Johns William L, Strong Benjamin, Kates Stephen, Patel Nirav K
Virginia Commonwealth University School of Medicine, VA, USA.
Department of Orthopaedic Surgery, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA, USA.
Geriatr Orthop Surg Rehabil. 2020 Jun 11;11:2151459320931674. doi: 10.1177/2151459320931674. eCollection 2020.
Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) and Portsmouth POSSUM (P-POSSUM) are general surgical tools used to efficiently assess mortality and morbidity risk. Data suggest that these tools can be used in hip fracture patients to predict morbidity and mortality; however, it is unclear what score indicates a significant risk on a case-by-case basis. We examined the POSSUM and P-POSSUM scores in a group of hip fracture mortalities in order to assess their accuracy in identification of similar high-risk patients.
Retrospective analysis of all consecutive mortalities in hip fracture patients at a single tertiary care center over 2 years was performed. Patient medical records were examined for baseline demographics, fracture characteristics, surgical interventions, and cause of death. Twelve physiological and 6 operative variables were used to retrospectively calculate POSSUM and P-POSSUM scores at the time of injury.
Forty-seven hip fracture mortalities were reviewed. Median patient age was 88 years (range: 56-99). Overall, 68.1% (32) underwent surgical intervention. Mean predicted POSSUM morbidity and mortality rates were 73.9% (28%-99%) and 31.1% (5%-83%), respectively. The mean predicted P-POSSUM mortality rate was 26.4% (1%-91%) and 53.2% (25) had a P-POSSUM predicted mortality of >20%. Subgroup analysis demonstrated poor agreement between predicted mortality and observed mortality rate for POSSUM in operative (χ = 127.5, < .00001) and nonoperative cohorts (χ = 14.6, < .00001), in addition to P-POSSUM operative (χ = 101.9, < .00001) and nonoperative (χ = 11.9, < .00001) scoring.
DISCUSSION/CONCLUSION: Hip fracture patients are at significant risk of both morbidity and mortality. A reliable, replicable, and accurate tool to represent the expected risk of such complications could help facilitate clinical decision-making to determine the optimal level of care. Screening tools such as POSSUM and P-POSSUM have limitations in accurately identifying high-risk hip fracture patients.
用于计算死亡率和发病率的生理与手术严重程度评分系统（POSSUM）及朴茨茅斯POSSUM（P-POSSUM）是普通外科中用于有效评估死亡和发病风险的工具。数据表明，这些工具可用于髋部骨折患者以预测发病和死亡情况；然而，尚不清楚在具体病例中何种评分表明存在显著风险。我们对一组髋部骨折死亡患者的POSSUM和P-POSSUM评分进行了研究，以评估其在识别类似高危患者方面的准确性。
对一家三级医疗中心2年内所有连续的髋部骨折死亡患者进行回顾性分析。检查患者病历以获取基线人口统计学信息、骨折特征、手术干预措施及死因。采用12项生理变量和6项手术变量回顾性计算受伤时的POSSUM和P-POSSUM评分。
对47例髋部骨折死亡病例进行了分析。患者年龄中位数为88岁（范围：56 - 99岁）。总体而言，68.1%（32例）接受了手术干预。POSSUM预测的平均发病和死亡率分别为73.9%（28% - 99%）和31.1%（5% - 83%）。P-POSSUM预测的平均死亡率为26.4%（1% - 91%），53.2%（25例）的P-POSSUM预测死亡率>20%。亚组分析表明，在手术队列（χ = 127.5，P <.00001）和非手术队列（χ = 14.6，P <.00001）中，POSSUM预测死亡率与观察到的死亡率之间一致性较差，P-POSSUM在手术（χ = 101.9，P <.00001）和非手术（χ = 11.9，P <.00001）评分中也是如此。
讨论/结论：髋部骨折患者存在显著的发病和死亡风险。一种可靠、可重复且准确的工具来表示此类并发症的预期风险，有助于促进临床决策以确定最佳护理水平。诸如POSSUM和P-POSSUM等筛查工具在准确识别高危髋部骨折患者方面存在局限性。
