Goodman Matthew, Pillai Anand
Trauma and Orthopaedics, University of Manchester, Manchester, GBR.
Trauma and Orthopaedics, Wythenshawe Hospital, Manchester, GBR.
Cureus. 2024 Nov 4;16(11):e73021. doi: 10.7759/cureus.73021. eCollection 2024 Nov.
Background and objective Hip fracture is a condition associated with high mortality rates, necessitating the use of risk assessment tools to optimise patient care. This study aimed to introduce and describe a novel score using Age/BMI as an improved predictor of 30-day mortality Methods A retrospective cohort study was conducted at a high-volume neck of the femur centre. Data from 574 patients treated over one year were collected and analysed. Multivariate logistic regression analysis was used to determine variables that significantly increased the risk of 30-day mortality. Results A total of 574 patients were identified: 388 females and 186 males. The overall mortality of the patient cohort at the time of data collection was 21.78% (n=125). The 30-day mortality was found to be 5.75% (n=33) while the one-year mortality rate was 21.08% (n=121). The key risk factors for mortality in neck of femur fractures, highlighted in the literature review, were compared against the binomial outcome variable of 30-day mortality. Categorical data analysis was first completed to highlight key trends. A regression analysis then demonstrated the significance of each factor. Age (p=0.75207), BMI (p=0.97674), and Age/BMI (p=0.92205) showed no statistical significance. The Nottingham Hip Fracture Score (NHFS) was marginally significant (p=0.05749). The American Society of Anesthesiologists (ASA) grade was shown to be statistically significant, emerging as the strongest predictor of 30-day mortality (p=0.00953). Conclusions Our findings show that current guidelines utilising ASA and NHFS are excellent predictors of 30-day mortality in hip fracture patients. The proposed Age/BMI score did not demonstrate efficacy in this cohort. Further research is warranted to explore alternative predictors and enhance risk assessment in this population.
背景与目的 髋部骨折是一种与高死亡率相关的疾病，因此需要使用风险评估工具来优化患者护理。本研究旨在引入并描述一种以年龄/体重指数（Age/BMI）为基础的新型评分系统，作为30天死亡率的改进预测指标。方法 在一个股骨颈手术量大的中心进行了一项回顾性队列研究。收集并分析了一年多来574例接受治疗患者的数据。采用多因素逻辑回归分析来确定显著增加30天死亡风险的变量。结果 共纳入574例患者，其中女性388例，男性186例。在数据收集时，患者队列的总体死亡率为21.78%（n = 125）。30天死亡率为5.75%（n = 33），一年死亡率为21.08%（n = 121）。在文献综述中强调的股骨颈骨折死亡的关键危险因素与30天死亡的二项式结果变量进行了比较。首先完成分类数据分析以突出关键趋势。然后进行回归分析以证明每个因素的显著性。年龄（p = 0.75207）、体重指数（p = 0.97674）和年龄/体重指数（p = 0.92205）均无统计学意义。诺丁汉髋部骨折评分（NHFS）有边际显著性（p = 0.05749）。美国麻醉医师协会（ASA）分级具有统计学意义，是30天死亡率的最强预测指标（p = 0.00953）。结论 我们的研究结果表明，目前使用ASA和NHFS的指南是髋部骨折患者30天死亡率的优秀预测指标。所提出的年龄/体重指数评分在该队列中未显示出有效性。有必要进一步研究以探索其他预测指标并加强对该人群的风险评估。
