Moriwaki Mutsuko, Takae Asuka, Toba Mikayo, Sasaki Miki, Ogata Yasuko, Obayashi Satoshi, Kakehashi Masayuki, Fushimi Kiyohide
Quality Management Center, Tokyo Medical and Dental University Hospital, Bunkyo-ku, Tokyo, Japan.
School of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
BMJ Qual Saf. 2025 Mar 19;34(4):234-243. doi: 10.1136/bmjqs-2023-016865.
Proximal femoral fractures in older adults affect prognosis, quality of life and medical expenses. Therefore, identifying patients with an elevated risk for proximal femoral fractures and implementing preventive measures to mitigate their occurrence are crucial.
This study aimed to develop an accurate in-hospital fracture prediction model that considers patients' daily conditions and medical procedure status. Additionally, it investigated the changes in their conditions associated with fractures during hospital stays.
A retrospective observational study.
Acute care hospitals in Japan.
Participants were 8 514 551 patients from 1321 medical facilities who had been discharged between April 2018 and March 2021 with hip and proximal femoral fractures.
Logistic regression analysis determined the association between patients' changes in their ability to transfer at admission and the day before fracture, and proximal femoral fracture during hospital stays.
Patients were classified into fracture and non-fracture groups. The mean ages were 77.4 (SD: 7.7) and 82.6 (SD: 7.8), and the percentages of women were 42.7% and 65.3% in the non-fracture and fracture groups (p<0.01), respectively. Model 4 showed that even if a patient required partial assistance with transfer on the day before the fracture, the fracture risk increased in each category of change in ability to transfer in the following order: 'declined', 'improved' and 'no change'.
Patients showing improved ability to transfer during their hospitalisation are at a higher risk for fractures. Monitoring patients' daily conditions and tracking changes can help prevent fractures during their hospital stays.
老年人股骨近端骨折会影响预后、生活质量和医疗费用。因此，识别股骨近端骨折风险较高的患者并采取预防措施以减少其发生至关重要。
本研究旨在开发一种准确的院内骨折预测模型，该模型考虑患者的日常状况和医疗程序状态。此外，还调查了他们在住院期间与骨折相关的状况变化。
一项回顾性观察研究。
日本的急性护理医院。
参与者为来自1321家医疗机构的8514551名患者，这些患者在2018年4月至2021年3月期间因髋部和股骨近端骨折出院。
逻辑回归分析确定了患者入院时和骨折前一天转移能力的变化与住院期间股骨近端骨折之间的关联。
患者被分为骨折组和非骨折组。非骨折组和骨折组的平均年龄分别为77.4岁（标准差：7.7）和82.6岁（标准差：7.8），女性比例分别为42.7%和65.3%（p<0.01）。模型4显示，即使患者在骨折前一天需要部分转移协助，在转移能力变化的每一类中，骨折风险按以下顺序增加：“下降”、“改善”和“无变化”。
住院期间转移能力有所改善的患者骨折风险更高。监测患者的日常状况并跟踪变化有助于预防其住院期间发生骨折。
