Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.
Scottish Orthopaedic Research Trust into Trauma (SORT-IT), Edinburgh, UK.
Bone Joint J. 2020 Sep;102-B(9):1219-1228. doi: 10.1302/0301-620X.102B9.BJJ-2020-1100.R1. Epub 2020 Jul 7.
The primary aim was to assess the independent influence of coronavirus disease (COVID-19) on 30-day mortality for patients with a hip fracture. The secondary aims were to determine whether: 1) there were clinical predictors of COVID-19 status; and 2) whether social lockdown influenced the incidence and epidemiology of hip fractures.
A national multicentre retrospective study was conducted of all patients presenting to six trauma centres or units with a hip fracture over a 46-day period (23 days pre- and 23 days post-lockdown). Patient demographics, type of residence, place of injury, presentation blood tests, Nottingham Hip Fracture Score, time to surgery, operation, American Society of Anesthesiologists (ASA) grade, anaesthetic, length of stay, COVID-19 status, and 30-day mortality were recorded.
Of 317 patients with acute hip fracture, 27 (8.5%) had a positive COVID-19 test. Only seven (26%) had suggestive symptoms on admission. COVID-19-positive patients had a significantly lower 30-day survival compared to those without COVID-19 (64.5%, 95% confidence interval (CI) 45.7 to 83.3 vs 91.7%, 95% CI 88.2 to 94.8; p < 0.001). COVID-19 was independently associated with increased 30-day mortality risk adjusting for: 1) age, sex, type of residence (hazard ratio (HR) 2.93; p = 0.008); 2) Nottingham Hip Fracture Score (HR 3.52; p = 0.001); and 3) ASA (HR 3.45; p = 0.004). Presentation platelet count predicted subsequent COVID-19 status; a value of < 217 × 10/l was associated with 68% area under the curve (95% CI 58 to 77; p = 0.002) and a sensitivity and specificity of 63%. A similar number of patients presented with hip fracture in the 23 days pre-lockdown (n = 160) and 23 days post-lockdown (n = 157) with no significant (all p ≥ 0.130) difference in patient demographics, residence, place of injury, Nottingham Hip Fracture Score, time to surgery, ASA, or management.
COVID-19 was independently associated with an increased 30-day mortality rate for patients with a hip fracture. Notably, most patients with hip fracture and COVID-19 lacked suggestive symptoms at presentation. Platelet count was an indicator of risk of COVID-19 infection. These findings have implications for the management of hip fractures, in particular the need for COVID-19 testing. Cite this article: 2020;102-B(9):1219-1228.
首要目的是评估新冠病毒（COVID-19）对髋部骨折患者 30 天死亡率的独立影响。次要目的是确定：1）是否存在 COVID-19 状态的临床预测因素；2）社会封锁是否影响髋部骨折的发病率和流行病学。
对在 46 天（封锁前 23 天和封锁后 23 天）期间因髋部骨折就诊于六家创伤中心或单位的所有患者进行了一项全国多中心回顾性研究。记录患者的人口统计学特征、居住类型、受伤地点、入院时的血液检查、诺丁汉髋部骨折评分、手术时间、手术类型、美国麻醉医师协会（ASA）分级、麻醉类型、住院时间、COVID-19 状态和 30 天死亡率。
317 例急性髋部骨折患者中，27 例（8.5%）COVID-19 检测呈阳性。只有 7 例（26%）入院时出现了有提示性的症状。COVID-19 阳性患者的 30 天生存率明显低于 COVID-19 阴性患者（64.5%，95%置信区间[CI]45.7 至 83.3 与 91.7%，95%CI88.2 至 94.8；p < 0.001）。在调整年龄、性别、居住类型（危险比[HR]2.93；p = 0.008）、诺丁汉髋部骨折评分（HR 3.52；p = 0.001）和 ASA 分级（HR 3.45；p = 0.004）后，COVID-19 与 30 天死亡率增加独立相关。入院时血小板计数预测了随后的 COVID-19 状态；血小板计数＜217×10/L 与曲线下面积（AUC）的 68%相关（95%CI58 至 77；p = 0.002），且具有 63%的敏感性和特异性。在封锁前 23 天（n = 160）和封锁后 23 天（n = 157）就诊的髋部骨折患者数量相似，患者人口统计学特征、居住类型、受伤地点、诺丁汉髋部骨折评分、手术时间、ASA 分级或管理无显著差异（所有 p≥0.130）。
COVID-19 与髋部骨折患者 30 天死亡率增加独立相关。值得注意的是，大多数 COVID-19 阳性髋部骨折患者在就诊时缺乏提示性症状。血小板计数是 COVID-19 感染风险的指标。这些发现对髋部骨折的管理具有重要意义，特别是需要进行 COVID-19 检测。
2020；102-B（9）：1219-1228.
