COVID-19: Clinical Frailty Scale in intensive and critical care settings

As cases of COVID-19 increase, clinicians require decision making tools to assess which patient might benefit most from ventilation in intensive and critical care.

Guidance published by the National Institute for Health and Care Excellence (27 March 2020) advises clinicians to use the Clinical Frailty Scale (CFS) as part of a holistic assessment to guide decisions around referral to critical care for those aged over 65, but not those under 65 years.

At present, there is little evidence about whether the CFS is valid for identifying frailty in younger populations.

For other relevant research, see our frailty data project.

Findings

We identified no evidence within these existing searches about the use of the CFS as a decision- making tool for referral to critical care for populations under 65.

Systematic review

A systematic review by Pugh and colleagues (2019) synthesised evidence about the feasibility and reliability of frailty assessment measures in critical care, for populations aged over 16 years.

This review found that the CFS was most widely used among clinicians in critical care, but that there was limited evidence about its reliability in this setting. There was no indication of whether reliability varied according to the age of the sample.

Primary studies

Across the seven studies identified, the CFS predicted ICU/hospital or post-discharge death in four of the studies. The study by Tipping and colleagues (2019) found that the Frailty Phenotype identified frailty in more patients than the CFS.

Conclusions

Based on studies identified from an existing search on a related topic, there was limited evidence identified about the use of the CFS in intensive and critical care settings.

A recent systematic review indicates there is limited reliability for the use of the CFS in intensive care settings, although it is not clear if and how this varies according to patient age.

A dedicated rapid review with focused searches may highlight other evidence not contained within the existing set of searches that we drew upon for this summary.

Associated publication

• Full briefing paper – COVID-19: The use of the Clinical Frailty Scale in intensive and critical care settings (PDF)