Kitcharanant Nitchanant, Atthakomol Pichitchai, Khorana Jiraporn, Phinyo Phichayut, Unnanuntana Aasis
Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Medicina (Kaunas). 2024 Apr 9;60(4):615. doi: 10.3390/medicina60040615.
: Achieving prefracture functional status is a critical objective following a hip fracture, yet fewer than half of patients reach this milestone. The adoption of tools for assessing functional outcomes is increasingly recognized as essential for evaluating recovery following treatment for fragility hip fractures. We developed multivariable clinical prediction criteria to estimate the likelihood of patients regaining their prefracture activities-of-daily-living (ADL) status one year after sustaining a fragility hip fracture. : A retrospective cohort of patients treated for fragility hip fractures at a university-affiliated tertiary care center between February 2017 and April 2019 served as the basis for developing and internally validating the clinical prediction criteria. We applied a multivariable fractional polynomial method to integrate several continuous predictors into a binary logistic regression model. : The study included 421 patients, 324 (77%) of whom reported regaining their prefracture activities-of-daily-living level one year after experiencing fragility hip fractures. Significant predictors, such as the prefracture Barthel index, EQ-VAS score, and treatment modality, were incorporated into the predictive model. The model demonstrated excellent discriminative power (AuROC of 0.86 [95% CI 0.82-0.91]) and satisfactory calibration. : The predictive model has significant discriminative ability with good calibration and provides clinicians with a means to forecast the recovery trajectories of individual patients one year after a fragility hip fracture, which could be useful because prompt clinical decision-making is aided by this information. Patients and caregivers can also be counseled and encouraged to follow up with the medical activities and interventions deemed essential by doctors who used the prediction tool. Access to the model is provided through a web application. External validation is warranted in order to prove its applicability and generalizability.
髋部骨折后恢复骨折前的功能状态是一个关键目标，但只有不到一半的患者能达到这一里程碑。人们越来越认识到，采用评估功能结果的工具对于评估脆性髋部骨折治疗后的恢复情况至关重要。我们制定了多变量临床预测标准，以估计脆性髋部骨折患者在受伤一年后恢复其骨折前日常生活活动（ADL）状态的可能性。
2017年2月至2019年4月期间，在一家大学附属三级医疗中心接受脆性髋部骨折治疗的患者回顾性队列，作为制定和内部验证临床预测标准的基础。我们应用多变量分数多项式方法将几个连续预测变量整合到二元逻辑回归模型中。
该研究纳入了421名患者，其中324名（77%）报告在经历脆性髋部骨折一年后恢复了骨折前的日常生活活动水平。重要的预测因素，如骨折前的Barthel指数、EQ-VAS评分和治疗方式，被纳入预测模型。该模型显示出出色的辨别能力（曲线下面积为0.86 [95%可信区间0.82-0.91]）和令人满意的校准。
该预测模型具有显著的辨别能力和良好的校准，并为临床医生提供了一种手段来预测脆性髋部骨折患者一年后的恢复轨迹，这可能是有用的，因为这些信息有助于及时做出临床决策。患者和护理人员也可以得到咨询和鼓励，以跟进使用预测工具的医生认为必要的医疗活动和干预措施。可通过网络应用程序访问该模型。有必要进行外部验证，以证明其适用性和普遍性。
