Williams H, Gwyn R, Smith A, Dramis A, Lewis J
Trauma and Orthopaedic Department, University Hospital of Wales, 2 Canada Road, Cardiff, CF14 3BW, UK,
Eur J Orthop Surg Traumatol. 2015 Aug;25(6):1047-50. doi: 10.1007/s00590-015-1620-7. Epub 2015 Mar 10.
With restructuring within the NHS, there is increased public and media interest in surgical outcomes. The Nottingham Hip Fracture Score (NHFS) is a well-validated tool in predicting 30-day mortality in hip fractures. VLAD provides a visual plot in real time of the difference between the cumulative expected mortality and the actual death occurring. Survivors are incorporated as a positive value equal to 1 minus the probability of survival and deaths as a negative value equal to the probability of survival. Downward deflections indicate mortality and potentially suboptimal care.
We prospectively included every hip fracture admitted to UHW that underwent surgery from January-August 2014. NHFS was then calculated and predicted survival identified. A VLAD plot was then produced comparing the predicted with the actual 30-day mortality.
Two hundred and seventy-seven patients have completed the 30-day follow-up, and initial results showed that the actual 30-day mortality (7.2 %) was much lower than that predicted by the NHFS (8.0 %). This was reflected by a positive trend on the VLAD plot.
Variable life-adjusted display provides an easy-to-use graphical representation of risk-adjusted survival over time and can act as an "early warning" system to identify trends in mortality for hip fractures.
随着英国国民医疗服务体系（NHS）的重组，公众和媒体对外科手术结果的关注度日益增加。诺丁汉髋部骨折评分（NHFS）是一种经过充分验证的工具，可用于预测髋部骨折患者的30天死亡率。VLAD实时提供累积预期死亡率与实际死亡情况之间差异的直观图表。幸存者被视为正值，等于1减去生存概率；死亡者被视为负值，等于生存概率。向下的偏差表明死亡率及可能存在的护理欠佳情况。
我们前瞻性纳入了2014年1月至8月期间在UHW接受手术的每一例髋部骨折患者。然后计算NHFS并确定预测的生存率。接着生成VLAD图表，将预测的30天死亡率与实际死亡率进行比较。
277例患者完成了30天的随访，初步结果显示实际30天死亡率（7.2%）远低于NHFS预测值（8.0%）。这在VLAD图表上表现为正向趋势。
可变寿命调整显示提供了一种易于使用的随时间变化的风险调整生存情况的图形表示，可作为一种“早期预警”系统，用于识别髋部骨折死亡率的趋势。
