Identifying a standard set of outcome parameters for the evaluation of orthogeriatric co-management for hip fractures

Liem, I. S. L.; Kammerlander, Christian; Suhm, Norbert; Blauth, M.; Roth, Tobias; Gosch, Markus; Hoang‐Kim, Amy; Mendelson, Daniel A.; Zuckerman, Joseph D.; Leung, Frankie; Burton, Jennifer; Moran, Chris; Parker, Martyn J.; Giusti, Andrea; Pioli, Giulio; Goldhahn, Jörg; Kates, Stephen L.

doi:10.1016/j.injury.2013.06.018

Cited by 117 publications

(70 citation statements)

References 81 publications

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“…Orthogeriatric intervention is often reported to reduce waiting time for surgery (see Liem [37] for an overview). In our study, however, the waiting time for surgery was two hours longer in the intervention group.…”

Section: Discussionmentioning

confidence: 99%

The effect of a pre- and postoperative orthogeriatric service on cognitive function in patients with hip fracture: randomized controlled trial (Oslo Orthogeriatric Trial)

Watne

Torbergsen

Conroy

et al. 2014

BMC Med

149

210

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BackgroundDelirium is a common complication in patients with hip fractures and is associated with an increased risk of subsequent dementia. The aim of this trial was to evaluate the effect of a pre- and postoperative orthogeriatric service on the prevention of delirium and longer-term cognitive decline.MethodsThis was a single-center, prospective, randomized controlled trial in which patients with hip fracture were randomized to treatment in an acute geriatric ward or standard orthopedic ward. Inclusion and randomization took place in the Emergency Department at Oslo University hospital. The key intervention in the acute geriatric ward was Comprehensive Geriatric Assessment including daily interdisciplinary meetings. Primary outcome was cognitive function four months after surgery measured using a composite outcome incorporating the Clinical Dementia Rating Scale (CDR) and the 10 words learning and recalls tasks from the Consortium to Establish a Registry for Alzheimer’s Disease battery (CERAD). Secondary outcomes were pre- and postoperative delirium, delirium severity and duration, mortality and mobility (measured by the Short Physical Performance Battery (SPPB)). Patients were assessed four and twelve months after surgery by evaluators blind to allocation.ResultsA total of 329 patients were included. There was no significant difference in cognitive function four months after surgery between patients treated in the acute geriatric and the orthopedic wards (mean 54.7 versus 52.9, 95% confidence interval for the difference -5.9 to 9.5; P = 0.65). There was also no significant difference in delirium rates (49% versus 53%, P = 0.51) or four month mortality (17% versus 15%, P = 0.50) between the intervention and the control group. In a pre-planned sub-group analysis, participants living in their own home at baseline who were randomized to orthogeriatric care had better mobility four months after surgery compared with patients randomized to the orthopedic ward, measured with SPPB (median 6 versus 4, 95% confidence interval for the median difference 0 to 2; P = 0.04).ConclusionsPre- and postoperative orthogeriatric care given in an acute geriatric ward was not effective in reducing delirium or long-term cognitive impairment in patients with hip fracture. The intervention had, however, a positive effect on mobility in patients not admitted from nursing homes.Trial registrationClinicalTrials.gov NCT01009268 Registered November 5, 2009

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Section: Discussionmentioning

confidence: 99%

The effect of a pre- and postoperative orthogeriatric service on cognitive function in patients with hip fracture: randomized controlled trial (Oslo Orthogeriatric Trial)

Watne

Torbergsen

Conroy

et al. 2014

BMC Med

149

210

View full text Add to dashboard Cite

show abstract

“…Data was collected from the prospectively recorded hospital NHFD entries, PACS system, and the electronic medical records regarding age, gender, ASA, type of fracture, time to theatre, reason for any delay to theatre, length of acute hospital stay, post-operative complications, and mortality at 30, 120 and 365 days. Medical and surgical post-operative complications were defined according to the consensus opinion identifying standard outcome parameters for orthogeriatric comanagement of hip fractures [12].…”

Section: Methodsmentioning

confidence: 99%

The effect of becoming a major trauma centre on outcomes for elderly hip fracture patients

Barr

Vindlacheruvu

Gooding

2015

Injury

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“…Evidence-based fall risk assessment and management becomes feasible and effective with the implementation of screening instruments, acknowledgement of reciprocal effects of competing conditions and a resilient and confident network of members of the health care team [9]. A close cooperation between multiple specialties represents a key factor in the prevention and treatment principles of elderly patients at risk of falls [3,7-11]. The causes of falls can be multifactorial and may derive from cardiac arrhythmias, cerebrovascular, neurologic causes, or are well described to require the care of an ear, nose and throat physician.…”

Section: Discussionmentioning

confidence: 99%

The ‘Aachen Falls Prevention Scale’ - development of a tool for self-assessment of elderly patients at risk for ground level falls

Pape¹,

Schemmann²,

Foerster³

et al. 2015

Patient Saf Surg

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BackgroundThe incidence of falls in the elderly population is difficult to determine and therefore potentially underestimated. Screening algorithms usually have in common that the evaluation is undertaken by trained individuals in a hospital setting. This leads to the inclusion of a high proportion of low-risk people and a waste of resources. It would be advantageous to pretest the individuals at risk in their own environment using a simple self-assessment approach.MethodsThe consensus process of our group of clinicians and physical therapists included: 1. a preparative literature review about risk profiles and assessment tools for ground level falls; 2. a selection of appropriate questions that cover all health aspects involved in an increased risk for falling; and 3. a selection of a simple physical test that can be used at home without the need of a health care professional. We thus searched to develop a scale that can be used by older citizen at higher risk of falling. The current manuscript summarizes the results of this review, consensus and selection process.ResultsThe literature search was undertaken between March and August 1, 2013. The selection process for the questions used (Part I) lasted between March 2013 and January 2014. Among all tests evaluated the 20 second standing test (Part II) was deemed to be safe to be performed even by an individual at risk for a fall, as it closely resembles activities of daily living. The `Aachen Falls Prevention Scale` finally uses a self-assessment tool grading falls risk on a scale of 1 to 10 by the individual itself after completion of Part I and Part II. In summary, we present a scale that might offer a self-assessment option to improve the measures of falls prevention pass for elderly citizens.ConclusionsThe introduction of the `Aachen Falls Prevention Scale` which combines a simple questionnaire with a safe and quick balance tool, meets the criteria to identify whether or not a balance problem exists – the first step in evaluation of falls risk. Further studies will have to assess the ability of an individual to estimate his or her individual falls risk on a longitudinal basis and possibly trigger the necessity for the assessment by a physician.

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Identifying a standard set of outcome parameters for the evaluation of orthogeriatric co-management for hip fractures

Cited by 117 publications

References 81 publications

The effect of a pre- and postoperative orthogeriatric service on cognitive function in patients with hip fracture: randomized controlled trial (Oslo Orthogeriatric Trial)

The effect of a pre- and postoperative orthogeriatric service on cognitive function in patients with hip fracture: randomized controlled trial (Oslo Orthogeriatric Trial)

The effect of becoming a major trauma centre on outcomes for elderly hip fracture patients

The ‘Aachen Falls Prevention Scale’ - development of a tool for self-assessment of elderly patients at risk for ground level falls

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