Inter-Rater Reliability of Clinical Frailty Scale in Onco-Critical Care

• Author Details:   
• Suresh Kumar Sundaramurthy ^*
• Thiriloga Sundary Murali Rajagopalan
• Premnath Balakrishnan
• Nagarajan Ramakrishnan
• Raymond Dominic Savio

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Introduction:

The importance of frailty assessment in critically ill cancer patients cannot be stressed enough. This is commonly done using the Clinical Frailty Scale (CFS) despite its subjective nature and the possibility of an inter-rater variability. Methods: Our single-center, prospective, observational study enrolled 627 consecutive adult cancer patients admitted to the Multidisciplinary Critical Care Unit in a tertiary cancer hospital. Frailty was assessed using clinical frailty scale within 48 hours of admission by a physician and a registered nurse, who were blinded to each other. Results: Inter-rater reliability, assessed using the kappa coefficient, revealed only a moderate level of agreement (kappa coefficient 0.56) between a physician and a registered nurse. This variability is likely influenced by professional backgrounds, clinical judgment, biased responses, and the inherent subjective nature of CFS. Conclusion: Our study underscores the subjective nature of frailty assessment using the clinical frailty scale in Onco-critical care and emphasizes the need for collaborative efforts in refining frailty tools tailored to the dynamic landscape of onco-critical care.