Institute for Health and Society, UCLouvain, Brussels, Belgium.
Aging Clin Exp Res. 2012 Feb;24(1):62-7. doi: 10.1007/BF03325355.
Hip fracture in older persons is a frequent reason for hospital admission and a substantial workload in orthopedic wards for geriatric liaison teams. However, robust patients who do not present in-hospital complications may not need geriatric liaison. For the sake of triage, we studied the ability of usual admission scores to identify patients who will not develop in-hospital complications, and who may therefore not be included in the overworked geriatric liaison teams.
A retrospective cohort of consecutive community- living elderly patients (age ≥ 75 yrs), admitted for traumatic hip fracture in the orthopedic divisions of a teaching hospital over 18 months was examined. The predictive value of commonly used frailty scores (ISAR, VIP, KATZ) to rule out the incidence of three frequent and preventable in-hospital acute geriatric events (major behavioral problems, pressure sores, falls) was assessed by ROC curves and negative likelihood ratio (-LR).
Of 145 older persons with hip fracture (median age 84 years; 76% women; 57% living alone, 44% with pre-existing geriatric syndromes), 81 (56%) presented some acute geriatric events (AGE), i.e. major behavioral problems (46%), pressure sores (19%) and/or falls (5%). The three frailty admission scores showed low power for AGE prediction (area under the ROC curve: 53- 58%) and identification of patients who will not present in-hospital AGE (-LR>0.5 at the most sensitive cut-off).
None of the three scores helped in the triage of patients according to their risk of future in-hospital AGE. All older patients with hip fracture, irrespective of their admission frailty-robustness profile, should receive geriatric evaluation and intervention.
老年人髋部骨折是住院的常见原因，也是老年联络团队骨科病房的主要工作量。然而，没有出现院内并发症的健壮患者可能不需要老年联络。为了进行分诊，我们研究了常用入院评分识别不会发生院内并发症的患者的能力，这些患者可能因此不会被纳入工作过度的老年联络团队。
回顾性分析了在教学医院骨科病房连续收治的 18 个月内因创伤性髋部骨折的社区居住的连续老年患者（年龄≥75 岁）队列。通过 ROC 曲线和负似然比（-LR）评估常用虚弱评分（ISAR、VIP、KATZ）排除三种常见且可预防的院内急性老年病事件（主要行为问题、压疮、跌倒）发生率的预测价值。
145 例髋部骨折的老年人（中位年龄 84 岁；76%女性；57%独居，44%有预先存在的老年综合征）中，81 例（56%）出现了一些急性老年病事件（AGE），即主要行为问题（46%）、压疮（19%）和/或跌倒（5%）。三种入院虚弱评分对 AGE 预测的能力较低（ROC 曲线下面积：53-58%），也无法识别不会出现院内 AGE 的患者（最敏感切点的负似然比>0.5）。
三种评分均无助于根据患者未来院内 AGE 风险进行分诊。所有髋部骨折的老年患者，无论其入院虚弱-健壮程度如何，都应接受老年评估和干预。
