Bujaković Tarik, Delibegović Samir
Clinic for Orthopaedics and Traumatology, University Clinical Centre Tuzla, Bosnia and Herzegovina.
Clinic for Surgery, University Clinical Centre Tuzla, Bosnia and Herzegovina; Faculty of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina.
Med Glas (Zenica). 2025 Jan 1;22(1):127-131. doi: 10.17392/1801-22-01.
Various predictive models have been developed to help identify patients with hip fractures with greater or lower probability of survival. The aim of this study was to establish the capacity of the APACHE II score to predict the survival of patients with hip fracture, in people aged over 65 years, and compare it with the existing score used to predict the survival of these patients.
This was a prospective, cohort study conducted in a tertiary care teaching hospital including 410 consecutive patients with hip fracture aged ≥65 years. As part of the preoperative preparation, general health of the patients was classified according to the ASA score. The Charlson Comorbidity Index (CCI), the Nottingham Hip Fracture Score (NHFS), the POSSUM-P and the APACHE II scores were analysed.
The sensitivity and specificity of the P-POSSUM score were 78.3 and 73.0, respectively, which was better than the APACHE II whose sensitivity and specificity were 56.6 and 89.7. The area beneath the ROC curve for P-POSSUM was 0.809, and for APACHE II, 0.803. However, there was no statistically significant difference between the APACHE II and P-POSSUM scores. The P-POSSUM and APACHE II scores were statistically significantly better than ASA, the Nottingham score and CCI.
This study showed that POSSUM-P and APACHE II can be used to predict mortality in elderly people with hip fractures.
已开发出多种预测模型，以帮助识别生存概率较高或较低的髋部骨折患者。本研究的目的是确定急性生理与慢性健康状况评分系统Ⅱ（APACHE II）对65岁以上髋部骨折患者生存情况的预测能力，并将其与用于预测这些患者生存情况的现有评分进行比较。
这是一项在三级护理教学医院进行的前瞻性队列研究，纳入了410例年龄≥65岁的连续髋部骨折患者。作为术前准备的一部分，根据美国麻醉医师协会（ASA）评分对患者的一般健康状况进行分类。分析了查尔森合并症指数（CCI）、诺丁汉髋部骨折评分（NHFS）、简化手术应激评分系统（POSSUM-P）和APACHE II评分。
POSSUM-P评分的敏感性和特异性分别为78.3和73.0，优于APACHE II评分，后者的敏感性和特异性分别为56.6和89.7。POSSUM-P评分的受试者工作特征曲线（ROC）下面积为0.809，APACHE II评分为0.803。然而，APACHE II评分与POSSUM-P评分之间无统计学显著差异。POSSUM-P评分和APACHE II评分在统计学上显著优于ASA评分、诺丁汉评分和CCI。
本研究表明，POSSUM-P和APACHE II可用于预测老年髋部骨折患者的死亡率。
