Background
Methods
Eligibility criteria
Information sources
Data management
Data items
Outcomes and prioritisation
Risk of bias for individual studies
Results
Study selection
Study characteristics
Study | Year | Full text | Country/countries | Number of sites | Setting | Intended study outcomes | Additional data provided by study authors? |
---|---|---|---|---|---|---|---|
2014, 2015, 2016 | Yes | Canada | 6 | Mixed medical-surgical ICU | Predictive validity: in-hospital mortality, health-related quality of life | - | |
Brummel [29] | 2017 | Yes | USA | 5 | Medical and surgical ICU | Predictive validity: mortality, disability, cognitive impairment | Yes |
Fisher [32] | 2015 | Yes | Australia | 1 | Mixed-medical surgical ICU | Predictive validity: mortality, length of stay, discharge destination Feasibility | - |
Flaatten [36] | 2017 | Yes | Europe (21 countries) | 311 | Mixed ICUs | Predictive validity: mortality | Yes |
2015, 2015 | Yes | Canada | 22 | Mixed ICUs | Predictive validity: prolonged dying experience, physical recovery at 12 months | Yes | |
Hope [35] | 2017 | Yes | USA | 2 | Medical and surgical ICUs | Construct validity: frailty markers, frailty assessment and demographic correlates of frailty. Predictive validity: new disability and death | Yes |
Le Maguet [30] | 2014 | Yes | France | 4 | Mixed medical-surgical ICU | Predictive validity: mortality | Yes |
Pugh [31] | 2017 | No - research letter only | UK | 1 | Mixed medical-surgical ICU | Inter-rater reliability of frailty assessment | Yes |
Study | Number of patients | Sex (% male) | Age restriction | Age in years, mean (+/- SD) or median (IQR) | Operative status | Proportion receiving invasive ventilation |
---|---|---|---|---|---|---|
421 | 61% | 50 Years and oldera | 67 +/-10 | Post-operative: 34% | 86% | |
Brummel [29] | 1040 | 60% | 18 Years and older | 62 (53- 72) | Post-operative: 16% | 88% |
Fisher [32] | 348 | 59%b | 18 Years and older | 60 (+/-17) | Post-operative: 53% | Not reported |
Flaatten [36] | 5021 | 52% | 80 Years and older | 84 (81- 86) | Post-operative: 27% | 51% |
610 | 55% | 80 Years and older | 84 (+/- 3) | Post-operative: 39% | 72% | |
Hope [35] | 95 | 56% | None | 57 (+/- 18) | Post-operative: 6% | 56% |
Le Maguet [30] | 196 | 65% | 65 Years and older | 75 (+/- 6) | Post-operative: 65% | 88% |
Pugh [31] | 30 | 60% | 16 Years and older | 67 (+/- 14) | Not collected | Not collected |
Risk of bias within studies
Study | Risk of bias | Notes | |||
---|---|---|---|---|---|
Selection biasa | Comparabilityb | Outcomec | Overall risk | ||
Low | Unclear | n/a | Unclear | No statistically significant differences between study participants and non-enrolled. Involvement of proxy vs. patient not specified. | |
Brummel [29] | Unclear | Unclear | n/a | Unclear | Reasons for non-enrolment described, but potential differences between such patients not explored. Timing of frailty assessment described, but data regarding proxy involvement not collected. |
Fisher [32] | Low | Low | n/a | Low | Reasons for not evaluating frailty not recorded, though there is comparison of evaluated vs. non-evaluated patients. |
Flaatten [36] | Unclear | Unclear | n/a | Unclear | Numbers of potentially eligible patients not enrolled and reasons for non-enrolment not collated. Proxy data not collected. |
Low | Low | n/a | Low | Characteristics of study cohort were similar to unselected hospital cohort. | |
Hope [35] | Unclear | Low | n/a | Unclear | Reasons for non-enrolment described, but potential differences between such patients and those enrolled not studied. Proxy involvement described. |
Le Maguet [30] | Unclear | Unclear | n/a | Unclear | Reasons for non-inclusion partially described. Potential differences between included and excluded patients not investigated. |
Pugh [31] | Unclear | Unclear | Low | Unclear | Reasons for non-enrolment not recorded nor details regarding proxy involvement. Interval between assessments not recorded. Assessors were blinded to other assessments. |
Assessment of frailty
Frailty domain | Fried [11] | Le Maguet [30] | Hope [35] |
---|---|---|---|
Shrinking | Unintentional (not due to dieting or exercise) weight loss 10 lbs (4.5 kg) or more than 5% of body weight in the prior year | Unintentional (not due to dieting or exercise) weight loss ≥ 4.5 kg or more than 5% of body weight in the prior year | Reported weight loss and BMI < 24 or ≥ 5% weight loss |
