Evidence map›Paper›PMID 32891413›Full record

ArticleBritish journal of anaesthesia2020

Frailty and outcomes from pneumonia in critical illness: a population-based cohort study.

Jai N Darvall, Rinaldo Bellomo, Michael Bailey, Eldho Paul, Paul J Young, Kenneth Rockwood, David Pilcher

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in British journal of anaesthesia, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
39citing papers in PubMed, 5 pooled it
6.6field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

39 citing papers in PubMed, 5 syntheses or guidelines pooled it, 91 citations in OpenAlex.

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  10. Rinaldo Bellomo and the evolution of critical care survivorship.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2025
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  14. Observational
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  16. Frailty in Critically Ill Patients with COVID-19: The Lessons Learned.Advances in experimental medicine and biology · 2024
    Review
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  20. The Clinical Frailty Scale as a triage tool for ICU admission of dialysis patients with COVID-19: an ERACODA analysis.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2022
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors at 5 institutions in 3 countries.

Jai N DarvallDepartment of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia; Centre for Integrated Critical Care, The University of Melbourne, Melbourne, VIC, Australia. Electronic address: jai.darvall@mh.org.au.
Rinaldo BellomoDepartment of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia; Centre for Integrated Critical Care, The University of Melbourne, Melbourne, VIC, Australia; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Data Analytics Research and Evaluation Centre, The University of Melbourne and Austin Hospital, Melbourne, VIC, Australia.
Michael BaileyCentre for Integrated Critical Care, The University of Melbourne, Melbourne, VIC, Australia; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Eldho PaulAustralian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Paul J YoungMedical Research Institute of New Zealand, Wellington, New Zealand.
Kenneth RockwoodGeriatric Medicine Research, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; Divisions of Geriatric Medicine & Neurology, Dalhousie University & Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.
David PilcherAustralian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Intensive Care, Alfred Hospital, Melbourne, VIC, Australia; Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, VIC, Australia.
Monash University · AUAustin Hospital · AUDalhousie University · CAMedical Research Institute of New Zealand · NZUniversity of Melbourne · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundA threshold Clinical Frailty Scale (CFS) of 5 (indicating mild frailty) has been proposed to guide ICU admission for UK patients with coronavirus disease 2019 (COVID-19) pneumonia. However, the impact of frailty on mortality with (non-COVID-19) pneumonia in critical illness is unknown. We examined the triage utility of the CFS in patients with pneumonia requiring ICU.

methodsWe conducted a retrospective cohort study of adult patients admitted with pneumonia to 170 ICUs in Australia and New Zealand from January 1, 2018 to September 31, 2019. We classified patients as: non-frail (CFS 1-4) frail (CFS 5-8), mild/moderately frail (CFS 5-6),and severe/very severely frail (CFS 7-8). We evaluated mortality (primary outcome) adjusting for site, age, sex, mechanical ventilation, pneumonia type and illness severity. We also compared the proportion of ICU bed-days occupied between frailty categories.

results1852/5607 (33%) patients were classified as frail, including1291/3056 (42%) of patients aged >65 yr, who would potentially be excluded from ICU admission under UK-based COVID-19 triage guidelines. Only severe/very severe frailty scores were associated with mortality (adjusted odds ratio [aOR] for CFS=7: 3.2; 95% confidence interval [CI]: 1.3-7.8; CFS=8 [aOR: 7.2; 95% CI: 2.6-20.0]). These patients accounted for 7% of ICU bed days. Vulnerability (CFS=4) and mild frailty (CFS=5) were associated with a similar mortality risk (CFS=4 [OR: 1.6; 95% CI: 0.7-3.8]; CFS=5 [OR: 1.6; 95% CI: 0.7-3.9]).

conclusionsPatients with severe and very severe frailty account for relatively few ICU bed days as a result of pneumonia, whilst adjusted mortality analysis indicated little difference in risk between patients in vulnerable, mild, and moderate frailty categories. These data do not support CFS ≥5 to guide ICU admission for pneumonia.

Indexed as

BetacoronavirusPatient Outcome AssessmentAgedAustraliaCohort StudiesCoronavirus InfectionsCOVID-19Critical IllnessFemaleFrail ElderlyGeriatric AssessmentHumansLength of StayMaleMiddle AgedNew ZealandCOVID-19frailtyintensive care unitmortalityobservational studypneumoniarespiratory failure

Identifiers

PMID32891413
PMCPMC7467940
OpenAlexW3082306624

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.