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Agreement and predictive value of the Rockwood Clinical Frailty Scale at emergency department triage
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    Interrater-variability in frailty screening using the Safety Management System (VMS).

     

    To the editor,

    In their article “Agreement and predictive value of the Rockwood Clinical Frailty Scale (CFS) at emergency department triage”, Shrier et al (1) nicely illustrate that the level of agreement between different health care professionals in obtaining the CFS at different clinical settings is weak. The CFS was rated for 8,568 patients over 65 years by the triage nurse at the emergency department (ED) and by the attending physician on admission on the ward. Both scores were compared using the Cohen’s kappa coefficient, which was  0.21 and therefore is considered weak (2). 
    We found similar results in our AmsterGEM study. The AmsterGEM study is an observational prospective cohort study that investigates the prognostic accuracy of frequently used frailty screening instruments (3). Patients aged over 70 years old attending the ED were screened with four screening instruments, including the Safety Management System (VMS) (4). The VMS consists of four geriatric domains, which are associated with functional decline: delirium, malnutrition, falls and ADL limitations (5,6). All Dutch hospitals have implemented the VMS screening instrument for hospitalized older patients. In a sub-analysis of our study, the VMS was applied on 173 hospitalized patients over 70 years old, at the ED by a research student and at admission by the attending nurse on the ward. The average age was 81.2 years old, 81 (47%) were male and 111 s...

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    Conflict of Interest:
    None declared.