Weakness | Hand-grip strength measured by dynamometer (stratified by gender and body mass index) | Difficulty rising from a chair | Unable to rise from a chair without using arms |
Slowness | Time to walk 15 feet (stratified by gender and height) | Slowed walking speed (during the last 6 months, with difficulties walking and with aid) and/or the occurrence of fall(s) | Falls or need for assistance with mobility inside or outside the home in the past year |
Low physical activity | Use of Minnesota Leisure Time Activity Questionnaire to calculate kilocalories expended per week | Discontinued daily leisure activities such as walking or gardening and/or discontinued some sport activity per week | Unable to climb flight of stairs or undertake moderate activity, e.g. pushing a vacuum cleaner or bowling |
Exhaustion | Feeling that everything the patient does is an effort and/or the feeling that he/she could not get going, and how often in the last 3 months he/she felt this way | Feeling that everything the patient does is an effort and/or the feeling that he/she could not get going, and how often in the last 3 months he/she felt this way | Feeling that everything the patient does is an effort and/or the feeling that he could not get going, in past 4 weeks; number of times he/she had a lot of energy in past 4 weeks |
Cognitive Impairment | Memory Impairment Screen, or modified version of the Short-Form Informant Questionnaire on Cognitive Decline in the Elderly | ||
Sensory Impairment | Problems in daily life because of poor vision or impaired hearing in last year |
Study | Frailty assessment tool | Timing of frailty assessment | Reference point for frailty assessment | Interval between assessments |
---|---|---|---|---|
CFS | Not recorded | Immediately before hospitalisation | Not applicable | |
Brummel [29] | CFS | Within 72 hours of ICU admission | Prior to critical illness | Not applicable |
Fisher [32] | CFS | Within first 24 hours of ICU admission (for next-of-kin) | Pre-ICU admission | Not applicable |
Flaatten [36] | CFS | Within first 24 hours of ICU admission | Before acute illness and hospital admission | Not applicable |
CFS, FI | At 48 − 72 hours after ICU admission | At 2 weeks pre-hospital admission | Not recorded | |
Hope [35] | CFS, FP | Within 72 hours of ICU admission | CFS: not specified FP: variable, depending on element | Within 24 hours |
Le Maguet [30] | CFS, FP | At ICU admission | At 1 month pre-hospital admission | Not recorded |
Pugh [31] | CFS | Not recorded | At 2 weeks pre- hospital admission | Not recorded |
Feasibility of frailty assessment
Study | Frailty assessor(s) | Training required | Time required for assessment | Patient participation | Proxy involvement | Neither patient nor proxy involved | Percent screened patientsa excluded due to lack of proxy |
---|---|---|---|---|---|---|---|
Research coordinator | Not described | Not recorded | Not recorded | Not recorded | Nil | Not recorded | |
Brummel [29] | Study personnel | Trained by geriatrician during 2-day trial start up | Not recorded | Not recorded | Not recorded | Nil | 31% because of lack of proxy |
Fisher [32] | Next-of-kin (NOK), nurse in charge if NOK unavailable in first 24 hours | Series of lectures for nurses; bedside introduction with standardised script for NOK | Not recorded | None | 73% | 27% | Nil |
Flaatten [36] | Critical care staff | None | Not recorded | Not recorded | Not recorded | Not recorded | < 0.2% because of lack of proxyb |
Research coordinator | Embedded within start-up training | Not recorded | None | 100% (excluded if no family member available) | Nil | 45% missed caregiver | |
Hope [35] | CFS: critical care doctor FP: research team | Bedside explanation (CFS) Specific training in use of questionnaire and frailty construct (FP) | Not recorded | 42% | 58% | Nil | 12% because of lack of proxy |
Le Maguet [30] | Critical care staff | Staff meeting | Not recorded | 39% | 69% | Nil | 20% because of lack of proxy |
Pugh [31] | Medical student investigators, critical care doctor | Training for medical students, bedside explanation for doctors. | Not recorded | Not recorded | Not recorded | Nil | Not recorded |