Assessment of frailty by paramedics using the clinical frailty scale - an inter-rater reliability and accuracy study
Abstract Background Frailty assessment by paramedics in the prehospital setting is understudied. The goals of this study were to assess the inter-rater reliability and accuracy of frailty assessment by paramedics using the Clinical Frailty Scale (CFS). Methods This was a cross-sectional study with p...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-10-01
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| Series: | BMC Emergency Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12873-023-00875-x |
| _version_ | 1797453665082015744 |
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| author | Christophe A. Fehlmann Loric Stuby Christophe Graf Matthieu Genoud Rebecca Rigney Judah Goldstein Debra Eagles Laurent Suppan |
| author_facet | Christophe A. Fehlmann Loric Stuby Christophe Graf Matthieu Genoud Rebecca Rigney Judah Goldstein Debra Eagles Laurent Suppan |
| author_sort | Christophe A. Fehlmann |
| collection | DOAJ |
| description | Abstract Background Frailty assessment by paramedics in the prehospital setting is understudied. The goals of this study were to assess the inter-rater reliability and accuracy of frailty assessment by paramedics using the Clinical Frailty Scale (CFS). Methods This was a cross-sectional study with paramedics exposed to 30 clinical vignettes created from real-life situations. There was no teaching intervention prior to the study and paramedics were only provided with the French version of the CFS (definitions and pictograms). The primary outcome was the inter-rater reliability of the assessment. The secondary outcome was the accuracy, compared with the expert-based assessment. Reliability was determined by calculating an intraclass correlation coefficient (ICC). Accuracy was assessed through a mixed effects logistic regression model. A sensitivity analysis was carried out by considering that an assessment was still accurate if the score differed from no more than 1 level. Results A total of 56 paramedics completed the assessment. The overall assessment was found to have good inter-rater reliability (ICC = 0.87 [95%CI 0.81–0.93]). The overall accuracy was moderate at 60.6% (95%CI 54.9–66.1) when considering the full scale. It was however much higher (94.8% [95%CI 92.0–96.7] when close assessments were considered as accurate. The only factor associated with accurate assessment was field experience. Conclusion The assessment of frailty by paramedics was reliable in this vignette-based study. However, the accuracy deserved to be improved. Future research should focus on the clinical impact of these results and on the association of prehospital frailty assessment with patient outcomes. Registration This study was registered on the Open Science Framework registries ( https://doi.org/10.17605/OSF.IO/VDUZY ). |
| first_indexed | 2024-03-09T15:26:24Z |
| format | Article |
| id | doaj.art-869a261924f340a68dfee5abc6191f28 |
| institution | Directory Open Access Journal |
| issn | 1471-227X |
| language | English |
| last_indexed | 2024-03-09T15:26:24Z |
| publishDate | 2023-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Emergency Medicine |
| spelling | doaj.art-869a261924f340a68dfee5abc6191f282023-11-26T12:32:09ZengBMCBMC Emergency Medicine1471-227X2023-10-012311910.1186/s12873-023-00875-xAssessment of frailty by paramedics using the clinical frailty scale - an inter-rater reliability and accuracy studyChristophe A. Fehlmann0Loric Stuby1Christophe Graf2Matthieu Genoud3Rebecca Rigney4Judah Goldstein5Debra Eagles6Laurent Suppan7Division of Emergency Medicine, Department of Acute Medicine, Geneva University HospitalsGenève TEAM Ambulances, Emergency Medical ServicesDepartment of rehabilitation and geriatrics, Geneva University HospitalsDivision of Emergency Medicine, Department of Acute Medicine, Geneva University HospitalsNational Ambulance ServiceDalhousie Department of Emergency Medicine, Division of EMSSchool of Epidemiology and Public Health, University of OttawaDivision of Emergency Medicine, Department of Acute Medicine, Geneva University HospitalsAbstract Background Frailty assessment by paramedics in the prehospital setting is understudied. The goals of this study were to assess the inter-rater reliability and accuracy of frailty assessment by paramedics using the Clinical Frailty Scale (CFS). Methods This was a cross-sectional study with paramedics exposed to 30 clinical vignettes created from real-life situations. There was no teaching intervention prior to the study and paramedics were only provided with the French version of the CFS (definitions and pictograms). The primary outcome was the inter-rater reliability of the assessment. The secondary outcome was the accuracy, compared with the expert-based assessment. Reliability was determined by calculating an intraclass correlation coefficient (ICC). Accuracy was assessed through a mixed effects logistic regression model. A sensitivity analysis was carried out by considering that an assessment was still accurate if the score differed from no more than 1 level. Results A total of 56 paramedics completed the assessment. The overall assessment was found to have good inter-rater reliability (ICC = 0.87 [95%CI 0.81–0.93]). The overall accuracy was moderate at 60.6% (95%CI 54.9–66.1) when considering the full scale. It was however much higher (94.8% [95%CI 92.0–96.7] when close assessments were considered as accurate. The only factor associated with accurate assessment was field experience. Conclusion The assessment of frailty by paramedics was reliable in this vignette-based study. However, the accuracy deserved to be improved. Future research should focus on the clinical impact of these results and on the association of prehospital frailty assessment with patient outcomes. Registration This study was registered on the Open Science Framework registries ( https://doi.org/10.17605/OSF.IO/VDUZY ).https://doi.org/10.1186/s12873-023-00875-xParamedicsClinical frailty scaleCfsReliabilityAccuracyEmergency medical services |
| spellingShingle | Christophe A. Fehlmann Loric Stuby Christophe Graf Matthieu Genoud Rebecca Rigney Judah Goldstein Debra Eagles Laurent Suppan Assessment of frailty by paramedics using the clinical frailty scale - an inter-rater reliability and accuracy study BMC Emergency Medicine Paramedics Clinical frailty scale Cfs Reliability Accuracy Emergency medical services |
| title | Assessment of frailty by paramedics using the clinical frailty scale - an inter-rater reliability and accuracy study |
| title_full | Assessment of frailty by paramedics using the clinical frailty scale - an inter-rater reliability and accuracy study |
| title_fullStr | Assessment of frailty by paramedics using the clinical frailty scale - an inter-rater reliability and accuracy study |
| title_full_unstemmed | Assessment of frailty by paramedics using the clinical frailty scale - an inter-rater reliability and accuracy study |
| title_short | Assessment of frailty by paramedics using the clinical frailty scale - an inter-rater reliability and accuracy study |
| title_sort | assessment of frailty by paramedics using the clinical frailty scale an inter rater reliability and accuracy study |
| topic | Paramedics Clinical frailty scale Cfs Reliability Accuracy Emergency medical services |
| url | https://doi.org/10.1186/s12873-023-00875-x |
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