Anaesthesia and Critical Care Section, Division of Clinical Neuroscience, Queen's Medical Centre, University of Nottingham, Nottingham, UK.
Department of Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Anaesthesia. 2016 May;71(5):515-21. doi: 10.1111/anae.13418. Epub 2016 Mar 4.
The care of the elderly with hip fractures and their outcomes might be improved with resources targeted by the accurate calculation of risks of mortality and morbidity. We used a multicentre national dataset to evaluate and recalibrate the Nottingham Hip Fracture Score and Surgical Outcome Risk Tool. We split 9,017 hip fracture cases from the Anaesthesia Sprint Audit of Practice into derivation and validation data sets and used logistic regression to derive new model co-efficients for death at 30 postoperative days. The area (95% CI) under the receiver operator characteristic curve of 0.71 (0.67-0.75) indicated acceptable discrimination by the Nottingham Hip Fracture Score and acceptable calibration fit (Hosmer-Lemeshow test), p = 0.23, with a similar discrimination by the Surgical Outcome Risk Tool, 0.70 (0.66-0.74), which was miscalibrated to the observed data, p = 0.001. We recommend that studies test these scores for patients with hip fractures in other countries. We also recommend these models are compared with case-mix adjustment tools used in the UK.
通过准确计算死亡率和发病率风险，针对资源进行老年髋部骨折患者的护理及其结果可能会得到改善。我们使用多中心国家数据集来评估和重新校准诺丁汉髋部骨折评分和手术结果风险工具。我们将 Anaesthesia Sprint Audit of Practice 中的 9017 例髋部骨折病例分为推导数据集和验证数据集，并使用逻辑回归来推导术后 30 天死亡的新模型系数。诺丁汉髋部骨折评分的接收器工作特征曲线下面积（95%置信区间）为 0.71（0.67-0.75），表明具有可接受的区分度和可接受的校准拟合（Hosmer-Lemeshow 检验，p = 0.23），手术结果风险工具的区分度也相似，为 0.70（0.66-0.74），但与观察数据不匹配，p = 0.001。我们建议其他国家的研究对髋部骨折患者进行这些评分测试。我们还建议将这些模型与英国使用的病例组合调整工具进行比较。
