Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/26674
Title: Routine frailty screening in critical illness- a population-based cohort study in Australia and New Zealand.
Austin Authors: Darvall, Jai N;Bellomo, Rinaldo ;Paul, Eldho;Bailey, Michael;Young, Paul J;Reid, Alice;Rockwood, Kenneth;Pilcher, David
Affiliation: Divisions of Geriatric Medicine & Neurology, and the Geriatric Medicine Research Unit, Division of Geriatric Medicine, Department of Medicine, Dalhousie University and Nova Scotia Health Authority, Nova Scotia, Canada
Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, VIC, Australia
Medical Research Institute of New Zealand, Wellington, New Zealand
Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
Department of Integrated Critical Care, The University of Melbourne, Melbourne, VIC, Australia
Data Analytics Research and Evaluation (DARE) Centre
Department of Intensive Care, Alfred Hospital, Melbourne, VIC, Australia
Issue Date: 2021
Date: 2021-06-02
Publication information: Chest 2021; 160(4): 1292-1303
Abstract: Frailty is associated with poor outcomes in critical illness. However, it is unclear whether frailty screening on admission to ICU can be routinely conducted at the population level and whether it has prognostic importance. Can population-scale frailty screening with the Clinical Frailty Scale (CFS) be implemented for critically ill adults in Australia and New Zealand (ANZ), and identify patients at risk of negative outcomes? We conducted a binational prospective cohort study of critically ill adult patients admitted between 1/7/2018 and 30/6/2020 in 175 ICUs in ANZ. We classified frailty with the CFS, on admission to ICU. Primary outcome was in-hospital mortality, secondary outcomes were length of stay, discharge destination, complications (delirium, pressure injury), and duration of survival. We included 234 568 critically ill patients; 45245 (19%) were diagnosed as living with frailty prior to ICU admission. Patients with vs. without frailty had higher in-hospital mortality (16% vs. 5%, p<0.001), delirium (10% vs. 4%, p<0.001), longer length of stay in ICU and hospital, and increased new chronic care discharge (3% vs. 1%, p<0.001), with worse outcomes associated with increasing CFS category. Of patients with very severe frailty (CFS=8), 39% died in-hospital vs. 2% of very fit (CFS=1) patients (multivariable categorical CFS=8 [ref=1] OR [95% CI] = 7.83 [6.39-9.59], p<0.001). After adjustment for illness severity, frailty remained highly significantly predictive of mortality, including among patients aged <50 years, with improvement in the AUROC (95% CI) of the Acute Physiology and Chronic Health Evaluation (APACHE) III-j score to 0.882 (0.879-0.885) from 0.868 (0.866-0.871) with the addition of frailty (p<0.001). Large scale population screening for frailty degree in critical illness was possible and prognostically important, with greater frailty (especially CFS≥6) associated with worse outcomes., including among younger patients.
URI: https://ahro.austin.org.au/austinjspui/handle/1/26674
DOI: 10.1016/j.chest.2021.05.049
Journal: Chest
PubMed URL: 34089741
Type: Journal Article
Subjects: Frailty
delirium
intensive care unit
mortality
risk prediction
Appears in Collections:Journal articles

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