Cross-Cultural Adaptation of the Clinical Frailty Scale for Critically Ill Patients in Spain and Concurrent Validity With FRAIL-Es.
Susana Arias-Rivera, María Nieves Moro-Tejedor, Fernando Frutos-Vivar and 23 others
PMID 39962771WHAT IT FOUND
ICU nurses and physicians can use a Spanish Clinical Frailty Scale at admission, taking about 3 minutes, but its frailty ratings did not fully agree with FRAIL-Es.
Key findings
01When CFS-Es level 4 was counted as non-frail, CFS-Es and FRAIL-Es agreed in 575 of 724 assessments (79.4%), and the kappa value was 0.514.
02The CFS-Es and FRAIL-Es scores showed a strong positive correlation, r = 0.681 (95% CI 0.640 to 0.718).
03In the clinical pilot, the scale took a median of 3 min and 10 s (1 to 7 min) to apply; nurses took a median of 2 min and 9 s (1 min to 4 min and 47 s) and physicians 5 min (1 to 10 min), with p = 0.183.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
There is no gold standard frailty scale, so CFS-Es sensitivity and specificity were not tested. CFS-Es depends on interviewer judgement because it lacks closed-ended questions, so ratings can be subjective. Some patients could not communicate, so family members reported the pre-admission state and may not know it fully. Frailty prevalence differed by scale, with 17.5% frail by CFS-Es and 24.5% frail by FRAIL-Es at admission. The pilot included 30 patients and the validation phase included 212 patients in a Spanish ICU setting. Other psychometric properties still need examination.
The easy way to misread this
Do not read the agreement and correlation as proof that CFS-Es identifies true frailty. The study had no gold standard, so sensitivity and specificity were not evaluated, and agreement changed when level 4 was counted as frail or non-frail.