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

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 C...

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Published in:Burns 2023-11, Vol.49 (7), p.1621-1631
Main Authors: Cords, Charlotte I., van Baar, Margriet E., Nieuwenhuis, Marianne K., Pijpe, Anouk, van der Vlies, Cornelis H., Roukema, G, Lucas, Y, Gardien, K, Middelkoop, E, Polinder, S, Scholten, SMHJ, Damen, J, Boudestein, K, Pijpe, A, van Zuijlen, PPM, Mattace-Raso, F.U.S., Bosma, E, Verhofstad, MHJ, Stoop, MM, Boekelaar, A, Roodbergen, D, Heijblom, M.C., van Es, A, van der Vlies, CH, Eshuis, H, Hiddingh, J, Scholten-Jaegers, SMHJ, van Baar, ME, Nieuwenhuis, MK, Novin, A
Format: Article
Language:English
Subjects:
Burn injury
Clinical frailty scale (CFS)
Frailty
Reliability
Validity
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Summary: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. 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. 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
ISSN:0305-4179
1879-1409
DOI:10.1016/j.burns.2023.05.001