Clinical Frailty Scale is a good predictor of mortality after proximal femur fracture

Abstract

Aims A proximal femur fracture (PFF) is a common orthopaedic presentation, with an incidence of over 25,000 cases reported in the Australian and New Zealand Hip Fracture Registry (ANZHFR) in 2018. Hip fractures are known to have high mortality. The purpose of this study was to determine the utility of the Clinical Frailty Scale (CFS) in predicting 30-day and one-year mortality after a PFF in older patients. Methods A retrospective review of all fragility hip fractures who met the inclusion/exclusion criteria of the ANZHFR between 2017 and 2018 was undertaken at a single large volume tertiary hospital. There were 509 patients included in the study with one-year follow-up obtained in 502 cases. The CFS was applied retrospectively to patients according to their documented pre-morbid function and patients were stratified into five groups according to their frailty score. The groups were compared using t-test, analysis of variance (ANOVA), and the chi-squared test. The discriminative ability of the CFS to predict mortality was then compared with American Society of Anaesthesiologists (ASA) classification and the patient’s chronological age. Results A total of 38 patients were deceased at 30 days and 135 patients at one year. The 30-day mortality rate increased from 1.3% (CFS 1 to 3; 1/80) to 14.6% (CFS ≥ 7; 22/151), and the one-year mortality increased from 3.8% (CFS 1 to 3; 3/80) to 41.7% (CFS ≥ 7; 63/151). The CFS was demonstrated superior discriminative ability in predicting mortality after PFF (area under the curve (AUC) 0.699; 95% confidence interval (CI) 0.651 to 0.747) when compared with the ASA (AUC 0.634; 95% CI 0.576 to 0.691) and chronological age groups (AUC 0.585; 95% CI 0.523 to 0.648). Conclusion The CFS demonstrated utility in predicting mortality after PFF fracture. The CFS can be easily performed by non-geriatricians and may help to reduce age related bias influencing surgical decision making. Cite this article: Bone Joint Open 2020;1-8:443–449.

A multi-institutional prospective observational study to evaluate fascia iliaca compartment block (FICB) for preventing delirium in adults with hip fracture

“…We did not directly collect any markers of frailty, nor are they routinely documented in the patient’s electronic medical record. Previous studies suggest that frailty scores are prognostically superior to ASA scores in the hip fracture population, and this study could have benefited from a frailty assessment 21 22. Fourth, regional blockade fell out of favor over the course of the study.…”

Prognostic Value of Glycated Hemoglobin in Frail Older Diabetic Patients With Hip Fracture

“…On the other hand, frailty seems to represent a crucial aspect that need to be considered when approaching a diabetic patient with hip fracture. On this regard, the Clinical Frailty Scale is a widely used and easy-to-apply tool for identifying frail geriatric patients, and has a high predictive value of negative outcomes and mortality in hip fractured patients ( 35 , 36 ).…”

Waiting time for hip fracture surgery: hospital variation, causes, and effects on postoperative mortality

“…However, others have shown a low predictive power of comorbidity indicies for mortality after hip fractures treated with arthroplasty. 22 Recently, Narula et al 23 has shown, in a retrospective study, that the Clinical Frailty Scale (CFS) was a good predictor of mortality for hip fracture patients. CFS can not be estimated based on routine administrative data but CFS data should be recorded in future prospective studies.…”