The inter-rater reliability of emergency department and paramedic frailty screening in older patients following a fall

Background: Screening for frailty in the emergency setting may be useful in directing patients to appropriate management pathways. The main aim of this study was to assess the inter-rater reliability of the Clinical Frailty Scale between paramedics and emergency department staff (doctors and allied heath) for patients after a fall. Secondarily, to assess how these scores correlate with patient outcomes. Methods: A prospective study of older patients arriving by ambulance to a single hospital in Western Australia following a fall. The inter-rater reliability was assessed using a weighted Cohen's kappa. The relationship between Clinical Frailty Scale and secondary outcomes were assessed using chi-squared and Kruskal-Wallis tests. Results: Data from 94 patients were included, the mean age was 82 years and 64 % were female. The inter-rater reliability between paramedics and emergency department staff using the Clinical Frailty Scale was moderate (kappa 0.48 (95 % CI 0.36-0.59)). Conclusions: There is only moderate agreement between emergency department staff and paramedics when screening for frailty in patients who present after a fall. The findings indicate the need to improve reliability as a pre-requisite to the use of frailty screening in emergency settings.