Buecking Benjamin, Eschbach Daphne, Knobe Matthias, Oberkircher Ludwig, Balzer-Geldsetzer Monika, Dodel Richard, Sielski Robert, Doering Bettina, Ruchholtz Steffen, Bliemel Christopher
Center of Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg Department of Orthopedic Trauma, University of Aachen Medical Center Department of Neurology, University Hospital Giessen and Marburg, Marburg Department of Clinical Psychology and Psychotherapy, Philipps University Marburg, Germany.
Medicine (Baltimore). 2017 Sep;96(37):e7820. doi: 10.1097/MD.0000000000007820.
Hip fractures are frequent fractures in geriatric patients. These fractures have great socioeconomic implications because of the significantly higher risk of mortality and institutionalization. The aim of this study was to develop a prognostic tool to predict survival without institutionalization within 1 year after hip fracture.A total of 402 hip fracture patients aged >60 years (84% community-dwelling) were included in a prospective observational cohort study. Multiple regression analyses determined independent predictors for noninstitutionalized 1-year survival. Finally, the Marburg Rehabilitation Tool for Hip fractures (MaRTHi) was developed based on these independent predictors.Of the 312 patients who were followed up for 1 year, 168 (54%) survived noninstitutionalized, 104 (33%) died, and 40 (13%) lived in nursing homes. Independent predictors for patients' noninstitutionalized survival included the American Society of Anesthesiologists (ASA) score [ASA 1 or 2: odds ratio (OR) = 7.828; 95% confidence interval (CI) = 2.496-24.555 and ASA 3: OR = 8.098; 95% CI = 2.982-21.993 compared with ASA 4 or 5], the Mini Mental State Examination upon admission to the hospital (OR = 7.365; 95% CI = 2.967-18.282 for 27-30 compared with 0-10), patients' age (OR = 2.814; 95% CI = 1.386-5.712 for 75-89 y and OR = 2.520; 95% CI = 0.984-6.453 for 90-99 y compared with 60-74 ys), and prefracture EQ-5D (OR = 2.163; 95% CI = 1.119-4.179 for EQ-5D >0.80 compared with <0.60). The area under the receiver-operating characteristic curve was 0.756 (95% CI = 0.703-0.809), and the sensitivity analysis yielded a MaRTHi score that ranged from 0 to 12 points.The MaRTHi score is the first instrument to predict noninstitutionalized survival with only 4 variables. In addition to 3 well-known factors influencing outcome (age, comorbidities, and cognitive ability), prefracture health-related quality of life was identified as an independent predictor of noninstitutionalized survival. Further studies must be conducted to validate the MaRTHi score and define cutoff scores. Health-related quality of life seems to be an important patient-reported outcome measurement and may play a role in determining patient prognosis.
髋部骨折是老年患者常见的骨折类型。由于死亡率和入住养老机构的风险显著更高，这些骨折具有重大的社会经济影响。本研究的目的是开发一种预后工具，以预测髋部骨折后1年内未入住养老机构的生存情况。
一项前瞻性观察队列研究纳入了402例年龄大于60岁的髋部骨折患者（84%为社区居住者）。多元回归分析确定了未入住养老机构1年生存的独立预测因素。最后，基于这些独立预测因素开发了马尔堡髋部骨折康复工具（MaRTHi）。
在312例随访1年的患者中，168例（54%）未入住养老机构存活，104例（33%）死亡，40例（13%）住在养老院。患者未入住养老机构生存的独立预测因素包括美国麻醉医师协会（ASA）评分[ASA 1或2：优势比（OR）=7.828；95%置信区间（CI）=2.496 - 24.555，ASA 3：OR = 8.098；95% CI = 2.982 - 21.993，与ASA 4或5相比]、入院时的简易精神状态检查（27 - 30分与0 - 10分相比，OR = 7.365；95% CI = 2.967 - 18.282）、患者年龄（75 - 89岁与60 - 74岁相比，OR = 2.814；95% CI = 1.386 - 5.712，90 - 99岁与60 - 74岁相比，OR = 2.520；95% CI = 0.984 - 6.453）以及骨折前EQ - 5D（EQ - 5D > 0.80与< 0.60相比，OR = 2.163；95% CI = 1.119 - 4.179）。受试者工作特征曲线下面积为0.756（95% CI = 0.703 - 0.809），敏感性分析得出MaRTHi评分范围为0至12分。
MaRTHi评分是首个仅用4个变量预测未入住养老机构生存情况的工具。除了3个影响预后的众所周知的因素（年龄、合并症和认知能力）外，骨折前健康相关生活质量被确定为未入住养老机构生存的独立预测因素。必须进行进一步研究以验证MaRTHi评分并确定临界值。健康相关生活质量似乎是一项重要的患者报告结局指标，可能在确定患者预后中发挥作用。
