Hospital Rapid Geriatric Assessment Scale — a new diagnostic tool for frailty screening

Background. The Short Physical Performance Battery (SPPB) is considered a standard screening test for frailty, however certain conditions it requires are frequently inaccessible.

Aim. To develop Hospital Rapid Geriatric Assessment Scale (HRGAS) and to evaluate its diagnostic value in frailty screening.  

Materials and methods. 408 sequentially hospitalized patients (23% male) aged 60–95 (median 73) years were examined using our specially designed algorithm (HRGAS) that includes 9 items: 1) age; 2) Mini-Cog test; 3) short depression assessment; 4) dynamometry; 5) falls in the past year; 6) mobility; 7) self-feeding ability; 8) urinary incontinence; 9) body mass index. The results were scored from 0 to 3 for age and from 0 to 2 for all other items. Minimum score sum is 0, maximum — 19. Assessment time was approximately 5 minutes. As control SPPB was used for frailty screening. The HRGAS results were compared with SPPB. 

Results. Based on SPPB, frailty rate was 46,3%, pre-frail — 26%, robust — 27,7%. HRGAS score was ranged from 0 to 14 (median 4, IQR 2–6) and negatively correlated to SPPB score (rS = -0,63; p<0,001). For frailty detection (SPPB score 0–7), ROC-analysis showed AUC 0,815 (95% CI 0,774–0,856), p<0,001, cut-off value ≥5, sensitivity 67,2%, specificity 81,3%, positive prognostic value (PPV) 76,5%, negative prognostic value (NPV) 74,2%, diagnostic accuracy 74,8%. For robust detection (SPPB score 10–12), ROC-analysis showed AUC 0,805 (95% CI 0,761–0,849), p<0,001, cut-off value ≤2, sensitivity 55,8%, specificity 84,1%, PPV 57,3%, NPV 83,2%, diagnostic accuracy 76,2%.  

Conclusion. We developed HRGAS and calculated its cut-off values to identify and rule out frailty syndrome: score 0–2 by HRGAS indicate robust, score 3–4 — pre-frail and score ≥5 — frail patients.

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