Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Injury. 2024 Jul;55(7):111584. doi: 10.1016/j.injury.2024.111584. Epub 2024 Apr 26.
Intensive care unit risk stratification models have been utilized in elective joint arthroplasty; however, hip fracture patients are fundamentally different in their clinical course. Having a critical care risk calculator utilizing pre-operative risk factors can improve resourcing for hip fracture patients in the peri‑operative period.
A cohort of geriatric hip fracture patients at a single institution were reviewed over a three-year period. Non-operative patients, peri‑implant fractures, additional procedures performed under the same anesthesia period, and patients admitted to the intensive care unit (ICU) prior to surgery were excluded. Pre-operative laboratory values, Revised Cardiac Risk Index (RCRI), and American Society of Anesthesiologists (ASA) scores were calculated. Pre-operative ambulatory status was determined. The primary outcome measure was ICU admission in the post-operative period. Outcomes were assessed with Fisher's exact test, Kruskal-Wallis test, logistic regression, and ROC curve.
315 patient charts were analyzed with 262 patients meeting inclusion criteria. Age ≥ 80 years, ASA ≥ 4, pre-operative hemoglobin < 10 g/dL, and a history of CVA/TIA were found to be significant factors and utilized within a "training" data set to create a 4-point scoring system after reverse stepwise elimination. The 4-point scoring system was then assessed within a separate "validation" data set to yield an ROC area under the curve (AUC) of 0.747. Score ≥ 3 was associated with 96.8 % specificity and 14.2 % sensitivity for predicting post-op ICU admission. Score ≥ 3 was associated with a 50 % positive predictive value and 83 % negative predictive value.
A hip fracture risk stratification scoring system utilizing pre-operative patient specific values to stratify geriatric hip patients to the ICU post-operatively can improve the pre-operative decision-making of surgical and critical care teams. This has important implications for triaging vital hospital resources.
III (retrospective study).
重症监护病房风险分层模型已应用于择期关节置换术；然而，髋部骨折患者在临床过程中存在根本差异。使用包含术前危险因素的重症监护风险计算器可以改善髋部骨折患者围手术期的资源配置。
回顾了一家医疗机构的 3 年期间的一组老年髋部骨折患者。排除非手术患者、植入物周围骨折、同一麻醉期下进行的其他手术以及手术前入住重症监护病房（ICU）的患者。计算了术前实验室值、修正心脏风险指数（RCRI）和美国麻醉医师协会（ASA）评分。确定了术前的活动状态。主要观察指标是术后入住 ICU。采用 Fisher 确切检验、Kruskal-Wallis 检验、逻辑回归和 ROC 曲线评估结果。
分析了 315 份患者病历，符合纳入标准的有 262 例患者。年龄≥80 岁、ASA≥4、术前血红蛋白<10g/dL 和 CVA/TIA 病史被发现是显著因素，并在反向逐步消除后用于创建一个 4 分评分系统的“训练”数据集。然后，在单独的“验证”数据集中评估 4 分评分系统，得出 ROC 曲线下面积（AUC）为 0.747。评分≥3 与术后 ICU 入住的 96.8%特异性和 14.2%敏感性相关。评分≥3 与 50%阳性预测值和 83%阴性预测值相关。
一种利用术前患者特定值对老年髋部骨折患者进行分层以预测术后入住 ICU 的髋部骨折风险分层评分系统，可以改善手术和重症监护团队的术前决策。这对分诊重要的医院资源具有重要意义。
III（回顾性研究）。
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