Should the Clinical Frailty Score (CFS) be used to guide decision-making among Intensive Care Unit (ICU) inpatients?

• Abstract ID - 4412
• Abstract title - Should the Clinical Frailty Score (CFS) be used to guide decision-making among Intensive Care Unit (ICU) inpatients?
• Abstract Author Name - Dr H-M JAMES; Professor A JOHANSEN; Dr B JONES
• Abstract Provenance - Cardiff and Vale University Health Board, Intensive Care Unit
   

Should the Clinical Frailty Score (CFS) be used to guide decision-making among Intensive Care Unit (ICU) inpatients?

Background

When deciding on the appropriateness of ICU admission an understanding of patients’ prior dependency is just one issue to be considered, alongside their medical history, the nature, severity, and reversibility of their acute illness. No individual scoring tool can reliably predict ICU survival and we set out to question whether perceived CFS might have a role in guiding ICU decision making.

Method

We reviewed all 443 patients aged ≥65 years who were admitted to our teaching hospital ICU during 2023, excluding only those repatriated to hospitals outside Wales.  We examined what the CFS of older people admitted to ITU tells us about their mortality (at ITU and hospital discharge and 12 months), and their outcome (Readmission, and outpatient care). We set the CFS recorded on ICU admission against outcome in terms of mortality and morbidity.

Results

A total of 443 older patients were admitted. 301 (70%) survived ICU, but 15.6% of these subsequently died in hospital. 53% of all admissions survived 12 months. Of those discharged from ICU, 43% were re-admitted to hospital at least once within the year. The vast majority (97.6%) of patients accepted for ICU were of CFS scores 2-7, with 40.8% having a CSF of 3. However, the CFS provided no useful indication of prognosis with no linear relationship between CFS and mortality. The majority (58-71%) of patients survived across all these CFS categories.

Conclusion

An understanding of a patient’s frailty should inform the decision as to whether they are appropriate for ICU admission. It may also influence decisions as to the length and intensity of the ICU care they receive. However, other factors appear more important determinants of outcome, and it seems unlikely that CFS will be a useful addition to existing critical care outcome prediction tools.