Frailty at ICU admission: a potential alternative to scoring systems based on clinical observation

Abstract

Frailty is a common clinical syndrome associated with increased risks of morbidity, mortality and other adverse outcomes. It is often used by healthcare providers as a tool for estimating patients` condition and triaging for Intensive Care Unit (ICU) admission, as recommended by several national guidelines. This study aimed to evaluate the utility of observed frailty, a subjective clinical assessment by physicians, as an alternative to the validated Clinical Frailty Score (CFS) and Modified Frailty Index (MFI). Additionally, the study explored the association of these frailty scoring systems with 30 day mortality, mechanical ventilation duration, and ICU length of stay. This retrospective study analyzed 100 patients admitted to an ICU at a tertiary center between March 12 and April 30, 2019. Observed frailty was assessed on a 4-point scale by physicians at ICU admission. CFS (7-point scale) and MFI (11-point scale) were retrospectively calculated. Correlations between these frailty assessments and their relationships with clinical outcomes were examined. Observed frailty correlated moderately with the CFS (Spearman coefficient = 0.4, p < 0.001) but showed a weaker, non-significant correlation with the MFI (Spearman coefficient = 0.18, p = 0.07). Significant differences in 30 day survival were observed based on the 4-point observed frailty scale (p < 0.001). Subjective assessment of frailty using a 4-point scale by physicians at ICU admission correlates with the CFS and is significantly associated with 30 day mortality. This suggests that observed frailty may be a practical tool for clinical decision-making. Further prospective studies are required to validate its utility and prognostic implications.

Keywords: Chronic disease; Clinical frailty score (CFS); Frailty; Geriatrics; Intensive care unit.