全球大流行期间股骨近端骨折患者的死亡率：西班牙 HIP-COVID 观察性研究的初步结果。
Mortality Rates of Patients with Proximal Femoral Fracture in a Worldwide Pandemic: Preliminary Results of the Spanish HIP-COVID Observational Study.
机构信息
Orthopaedic Department, Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Spain.
Orthopaedic Department, Hospital Clinic, Barcelona, Spain.
出版信息
J Bone Joint Surg Am. 2020 Jul 1;102(13):e69. doi: 10.2106/JBJS.20.00686.
BACKGROUND
The outbreak of coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), in December 2019 in Wuhan, People's Republic of China, has developed into an unprecedented pandemic with enormous pressure on health-care providers around the world. A higher mortality rate has been described in older infected individuals. Patients with hip fracture are a particularly vulnerable population during this pandemic because older age is associated with a higher mortality rate. Our aim was to describe the early mortality rate and demographic variables in a hip fracture sample population in Spain during the coronavirus pandemic.
METHODS
This is a multicenter, observational, retrospective, descriptive study. We collected data from 13 major hospitals in Spain from the beginning of the national state of alarm (declared on March 14, 2020, by the Spanish government) until the end of our study period on April 4, 2020. All patients who were ≥65 years of age, presented to the Emergency Department of the participating hospitals during this period with a diagnosis of proximal femoral fracture, and had a minimum follow-up of 10 days were included in the cohort. In addition to mortality, demographic and other potential prognostic variables were also collected.
RESULTS
In this study, 136 patients with a hip fracture were included. Of these patients, 124 underwent a surgical procedure and 12 were managed nonoperatively. The total mortality rate was 9.6%. Sixty-two patients were tested for COVID-19, with 23 patients being positive. The mortality rate for these 23 patients was 30.4% (7 of 23 patients) at a mean follow-up of 14 days. The mortality rate was 10.3% (4 of 39) for patients who had been tested and had a negative result and 2.7% (2 of 74) for patients who had not been tested. Of the 12 patients who were managed nonoperatively, 8 (67%) died, whereas, of the 124 patients who were surgically treated, 5 (4%) died. Results differed among centers.
CONCLUSIONS
There is a higher mortality rate in patients with a hip fracture and an associated positive test for COVID-19.
LEVEL OF EVIDENCE
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
背景
由严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2）引起的 2019 年冠状病毒病（COVID-19）于 2019 年 12 月在中国武汉爆发，现已发展成为一场史无前例的大流行，给全球医疗保健提供者带来了巨大压力。有研究表明，老年感染者的死亡率更高。在这场大流行中，髋部骨折患者是一个特别脆弱的群体，因为年龄越大，死亡率越高。我们的目的是描述在西班牙 COVID-19 大流行期间髋部骨折患者的早期死亡率和人口统计学变量。
方法
这是一项多中心、观察性、回顾性、描述性研究。我们从西班牙 13 家主要医院收集了数据，时间从国家警戒状态开始（2020 年 3 月 14 日由西班牙政府宣布）到我们的研究期结束（2020 年 4 月 4 日）。所有年龄≥65 岁、在此期间因股骨近端骨折到参与医院急诊就诊、且随访时间至少为 10 天的患者均纳入队列。除死亡率外，还收集了人口统计学和其他潜在预后变量。
结果
本研究共纳入 136 例髋部骨折患者。其中 124 例行手术治疗，12 例非手术治疗。总死亡率为 9.6%。对 62 例患者进行了 COVID-19 检测，其中 23 例检测结果呈阳性。这 23 例患者的死亡率为 30.4%（23 例患者中的 7 例），平均随访 14 天。在接受检测且结果为阴性的 39 例患者中，死亡率为 10.3%（4 例），在未接受检测的 74 例患者中，死亡率为 2.7%（2 例）。在非手术治疗的 12 例患者中，有 8 例（67%）死亡，而在接受手术治疗的 124 例患者中，有 5 例（4%）死亡。不同中心的结果存在差异。
结论
髋部骨折合并 COVID-19 检测阳性的患者死亡率更高。
证据水平
预后 IV 级。欲了解完整的证据水平描述，请参见作者说明。
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