Inter-rater Reliability of the Clinical Frailty Scale in a Swedish Emergency Department Setting

Study Overview
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Brief Summary
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Frailty is a common clinical syndrome in older adults, which may be assessed through various assessment tools. One frequently used tool is the Clinical Frailty Scale (CFS) which potentially can be adopted for daily use in the Emergency Department and has been appraised for reliability to some extent, but have so far not been evaluated in the Swedish emergency care context. The purpose of this study is to evaluate the inter-rater reliability of the Clinical Frailty Scale (CFS) in a clinical Swedish Emergency Department (ED) setting. Members of multidisciplinary emergency care teams will conduct the assessments individually.

Detailed Description
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The CFS is introduced and tested as part of a quality-improvement process regarding elderly people within the Emergency departments (EDs) of Region Östergötland (Östergötland County) in Sweden. CFS is a 9-point scale developed within the Canadian Study of Health and Aging. It comprises of a pictograms and a clinical description to help assign scores ranging from very fit to terminally ill. CFS enables clinicians to rapidly stratify the degree of frailty in the elderly with the help of questions and clinical assessment. However, since the assessment is judgement based, it is important that the inter-rater reliability is satisfactory. This study is part of a larger project where all eligible patients who visit the ED (24/7) for a period of four weeks will be enrolled and then subsequently assessed with CFS by one of their responsible health-care professionals (i.e. physician, registered nurse or nurse assistant). For this study, each professional on the team will individually assess each patient. First, a clinical judgement is performed (frail/not frail) without any instrument, and then the patient is assessed by using the CFS. This will take place during work shifts when someone from the research team is present and can arrange the assessments, as well as ensure that they are conducted independently. These work shifts will be selected using the online application Research Randomizer, to randomly include all hours of the day as well as eligible health-care professionals. The research-team member will collect the assigned CFS-scores and information on the age, gender, profession, position (emergency physician or intern/resident from other specialities) and the number of years in the profession of each assessor. Informed consent will be obtained from all health-care professionals who participate. No data that can identify any patient will be collected. Sample size is determined to be 100 patients, which would be more than sufficient with a power of 90% and α 0,05.

Official Title
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Inter-rater Reliability of the Clinical Frailty Scale in a Swedish Emergency Department Setting

Conditions
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Frailty

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Health-care professionals: - Working in the ED, as part of the emergency-care team that are responsible for a patient ≥65 years Patients: - ≥65 years Exclusion Criteria: Health care professionals: - Unwilling to provide informed consent Patients: - ≤65 years

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Level of inter-rater reliability regarding frailty as assessed by CFS | Inter-rater reliability of the CFS, expressed as Intraclass Correlation Coefficient | The assessment will be made in connection with the patient´s first meeting with the care team, i.e. within 1 hour from the patient´s arrival to the ED | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Level of correlation between degree of frailty (CFS 1-9) and degree of inter-rater reliability | Investigates whether inter-rater reliability, expressed as Intraclass Correlation Coefficient, varies between scale scores in CFS. Described descriptively. | The assessment will be made in connection with the patient´s first meeting with the care team, i.e. within 1 hour from the patient´s arrival to the ED | 
| Agreement between CFS and clinical judgement (frail/not frail) | Investigates the agreement between a clinical judgement (with no frailty tool) regarding the patient being frail or not, compared to frailty according to the CFS (cut-off 5). Expressed as a percentage. | The clinical judgement is made just before the assessment with CFS | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Frailty, Inter-rater reliability, Clinical Frailty Scale, Frailty assessment, Observer variation, Emergency service