Concurrent Validity of Clinical Frailty Scale (CFS) Brief Aids for Frailty Identification
Applied/Translational Research
Ng Teng Fong Healthcare Innovation Programme
National Healthcare Group
31 December 2024
We aim to conduct a prospective cohort study to examine the concurrent and predictive validity of the CFS-Fast, CFS-Self. Amongst the 3 tools, CFS-Self showed the most promise as a front-door diagnostic tool for use in geriatric patients presenting at the.
Year Submitted: 2024
Published Date: 31 December 2024
Tags: Applied/Translational Research, Quality Improvement, Workflow Redesign, Cost Saving
About this Content
Aims
We aim to conduct a prospective cohort study to examine the concurrent and predictive validity of the CFS-Fast, CFS-Self, and CFS-A for use at the ED setting. Primary Objectives: To evaluate the utility of CFS-Fast, CFS-Self, and CFS-A against the Frailty Index (FI) for use at the ED among older adults aged 65 years and above, by examining concurrent validity. Secondary Objectives: To evaluate the predictive performance of the CFS-ED, CFS-Self, and CFS-A against the gold standard frailty measure, FI.
Background
The ED is vital in the care and frailty risk assessment of the elderly. However, the implementation of frailty screening and frailty-centred care in the ED is challenging due to limitations of resources and manpower, prioritisation of disease-specific care and the time-pressured environment to assess and transfer patients. The CFS-A has been retrospectively validated locally for use in hospitalised older adults, however no tools have been validated in the ED setting to assess the degree of frailty. The development of brief, accurate, reliable and easily implemented tools in the ED would enable early risk assessment of the elderly.
Methods
This is a prospective cohort study. A convenience sample of patients aged 65 years and above presenting to TTSH ED will be recruited until target sample size is achieved. At the ED visit, CFS-Fast will be performed by the ED triage nurses, CFS-Self will be performed by the patient or their caregiver, and a research assistant will interview the patient and/or next-of-kin to complete a baseline data collection form. Subsequently, a geriatrician or geriatric advanced practice nurse will perform CFS-A. Telephonic follow up will be performed at 1, 3 and 6 months to assess outcomes, function, health-related quality of life and falls. All three raters will perform the rating at different times, and will be blinded to each other’s ratings.
Results
Patients who scored CFS 5 and above were considered frail. Agreement in frailty classification was fair-to-moderate between the novel tools and the gold standard of Frailty Index. The CFS-A and CFS-Fast had fair agreement, whilst the CFS-Self had moderate agreement. The 3 tools exhibited moderate-to-good discriminative performance with varying sensitivity and specificity for frailty classification. Of the 3 tools, only CFS-Self was able to differentiate frail and non-frail patients presenting at the ED with reasonable performance.
Conclusion
Amongst the 3 tools, CFS-Self showed the most promise as a front-door diagnostic tool for use in geriatric patients presenting at the Emergency Department, based on a cut-off of CFS 5 and above to denote frailty. The tool exhibited moderate agreement with the gold standard, high AUC with reasonable sensitivity when applied on a patient cohort with low frailty prevalence and high functional ability.
Lessons Learnt
Obtaining consent from patients’ next-of-kin in the Emergency Department proved to be a challenge in our study. Due to the ED visitor policy, next-of-kin were frequently not found by the patient’s bedside. Hence, patients who were unable to provide consent due to underlying medical conditions such as dementia or delirium could not be recruited. This resulted in the study population being skewed towards patients who could provide consent, that is, the non-frail population.
Additional Information
The team is targeting to submit a poster for the upcoming Singapore Health and Biomedical Congress. Also, the team will be submitting a manuscript to the International Journal of Emergency Medicine (IF 3.747).
Keywords
Frailty, Emergency Department, CFS-Fast, CFS-Self, CFS-A
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | National Healthcare Group |
Organization(s) Involved | Tan Tock Seng Hospital, National Healthcare Group |
Platform(s) | Ng Teng Fong Healthcare Innovation Programme |
Healthcare Professional Group(s) | Healthcare Administration, Medical |
Applicable Specialty or Discipline | Geriatric Medicine |
Project Lead(s) | Tham Yumin Audrey |
Project Member(s) | Magdalene Lee |
Connect with this contributor!
Dr. Tham Yumin Audrey - Audrey_y_tham@ttsh.com.sg