAHL, PsycINFO, AMED, Cochrane Database of Systematic Reviews, and Web of Science (January 2001 to October 2017). We included observational studies reporting data on feasibility and reliability of frailty assessment in the critical care setting in patients 16 years and older. Feasibility was assessed in terms of timing of evaluation, the background, training and expertise required for assessors, and reliance upon proxy input. Reliability was assessed in terms of inter-rater reliability. RESULTS: Data from 11 study publications are included, representing 8 study cohorts and 7761 patients. Proxy involvement in frailty assessment ranged from 58 to 100%. Feasibility data were not well-reported overall, but the exclusion rate due to lack of proxy availability ranged from 0 to 45%, the highest rate observed where family involvement was mandatory and the assessment tool relatively complex (frailty index, FI). Conventional elements of frailty phenotype (FP) assessment required modification prior to use in two studies. Clinical staff tended to use a simple judgement-based tool, the clinical frailty scale (CFS). Inter-rater reliability was reported in one study using the CFS and although a good level of agreement was observed between clinician assessments, this was a small and single-centre study. CONCLUSION: Though of unproven reliability in the critically ill, CFS was the tool used most widely by critical care clinical staff. Conventional FP assessment required modification for general application in critical care, and an FI-based assessment may be difficult to deliver by the critical care team on a routine basis. There is a high reliance on proxies for frailty assessment, and the reliability of frailty assessment tools in critical care needs further evaluation. PROSPERO REGISTRATION NUMBER: CRD42016052073.
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spelling pubmed-63891322019-03-19 Feasibility and reliability of frailty assessment in the critically ill: a systematic review Pugh, Richard J. Ellison, Amy Pye, Kate Subbe, Christian P. Thorpe, Chris M. Lone, Nazir I. Clegg, Andrew Crit Care Research BACKGROUND: For healthcare systems, an ageing population poses challenges in the delivery of equitable and effective care. Frailty assessment has the potential to improve care in the intensive care setting, but applying assessment tools in critical illness may be problematic. The aim of this systematic review was to evaluate evidence for the feasibility and reliability of frailty assessment in critical care. METHODS: Our primary search was conducted in Medline, Medline In-process, EMBASE, CINAHL, PsycINFO, AMED, Cochrane Database of Systematic Reviews, and Web of Science (January 2001 to October 2017). We included observational studies reporting data on feasibility and reliability of frailty assessment in the critical care setting in patients 16 years and older. Feasibility was assessed in terms of timing of evaluation, the background, training and expertise required for assessors, and reliance upon proxy input. Reliability was assessed in terms of inter-rater reliability. RESULTS: Data from 11 study publications are included, representing 8 study cohorts and 7761 patients. Proxy involvement in frailty assessment ranged from 58 to 100%. Feasibility data were not well-reported overall, but the exclusion rate due to lack of proxy availability ranged from 0 to 45%, the highest rate observed where family involvement was mandatory and the assessment tool relatively complex (frailty index, FI). Conventional elements of frailty phenotype (FP) assessment required modification prior to use in two studies. Clinical staff tended to use a simple judgement-based tool, the clinical frailty scale (CFS). Inter-rater reliability was reported in one study using the CFS and although a good level of agreement was observed between clinician assessments, this was a small and single-centre study. CONCLUSION: Though of unproven reliability in the critically ill, CFS was the tool used most widely by critical care clinical staff. Conventional FP assessment required modification for general application in critical care, and an FI-based assessment may be difficult to deliver by the critical care team on a routine basis. There is a high reliance on proxies for frailty assessment, and the reliability of frailty assessment tools in critical care needs further evaluation. PROSPERO REGISTRATION NUMBER: CRD42016052073. BioMed Central 2018-02-26 /pmc/articles/PMC6389132/ /pubmed/29478414 http://dx.doi.org/10.1186/s13054-018-1953-9 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Pugh, Richard J.
Ellison, Amy
Pye, Kate
Subbe, Christian P.
Thorpe, Chris M.
Lone, Nazir I.
Clegg, Andrew
Feasibility and reliability of frailty assessment in the critically ill: a systematic review
title Feasibility and reliability of frailty assessment in the critically ill: a systematic review
title_full Feasibility and reliability of frailty assessment in the critically ill: a systematic review
title_fullStr Feasibility and reliability of frailty assessment in the critically ill: a systematic review
title_full_unstemmed Feasibility and reliability of frailty assessment in the critically ill: a systematic review
title_short Feasibility and reliability of frailty assessment in the critically ill: a systematic review
title_sort feasibility and reliability of frailty assessment in the critically ill: a systematic review
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6389132/
https://www.ncbi.nlm.nih.gov/pubmed/29478414
http://dx.doi.org/10.1186/s13054-018-1953-9
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