Department of Post Acute and Continuity Care, SingHealth Community Hospital - Sengkang, 1 Anchorvale St, Singapore, 544835, Singapore.
Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
BMC Musculoskelet Disord. 2019 Nov 27;20(1):568. doi: 10.1186/s12891-019-2950-0.
Hip fracture is an important and prevalent medical condition associated with adverse outcomes. The aim of this article is to systematically review and summarise the predictors of poor functional outcomes and mortality for patients with hip fractures.
We conducted a systemic literature search using PubMed, EMBASE and Cochrane Library. We included English peer-reviewed cohort studies that examined predictors of poor functional outcomes (such as independence in Activities of Daily Living) and mortality for patients with hip fracture published in the past 15 years (from 1 Jan 2004 up to 30 May 2019). Two independent researchers evaluated the articles for eligibility. Consensus on the eligibility was sought and a third researcher was involved if there was disagreement. A standardised form was used to extract relevant data. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included studies.
We retrieved 4339 and included 81 articles. We identified two emerging predictors of poor functional outcomes and mortality for patients with hip fractures: low hand grip strength and frailty in line with an emerging concept of "physical performance". The predictors identified in this systematic review can be grouped into 1) medical factors, such as presence of co-morbidities, high American Society of Anesthesiologists (ASA) grade, sarcopenia, 2) surgical factors including delay in operation (e.g. > 48 h), type of fracture s, 3) socio-economic factors which include age, gender, ethnicity, and 4) system factors including lower case-volume centers.
This systematic review identified multiple significant predictors of poor functional outcomes and mortality, with the hand grip strength and frailty being important emerging predictors in the most recent literature. These predictors would further inform healthcare providers of their patients' health status and allow for early intervention for modifiable predictors.
髋部骨折是一种重要且普遍的医疗状况，与不良结局相关。本文旨在系统地回顾和总结髋部骨折患者功能结局不良和死亡率的预测因素。
我们使用 PubMed、EMBASE 和 Cochrane Library 进行了系统的文献检索。我们纳入了过去 15 年（2004 年 1 月 1 日至 2019 年 5 月 30 日）发表的、检查髋部骨折患者功能结局不良（如日常生活活动自理能力）和死亡率预测因素的英语同行评议队列研究。两名独立的研究人员评估文章的入选资格。如果存在分歧，则寻求达成共识，如果需要则由第三名研究人员介入。使用标准化表格提取相关数据。采用 Newcastle-Ottawa 量表（NOS）评估纳入研究的质量。
我们检索到 4339 篇文章，并纳入了 81 篇文章。我们确定了两个与髋部骨折患者功能结局不良和死亡率相关的新兴预测因素：握力低和衰弱，符合“身体表现”的新兴概念。本系统综述中确定的预测因素可分为 1）医疗因素，如合并症、美国麻醉医师协会（ASA）分级高、肌少症；2）手术因素，包括手术延迟（例如>48 小时）、骨折类型；3）社会经济因素，包括年龄、性别、种族；4）系统因素，包括低病例量中心。
本系统综述确定了多个与功能结局不良和死亡率相关的重要预测因素，握力和衰弱是最新文献中的重要新兴预测因素。这些预测因素将进一步告知医疗保健提供者其患者的健康状况，并允许对可改变的预测因素进行早期干预。
