{
  "abstract": "Background The Clinical Frailty Scale is an ordinal scale from 1 (very fit) to 9 (terminally ill) commonly used to assess frailty in older patients. It is simple for clinicians to apply and can help identify patients who may benefit from discussions around end-of-life care. We externally validated the Scale to assess its performance for predicting 90-day mortality in a cohort of admitted older patients who had screened positive for being at risk of nearing the end of life.Methods We used data from a randomised controlled trial assessing a tailored feedback loop for reducing non-beneficial care. Our study included patients aged 75 and above admitted between May 2020 and June 2021 from 3 Australian hospitals. We assessed whether the Scale could be used in a frail population to identify patients who were at risk of short-term mortality. Predictive performance was assessed using the c-statistic, smoothed calibration curves and decision curves. Models were tested for coefficient stability.Results Our dataset contained 4639 patients and 956 deaths within 90 days. The Clinical Frailty Scale had a c-statistic of 0.62 (95% CI 0.60 to 0.64) or 0.63 (95% CI 0.61 to 0.65) by adding age and transforming the Scale using a cubic spline. Risks were underestimated without a non-linear transformation as scores of 8 and 9 had a higher risk that diverged from a linear association. The net benefit of using the tool was greatest between 5 and 8 on the Scale.Conclusions The utility of the Clinical Frailty Scale may be as a flag to encourage clinicians to become more comfortable with discussing ageing and death, rather than as a highly discriminating model to classify patients as high risk or low risk. Statistical uncertainty over mortality should not be a barrier to initiating end-of-life care discussions with frail older patients.",
  "authors": [
    {
      "affiliations": [
        "Programme in Health Services Research & Population Health, Duke-NUS Medical School, Singapore",
        "Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia"
      ],
      "name": "Robin Blythe"
    },
    {
      "affiliations": [
        "Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia"
      ],
      "name": "Nicole Marie White"
    },
    {
      "affiliations": [
        "Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia"
      ],
      "name": "Christine Brown"
    },
    {
      "affiliations": [
        "The Simpson Centre for Health Services Research,Australian Institute of Health Innovation, University of New South Wales, Kensington, New South Wales, Australia",
        "University of New South Wales School of Clinical Medicine, Sydney, New South Wales, Australia",
        "Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia"
      ],
      "name": "Ken Hillman"
    },
    {
      "affiliations": [
        "Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia"
      ],
      "name": "Adrian Gerard Barnett"
    }
  ],
  "title": "Validation of the Clinical Frailty Scale for predicting 90-day mortality in hospitalised older adults screened as at risk of nearing the end of life in Queensland, Australia: a multisite observational study",
  "uid": "64c35515-00aa-5132-904c-b39c4abdf027"
}