McMaster University, 1200 Main Street, Hamilton, Ontario, L8S 4L8, Canada.
GERAS Centre for Aging Research, 88 Maplewood Avenue, 88 Maplewood Avenue, Hamilton, Ontario, L8M 1W9, Canada.
BMC Musculoskelet Disord. 2020 Jul 28;21(1):499. doi: 10.1186/s12891-020-03529-2.
Fractures have dire consequences including pain, immobility, and death. People receiving home care are at higher risk for fractures than the general population. Yet, current fracture risk assessment tools require additional testing and assume a 10-year survival rate, when many die within one year. Our objectives were to develop and validate a scale that predicts one-year incident hip fracture using the home care resident assessment instrument (RAI-HC).
This is a retrospective cohort study of linked population data. People receiving home care in Ontario, Canada between April 1st, 2011 and March 31st, 2015 were included. Clinical data were obtained from the RAI-HC which was linked to the Discharge Abstract Database and National Ambulatory Care Reporting System to capture one-year incident hip fractures. Seventy-five percent (n = 238,011) of the sample were randomly assigned to a derivation and 25% (n = 79,610) to a validation sample. A decision tree was created with the derivation sample using known fracture risk factors. The final nodes of the decision tree were collapsed into 8 risk levels and logistic regression was performed to determine odds of having a fracture for each level. c-Statistics were calculated to compare the discriminative properties of the full, derivation, and validation samples.
Approximately 60% of the sample were women and 53% were 80 years and older. A total of 11,526 (3.6%) fractures were captured over the 1-year time period. Of these, 5057 (43.9%) were hip fractures. The proportion who experienced a hip fracture in the next year ranged from 0.3% in the lowest risk level to 5.2% in the highest risk level. People in the highest risk level had 18.8 times higher odds (95% confidence interval, 14.6 to 24.3) of experiencing a hip fracture within one year than those in the lowest. c-Statistics were similar for the full (0.658), derivation (0.662), and validation (0.645) samples.
The FRS-HC predicts hip fracture over one year and should be used to guide clinical care planning for home care recipients at high risk for fracture. Our next steps are to develop a fracture risk clinical assessment protocol to link treatment recommendations with identified fracture risk.
骨折会导致严重后果，包括疼痛、活动受限和死亡。接受家庭护理的人比一般人群更容易发生骨折。然而，目前的骨折风险评估工具需要额外的检测，并假设 10 年生存率，而许多人在一年内死亡。我们的目标是开发和验证一种使用家庭护理评估工具（RAI-HC）预测一年内发生髋部骨折的量表。
这是一项回顾性队列研究，涉及关联的人群数据。2011 年 4 月 1 日至 2015 年 3 月 31 日期间在加拿大安大略省接受家庭护理的人被纳入研究。临床数据来自 RAI-HC，该数据与出院摘要数据库和国家门诊护理报告系统相链接，以捕捉一年内发生的髋部骨折。样本的 75%（n=238011）被随机分配到推导样本中，25%（n=79610）被分配到验证样本中。使用已知的骨折风险因素在推导样本中创建决策树。决策树的最终节点被合并为 8 个风险级别，并进行逻辑回归以确定每个级别发生骨折的可能性。计算 c 统计量以比较全样本、推导样本和验证样本的判别性能。
样本中约 60%为女性，53%为 80 岁及以上。在 1 年的时间内共捕获了 11526 例（3.6%）骨折。其中，5057 例（43.9%）为髋部骨折。在下一年经历髋部骨折的比例从风险最低级别 0.3%到风险最高级别 5.2%不等。风险最高级别的人在一年内经历髋部骨折的可能性是风险最低级别的人的 18.8 倍（95%置信区间，14.6 至 24.3）。全样本（0.658）、推导样本（0.662）和验证样本（0.645）的 c 统计量相似。
FRS-HC 可预测一年内髋部骨折，并应用于指导高骨折风险家庭护理接受者的临床护理计划。我们的下一步是制定骨折风险临床评估方案，将治疗建议与确定的骨折风险联系起来。
