Steiner J F, Kramer A M, Eilertsen T B, Kowalsky J C
Center for Health Services Research, University of Colorado Health Sciences Center, Denver, USA.
J Am Geriatr Soc. 1997 Dec;45(12):1510-4. doi: 10.1111/j.1532-5415.1997.tb03204.x.
To develop and validate a clinical prediction rule for nursing home residence 6 months after a hip fracture.
Two prospective cohort studies, a development study (DS) and a validation study (VS).
The DS included hip fracture patients admitted to 92 rehabilitation units or skilled nursing facilities; the VS included hip fracture patients from 11 integrated healthcare systems.
A total of 344 community-dwelling hip fracture patients aged 65 and older participated in the DS; 239 similar patients were enrolled in the VS.
None.
The acute hospital record, nursing evaluations, and patient questionnaires provided information about demographics, physical and neuropsychological function, and comorbidity. Residence 6 months after fracture was determined by phone interview. Multivariate analysis identified predictors for a risk score to assess the likelihood of nursing home residence.
18.7% of patients in the DS resided in nursing homes 6 months after hip fracture. The four independent risk factors for institutionalization were (1) being unmarried (OR = 6.7 [95% CI 2.4 to 19]), (2) incontinence (OR = 2.3 [CI 1.2 to 4.7]), (3) dependence in ambulation (OR = 5.0 [CI 2.1 to 12.3]), and (4) cognitive impairment (OR = 6.6 [CI 3.3 to 13.2]). Of patients with all four risk factors, 73.2% were institutionalized at 6 months, compared with 0% of patients with no risk factors. In the VS, 6.1% of patients resided in nursing homes after 6 months, with a range from 50.0% of patients with four risk factors to 0% of those with no risk factors. Areas under receiver-operating characteristic curves for the prediction rule were 0.84 +/- .03 in the DS, and 0.81 +/- .06 in the VS.
A clinical prediction rule using four easily measurable characteristics can identify individuals at high or low risk of nursing home residence 6 months after hip fracture.
制定并验证一项关于髋部骨折后6个月入住养老院情况的临床预测规则。
两项前瞻性队列研究，一项开发研究（DS）和一项验证研究（VS）。
开发研究纳入了92个康复单元或专业护理机构收治的髋部骨折患者；验证研究纳入了11个综合医疗系统的髋部骨折患者。
共有344名65岁及以上的社区居住髋部骨折患者参与了开发研究；239名类似患者纳入了验证研究。
无。
急性医院病历、护理评估和患者问卷提供了有关人口统计学、身体和神经心理功能以及合并症的信息。通过电话访谈确定骨折后6个月的居住情况。多变量分析确定了用于风险评分的预测因素，以评估入住养老院的可能性。
开发研究中18.7%的患者在髋部骨折后6个月入住养老院。入住养老院的四个独立风险因素为：（1）未婚（比值比[OR]=6.7[95%置信区间（CI）2.4至19]），（2）失禁（OR=2.3[CI 1.2至4.7]），（3）行走依赖（OR=5.0[CI 2.1至12.3]），以及（4）认知障碍（OR=6.6[CI 3.3至13.2]）。具有所有四个风险因素的患者中，73.2%在6个月时入住养老院，而无风险因素的患者这一比例为0%。在验证研究中，6.1%的患者在6个月后入住养老院，有四个风险因素的患者比例为50.0%，无风险因素的患者比例为0%。预测规则在开发研究中的受试者工作特征曲线下面积为0.84±0.03，在验证研究中为0.81±0.06。
一项使用四个易于测量特征的临床预测规则能够识别髋部骨折后6个月入住养老院风险高或低的个体。
