Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
Department of Emergency Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Calcif Tissue Int. 2021 Oct;109(4):372-382. doi: 10.1007/s00223-021-00846-z. Epub 2021 Apr 8.
Falls are the most frequent cause of hip fracture. We aimed to investigate whether specific fall patterns have predictive value for mortality after hip fracture. In this cohort study, data of individuals presented to the Severance Hospital, Seoul, Korea, between 2005 and 2019 due to fragility hip fracture (n = 1986) were analyzed. Fall patterns were defined as causes, activities leading to falls, and a combination of both, based on electronic medical records using pre-specified classification from a prior study on video-captured falls. Mean age of study subjects were 77 years (71% women) and 211 patients (10.6%) died during follow-up (median 544 days). Indoor falls at home had a higher mortality than outdoor falls (11.9 vs. 8.0%, p = 0.009). Among 16 fall patterns, incorrect weight shift while sitting down (adjusted hazard ratio [aHR] 4.03) or getting up (aHR 2.01), collapse during low-risk activity (aHR 2.39), and slipping while walking (aHR 2.90, p < 0.01 for all) were associated with increased mortality compared to outdoor falls, after adjustment for age, sex, and Charlson comorbidity index (CCI), constituting a high-risk pattern. High-risk fall patterns were associated with a higher risk of mortality (aHR 2.56, p < 0.001) than low-risk patterns (aHR 1.37, p = 0.080) and outdoor falls (referent; log rank p < 0.001), which improved mortality prediction when added to a base model including age, sex, and CCI (integrative area under receiver-operating characteristics curve 0.675 to 0.698, p < 0.001). Specific fall patterns were associated with higher mortality in older adults with hip fracture, independent of age, sex, and comorbidities.
跌倒 是髋部骨折最常见的原因。我们旨在研究特定的跌倒模式对髋部骨折后死亡率是否具有预测价值。在这项队列研究中，分析了 2005 年至 2019 年期间因脆性髋部骨折而在首尔 Severance 医院就诊的个体的数据（n = 1986）。跌倒模式是根据预先指定的分类，基于电子病历，根据跌倒视频捕捉研究的电子病历，定义为跌倒的原因、导致跌倒的活动以及两者的组合。研究对象的平均年龄为 77 岁（71%为女性），随访期间有 211 例（10.6%）患者死亡（中位数 544 天）。室内跌倒（家中）的死亡率高于室外跌倒（11.9%比 8.0%，p = 0.009）。在 16 种跌倒模式中，坐姿时不正确的体重转移（调整后的危险比[aHR] 4.03）或起身（aHR 2.01）、在低风险活动中摔倒（aHR 2.39）以及行走时滑倒（aHR 2.90，p < 0.01）与调整年龄、性别和 Charlson 合并症指数（CCI）后的室外跌倒相比，与死亡率增加相关，构成高危模式。高危跌倒模式与死亡率增加相关（aHR 2.56，p < 0.001），而低危模式（aHR 1.37，p = 0.080）和室外跌倒（参照；log rank p < 0.001）与死亡率增加相关，当添加到包括年龄、性别和 CCI 的基础模型时，改善了死亡率预测（综合接受者操作特征曲线下面积 0.675 至 0.698，p < 0.001）。在髋部骨折的老年患者中，特定的跌倒模式与更高的死亡率相关，与年龄、性别和合并症无关。
