"The feasibility and reliability of frailty assessment tools applicable in acute in-hospital trauma patients: a systematic review".

BACKGROUND Assessing frailty in patients with an acute trauma can be challenging. To provide trustworthy results, tools should be feasible and reliable. This systematic review evaluated existing evidence on the feasibility and reliability of frailty assessment tools applied in acute in-hospital trauma patients. METHODS A systematic search was conducted in relevant databases until February 2020. Studies evaluating the feasibility and/or reliability of a multidimensional frailty assessment tool used to identify frail trauma patients were identified. The feasibility and reliability results and the risk of bias of included studies was assessed. This study was conducted and reported in line with the PRISMA statement and registered in PROSPERO (ID = CRD42020175003). RESULTS Nineteen studies evaluating 12 frailty assessment tools were included. The risk of bias of the included studies was fair to good. The most frequently evaluated tool was the Clinical Frailty Scale (n = 5). All studies evaluated feasibility in terms of the percentage of patients for whom frailty could be assessed, feasibility was high (median 97%, range: 49%-100%). Other feasibility aspects, including time needed for completion, tool availability and costs, availability of instructions and necessity of training for users were hardly reported. Reliability was only assessed in three studies, all evaluating the Clinical Frailty Scale. The inter-rater reliability varied between 42% and > 90% agreement, with a Krippendorff alpha of 0.27-0.41. CONCLUSION Feasibility of most instruments was generally high. Other aspects were hardly reported. Reliability was only evaluated for the Clinical Frailty Scale with results varying from poor to good. The reliability of frailty assessment tools for acute trauma patients needs further critical evaluation to conclude whether assessment leads to trustworthy results that are useful in clinical practice. LEVEL OF EVIDENCE 1A, Systematic review.