Green Carl M, Zeiton Moez, Foulkes Katherine, Barrie Jim
Injury. 2014 Dec;45(12):1946-9. doi: 10.1016/j.injury.2014.09.022.
Fractured neck of femur (FNOF) is an increasing problem for the National Health Service (NHS) with 61,508 recorded on the National Hip Fracture Database (NHFD) in 2012–2013 and treatment of such patients is estimated to cost the NHS £1.5 billion per year. Inpatients falling in hospital and sustain a FNOF have rarely been studied as a separate group of patients to assess standards of patient care, time to operative management, and patient mortality. Of 694 patients sustaining an acute FNOF at a single trust between January 2012 and June 2013, 40 patients (5.8%) sustained an inpatient FNOF. 19 patients (47.5%) were male and 15 patients (37.5%) had an ASA grade of 4 or 5, compared to 153 patients (23.4%) and 127 patients (19.4%) respectively of “community” FNOF. 39 of 40 patients received operative management. Patients with an “inpatient” FNOF were less likely to be admitted to an orthopaedic ward within 4 h (30%) and receive operative management within 48 h (65%) according to “Blue Book” standards. Results according to best practice tariff (BPT) were also significantly reduced for the “inpatient” FNOF group, with 23 patients (57.5%) receiving operative management within 36 h and only 19 patients (47.5%) achieving BPT compared to 76.5% and 72.5% respectively for “community” FNOF patients. Mortality among inpatients reached 40% at 120 days and 50% at 1 year, significantly higher than community FNOF patients after multivariate analysis. Patients sustaining an “inpatient” FNOF are more likely to have significant medical co-morbidity and require aggressive medical and surgical management, especially due to their increased risk of mortality post-operatively. Such injuries have direct and indirect financial implications to a health care trust, which can be minimised by prompt management of these patients. This study highlights the need for a standardised protocol of management of this important subgroup of patients and for further work on falls prevention strategies within the National Health Service.
股骨颈骨折（FNOF）对英国国民医疗服务体系（NHS）来说是一个日益严重的问题，2012 - 2013年国家髋部骨折数据库（NHFD）记录了61,508例病例，据估计，治疗这类患者每年要花费NHS 15亿英镑。因住院跌倒而发生股骨颈骨折的患者作为一个单独的患者群体，很少被研究用于评估患者护理标准、手术治疗时间和患者死亡率。在2012年1月至2013年6月期间，在一家信托机构有694例急性股骨颈骨折患者，其中40例（5.8%）为住院期间发生的股骨颈骨折。19例（47.5%）为男性，15例（37.5%）美国麻醉医师协会（ASA）分级为4或5级，相比之下，“社区”股骨颈骨折患者中这两个比例分别为153例（23.4%）和127例（19.4%）。40例患者中有39例接受了手术治疗。根据“蓝皮书”标准，“住院”股骨颈骨折患者在4小时内被收入骨科病房的可能性较小（30%），在48小时内接受手术治疗的可能性也较小（65%）。“住院”股骨颈骨折组按照最佳实践收费标准（BPT）的结果也显著降低，23例（57.5%）在36小时内接受了手术治疗，只有19例（47.5%）达到BPT标准，相比之下，“社区”股骨颈骨折患者的这两个比例分别为76.5%和72.5%。住院患者120天时死亡率达到40%，1年时达到50%，多因素分析后显著高于社区股骨颈骨折患者。发生“住院”股骨颈骨折的患者更可能有严重的合并症，需要积极的药物和手术治疗，特别是因为他们术后死亡风险增加。这类损伤对医疗保健信托机构有直接和间接的经济影响，通过对这些患者的及时治疗可将影响降至最低。本研究强调需要针对这一重要亚组患者制定标准化的治疗方案，并在国民医疗服务体系内进一步开展预防跌倒策略的研究。
