The feasibility and reliability of frailty assessment tools applicable in acute in-hospital trauma patients: A systematic review

Charlotte I Cords; Inge Spronk; Francesco U S Mattace-Raso; Michiel H J Verhofstad; Cornelis H van der Vlies; Margriet E van Baar

doi:10.1097/TA.0000000000003472

The feasibility and reliability of frailty assessment tools applicable in acute in-hospital trauma patients: A systematic review

J Trauma Acute Care Surg. 2022 Mar 1;92(3):615-626. doi: 10.1097/TA.0000000000003472.

Authors

Charlotte I Cords¹, Inge Spronk, Francesco U S Mattace-Raso, Michiel H J Verhofstad, Cornelis H van der Vlies, Margriet E van Baar

Affiliation

¹ From the Association of Dutch Burn Centres (C.I.C., I.S., M.E.v.B.), Maasstad Hospital; Department of Public Health (I.S., M.E.v.B.), Section of Geriatric Medicine, Department of Internal Medicine (F.U.S.M.-R.), and Trauma Research Unit Department of Surgery (C.I.C., M.H.J.V., C.H.v.d.V.), Erasmus MC, University Medical Center; and Burn Center (C.H.v.d.V.), Maasstad Hospital, Rotterdam, the Netherlands.

PMID: 34789703
DOI: 10.1097/TA.0000000000003472

Abstract

Background: Assessing frailty in patients with an acute trauma can be challenging. To provide trustworthy results, tools should be feasible and reliable. This systematic review evaluated existing evidence on the feasibility and reliability of frailty assessment tools applied in acute in-hospital trauma patients.

Methods: A systematic search was conducted in relevant databases until February 2020. Studies evaluating the feasibility and/or reliability of a multidimensional frailty assessment tool used to identify frail trauma patients were identified. The feasibility and reliability results and the risk of bias of included studies were assessed. This study was conducted and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and registered in Prospective Register of Systematic Reviews (ID: CRD42020175003).

Results: Nineteen studies evaluating 12 frailty assessment tools were included. The risk of bias of the included studies was fair to good. The most frequently evaluated tool was the Clinical Frailty Scale (CFS) (n = 5). All studies evaluated feasibility in terms of the percentage of patients for whom frailty could be assessed; feasibility was high (median, 97%; range, 49-100%). Other feasibility aspects, including time needed for completion, tool availability and costs, availability of instructions, and necessity of training for users, were hardly reported. Reliability was only assessed in three studies, all evaluating the CFS. The interrater reliability varied between 42% and >90% agreement, with a Krippendorff α of 0.27 to 0.41.

Conclusion: Feasibility of most instruments was generally high. Other aspects were hardly reported. Reliability was only evaluated for the CFS with results varying from poor to good. The reliability of frailty assessment tools for acute trauma patients needs further critical evaluation to conclude whether assessment leads to trustworthy results that are useful in clinical practice.

Level of evidence: Systematic review, Level II.

Publication types

Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Frailty / classification*
Humans
Physical Examination / standards*
Risk Assessment / methods*
Wounds and Injuries*