Nia Arastoo, Popp Domenik, Thalmann Georg, Greiner Fabian, Jeremic Natasa, Rus Robert, Hajdu Stefan, Widhalm Harald K
Department of Orthopedics and Traumatology, Clinical Division of Traumatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
Diagnostics (Basel). 2021 Mar 11;11(3):497. doi: 10.3390/diagnostics11030497.
This study evaluated the use of risk prediction models in estimating short- and mid-term mortality following proximal hip fracture in an elderly Austrian population. Data from 1101 patients who sustained a proximal hip fracture were retrospectively analyzed and applied to four models of interest: Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM), Charlson Comorbidity Index, Portsmouth-POSSUM and the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Risk Score. The performance of these models according to the risk prediction of short- and mid-term mortality was assessed with a receiver operating characteristic curve (ROC). The median age of participants was 83 years, and 69% were women. Six point one percent of patients were deceased by 30 days and 15.2% by 180 days postoperatively. There was no significant difference between the models; the ACS-NSQIP had the largest area under the receiver operating characteristic curve for within 30-day and 180-day mortality. Age, male gender, and hemoglobin (Hb) levels at admission <12.0 g/dL were identified as significant risk factors associated with a shorter time to death at 30 and 180 days postoperative ( < 0.001). Among the four scores, the ACS-NSQIP score could be best-suited clinically and showed the highest discriminative performance, although it was not specifically designed for the hip fracture population.
本研究评估了风险预测模型在估计奥地利老年人群近端髋部骨折后短期和中期死亡率方面的应用。对1101例发生近端髋部骨折的患者的数据进行回顾性分析，并应用于四个感兴趣的模型：用于死亡率和发病率枚举的生理和手术严重程度评分（POSSUM）、查尔森合并症指数、朴茨茅斯 - POSSUM以及美国外科医师学会国家外科质量改进计划（ACS - NSQIP）风险评分。根据短期和中期死亡率的风险预测，使用受试者工作特征曲线（ROC）评估这些模型的性能。参与者的中位年龄为83岁，69%为女性。术后30天内6.1%的患者死亡，术后180天内15.2%的患者死亡。各模型之间无显著差异；ACS - NSQIP在30天和180天死亡率的受试者工作特征曲线下面积最大。年龄、男性性别以及入院时血红蛋白（Hb）水平<12.0 g/dL被确定为与术后30天和180天死亡时间较短相关的显著风险因素（<0.001）。在这四个评分中，ACS - NSQIP评分在临床上可能最适用，并且显示出最高的鉴别性能，尽管它并非专门为髋部骨折人群设计。
