Can Preoperative Scoring Systems be Applied to Asian Hip Fracture Populations? Validation of the Nottingham Hip Fracture Score (NHFS) and Identification of Preoperative Risk Factors in Hip Fractures

Abstract

Introduction: Hip fractures in the elderly are a major cause of morbidity and mortality. Determining which patients will benefit from hip fracture surgery is crucial to reducing mortality and morbidity. Our objectives are: 1) to define the rate of index admission, 1-month and 1-year mortality in all hip fracture patients, and 2) to apply the Nottingham Hip Fracture Score (NHFS) to determine validity in an Asian population. Materials and Methods: This is a prospective cohort study of 212 patients with hip fractures above 60 years from September 2009 to April 2010 for 1-year. Sociodemographic, prefracture comorbidity and data on functional status was collected on admission, and at intervals after discharge. The main outcome measures were mortality on index admission, 1 month and 12 months after treatment. Results: In our study, the overall mortality at 1-month and 1-year after surgery was 7.3% and 14.6% respectively. Surgically treated hip fracture patients had lower odds ratio (OR) for mortality as compared to conservatively treated ones. The OR was 0.17 during index admission, 0.17 at 1-month, and 0.18 at 12-months after discharge. These were statistically significant. Adjustments for age, gender, and duration to surgery were taken into account. The NHFS was found to be a good predictor of 1-month mortality after surgery. Conclusion: Surgically treated hip fracture patients have a lower OR for mortality than conservatively managed ones even up to 1-year. The NHFS has shown to predict 1-month mortality accurately for surgically treated hip fracture patients, even for our Asian population. It can be used as a tool for clinicians at the individual patient level to communicate risk with patients and help plan care for fracture patients. Key words: Elderly, Femur neck, Geriatric, Intertrochanteric

Analysis of clinical characteristics and predisposing risk factors of the contralateral hip fracture after initial hip fracture in elderly patients—A retrospective cohort study of 1,586 patients

“…However, advanced age can not cause hip fracture under normal circumstances, and only minor violence or nontraumatic factors results in controlateral hip fracture [14]. However, age was indeed the main risk factor of the contralateral hip fracture in the elderly, just as the older age, the higher risk of secondary osteoporotic fracture [15][16][17].…”

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“…Both the NHFS and the SORT score can predict 30-day mortality in fractured neck of femur patients using clearly defined set of variables that are easy to gather 8,9 .…”