Clinical Frailty Scale at presentation to the emergency department: interrater reliability and use of algorithm-assisted assessment

Key summary points Aim In this study, the interrater reliability of the Clinical Frailty Scale (CFS) ratings comparing assessments by both experienced and unexperienced staff (ED clinicians and a study team (ST) using a smartphone application to support CFS scoring) was evaluated. The feasibility of the CFS assignment at ED triage, defined as a majority of patients aged 65 or older assigned a CFS level at triage, was also investigated. Findings In this cross-sectional study of 1349 consecutive ED patients aged 65 years and older, the interrater reliability for CFS ratings was good for three different dyads assessed, whether used as an ordinal scale or as frailty categories (CFS 1–4 = non-frail to vulnerable; CFS 5–6 = mild to moderate frailty; CFS 7–9 = severe frailty to terminally ill). More than two-thirds (70.2%) of patients had a CFS rating assigned at triage. Message The CFS is a reliable scale for use in the ED and the implementation of frailty assessment could be facilitated with an algorithm-assisted assessment.