A reliable and record-based frailty assessment method for older medical inpatients
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RESEARCH PAPER
A reliable and record‑based frailty assessment method for older medical inpatients Troels K. Hansen1 · Else Marie Damsgaard1,3 · Seham Shahla2 · Jens M. Bruun2,3 · Merete Gregersen1 Received: 10 March 2020 / Accepted: 7 June 2020 © European Geriatric Medicine Society 2020
Key summary points Aim To examine the reproducibility and diagnostic accuracy of a comprehensive frailty assessment method based solely on the older medical inpatient’s electronic medical record. Findings We found good reliability, high agreement, and considerable diagnostic accuracy when comparing the recordbased method to the bedside method. Message The record-based MPI is highly desirable. It seems feasible, reproducible, accurate, and worth exploring in larger datasets and other settings. Abstract Purpose The comprehensive geriatric assessment (CGA) including frailty assessment is considered the gold standard of assessment in geriatric patients. The Multidimensional Prognostic Index (MPI) is a CGA-based bedside assessment tool. Older medical inpatients’ medical records comprehensively describe the MPI-featured components. Consequently, MPIbased frailty assessment may be accomplished retrospectively. We found no previous studies concerning record-based MPI. We studied the reproducibility and diagnostic accuracy of a record-based MPI. Methods The study was designed as a fully crossed, prospective, and cross-sectional study. A total of 50 inpatients aged ≥ 75 years were included from two medical wards. Record-based MPI was assessed by two independent raters in patients who required personal assistance on a daily basis or had a Charlson Comorbidity Index (CCI) ≥ 1. In the same patients, a bedside MPI rating was performed. Inter-rater and inter-method reproducibility and diagnostic accuracy measures were calculated. Results Evaluating the inter-rater reproducibility; the mean difference was -0.02 points [95% confidence interval (CI) − 0.06 to 0.01, p = 0.20]. Intraclass correlation coefficient (ICC) was 0.71. Evaluating inter-method reproducibility; the mean difference was -0.02 (95% CI − 0.04 to 0.01, p = 0.18); ICC = 0.83. Sensitivity was 100% and specificity 80%. The areas under the receiver operating curves (ROC) was 0.92 (95% CI 0.75–1.00) and 0.77 (95% CI 0.52–1.00). Conclusion The record-based MPI rating method has an acceptable inter-rater reliability, good inter-method reliability, and high agreement as compared to the bedside-rated MPI. The diagnostic accuracy seems considerable. The record-based MPI seems useful in retrospective frailty assessment among older medical inpatients. Keywords Frailty · Multidimensional Prognostic Index · Reproducibility · Diagnostic accuracy · Medical record review · Comprehensive geriatric assessment
* Troels K. Hansen [email protected] 1
Department of Geriatrics, Aarhus University Hospital, Palle Juul‑Jensens Boulevard 99, 8200 Aarhus N, Denmark
2
Randers Regional Hospital, Skovlyvej 1, 8930 Randers NØ, Denmark
3
Department of Clinical Medicine, University of Aarhus,
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