The importance of frailty

Published Date: 10th October 2016

Publication Authors: Tridente A

​Introduction

Demand for Critical Care (CC) is increasing but admission may be inappropriate if the patient is unlikely to survive. Consequently, published guidance may no longer reflect current practice [1-2]. Clinical frailty evaluation scores have recently been shown to be associated with increased mortality in patients already admitted to CC [3]. We aimed to establish the impact of frailty and other factors on the decision whether to admit a deteriorating hospital patient to CC.

Methods

Unplanned patient referrals were prospectively enrolled in a review cohort. Data included patient demographics, acute physiological parameters, prior hospital length of stay (LOS), Canadian Clinical Frailty Scale (CCFS) and comorbidities. Logistic regression analysis was used to assess factors influencing admission, using STATA 14.1. Results are expressed as median (interquartile range) and odds ratios (OR) with confidence intervals (CI).

Results

Between June and October 2015 data was collected on 220 patients referred to CC, of whom 87 (39.5%) were admitted. Median age was 66.5 (50-77) years, 134 (60.9%) were male and the median LOS prior to referral was 2 (0-7) days. The median SOFA score, CCFS and Charlson age-adjusted comorbidity index (CACI) was 5 (4-7), 4 (3-5) and 4 (2-6), respectively. At unadjusted logistic regression analysis age (p = 0.86), gender (p = 0.72), LOS (p = 0.34) and SOFA score (p = 0.42) did not impact on likelihood of admission to CC. Conversely, each unit increase in the CACI (OR 0.78, 95% CI 0.66-0.91, p = 0.002) and in the CCFS (OR 0.69, 95% CI 0.56-0.85, p < 0.001) caused a decrease of approximately 22% and 31% in the odds of admission, respectively. On age and gender adjusted multivariate logistic regression analysis CCFS retained its ability to predict admission to critical care (OR 0.65 per unit increase, 95% CI 0.49-0.85, p = 0.002), whilst CACI did not (OR 0.85, 95% CI 0.70-1.03, p = 0.09).

Conclusions

Frailty appears to be a major factor in decision making regarding admission to CC, even after adjusting for age, gender and other known comorbidities. Quantification of frailty using the CCFS may be a valuable tool in risk stratification and resource allocation, and merits further investigation in this context.

Bauchmuller, K; Tridente, A et al. (2016). Admission to critical care: The importance of frailty . Critical Care. 20 (Suppl 2)

« Back