Nottingham Hip Fracture Score: Does It Predict Mortality in Distal Femoral Fracture Patients?

Archunan, Maheswaran; Subhash, Sadhin; Attwood, Joseph; Kumar, Siddhant; Choudhry, Nameer; Fountain, James R.; Liew, Ignatius

doi:10.7759/cureus.19139

Cited by 7 publications

(6 citation statements)

References 11 publications

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“…Previous studies have also reported that increased NHFS is closely related to prolonged hospitalization stay 14 . The NHFS contains many components that can reflect poor physical condition, including advanced age, low hemoglobin level, cognitive impairment, complications, and the demand for other people's care before surgery 15 . All the above components can affect the recovery of these patients after surgery and increase the risk of complications.…”

Section: Discussionmentioning

confidence: 99%

“…14 The NHFS contains many components that can reflect poor physical condition, including advanced age, low hemoglobin level, cognitive impairment, complications, and the demand for other people's care before surgery. 15 All the above components can affect the recovery of these patients after surgery and increase the risk of complications. The postoperative complications could significantly influence the length of hospitalization.…”

Section: Clinical Significance Of Preoperative Assessmentmentioning

confidence: 99%

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Validation of the Nottingham Hip Fracture Score in Predicting Postoperative Outcomes Following Hip Fracture Surgery

Sun

Liu

et al. 2023

Orthopaedic Surgery

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Objective: Although several prognostic models have been developed for patients who underwent hip fracture surgery, their preoperative performance was insufficiently validated. We aimed to verify the effectiveness of the Nottingham Hip Fracture Score (NHFS) for predicting postoperative outcomes following hip fracture surgery. Methods:This was a single-center and retrospective analysis. A total of 702 elderly patients with hip fractures (age ≥ 65 years old) who received treatment in our hospital from June 2020 to August 2021 were selected as the research participants. They were divided into the survival group and the death group based on their survival 30 days after surgery. The multivariate logistic regression model was used to identify the independent risk factors for the 30-day mortality after surgery. The NHFS and American Society of Anaesthesiologists (ASA) grades were used to construct these models, and a receiver operating characteristic curve was plotted to assess their diagnostic significance. A correlation analysis was performed between NHFS and length of hospitalization and mobility 3 months after surgery.Results: There were significant differences in the age, albumin level, NHFS, and ASA grade between both groups (p < 0.05). The length of hospitalization in the death group was longer than the survival group (p < 0.05). The perioperative blood transfusion and postoperative ICU transfer rates in the death group were higher than in the survival group (p < 0.05). The death group's incidence of pulmonary infections, urinary tract infections, cardiovascular events, pressure ulcers, stress ulcers with bleeding, and intestinal obstruction was higher than the survival group (p < 0.05). The NHFS and ASA III were independent risk factors for the 30-day mortality after surgery, regardless of age and albumin level (p < 0.05). The area under the curve (AUC) of the NHFS and ASA grade for predicting the 30-day mortality after surgery was 0.791 (95% confidence interval [CI] 0.709-0.873, p < 0.05) and 0.621 (95% CI 0.477-0.764, p > 0.05), respectively. The NHFS positively correlated with hospitalization length and mobility grade 3 months after surgery (p < 0.05). Conclusion:The NHFS demonstrated a better predictive performance than the ASA score for the 30-day mortality after surgery and positively correlated with the hospitalization length and postoperative activity limitation in elderly patients with hip fractures.

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Section: Discussionmentioning

confidence: 99%

Section: Clinical Significance Of Preoperative Assessmentmentioning

confidence: 99%

Validation of the Nottingham Hip Fracture Score in Predicting Postoperative Outcomes Following Hip Fracture Surgery

Sun

Liu

et al. 2023

Orthopaedic Surgery

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“…It has shown correlation with CFS in predicting outcomes within the hip fracture population 25 and value in predicting outcome in distal femoral fractures. 26 However, as this score is not routinely collected in those without hip fractures, it has not been included in our analysis. Given our results have demonstrated similar outcomes between those with and without hip fractures, further work should be undertaken to compare CFS and NHFS as predictors of outcomes in fragility fractures outside of the hip fracture population.…”

Section: Discussionmentioning

confidence: 99%

Clinical frailty score: A useful tool in predicting outcomes in patients with fragility fractures

Brown

Gatfield

Rogers

et al. 2022

Trauma

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Introduction Frailty is a known risk factor for falls and subsequent fractures and is linked to greater hospitalisation, morbidity, and mortality in various areas of medicine. A 2017 Trauma Audit and Research Network (TARN) report identified that further research was needed to determine the effect of frailty on outcomes in trauma patients. The UK Best Practice Tariff currently awards a financial incentive for frailty scoring for all patients sustaining major trauma who are managed at Major Trauma Centres (MTCs). However, this currently does not extend to Trauma Units (TUs) or to patients without major trauma. This retrospective cohort study sought to investigate whether frailty also has a significant effect on outcomes in patients presenting with fragility fractures presenting to trauma units without major trauma. Methods Notes from all patients aged ≥65 admitted to Gloucestershire Royal Hospital in 2019 with any fragility fracture were reviewed retrospectively. Age, injury, length of stay, and mortality were recorded. A Clinical Frailty Score (CFS) was assigned retrospectively using the Rockwood Clinical Frailty Scale. Results Eight hundred sixty patients were reviewed (male:female 258:602, mean age 83 ± 8.2). Each consecutive stepwise increase in CFS was independently associated with an average cumulative increase in mortality rate at 30-day and 1 year (OR 1.55 and 1.58 respectively, p < 0.001), as well as average cumulative percentage increase in length of stay (OR 1.094, p < 0.001). Conclusion Clinical frailty score independently predicts adverse outcome in patients with fragility fractures managed at trauma units. Clinical frailty score could be used to easily identify patients at risk of poorer outcomes and may assist in allocation of limited orthogeriatric resources and future BPT guidelines. Further work should promote recognition of frailty within trauma settings, investigate how additional resources affect outcomes for patients of varying degrees of frailty, and consider multicentre studies relating to frailty-associated outcomes in trauma.

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“…We noted that the 30-day survival in low NHFS group patients was slightly lower than in the high NHFS group, but this did not reach statistical significance due to the overlap of confidence intervals. Previous studies performed with a much larger patient cohort have shown that the 30-day survival was indeed higher in patients with lower NHFS (with a score below 5) in patients who sustained a hip fracture or other femoral fractures [ 6 , 19 , 20 ]. For one-year mortality, our study did show a higher survival rate in patients with NHFS of less than 5, and these results were statistically significant, which was consistent with previously reported findings [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Mortality in Hip Fracture Patients During the COVID-19 Pandemic: A Retrospective Analysis in a District General Hospital in the United Kingdom

Yawar¹,

Auld²,

Salmon³

et al. 2022

Cureus

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Introduction Hip fracture is commonly seen in elderly patients because of low-energy trauma. It carries significant morbidity and mortality. Scoring systems such as the Nottingham hip fracture score (NHFS) have shown a good correlation with increased mortality as the value of these scores increases. In our study, we aim to ascertain the hip fracture mortality in our population, compare the mortality in hip fractures compared to previously reported figures in literature and nationally reported figures during the first year of the COVID-19 pandemic, and also ascertain the usefulness of NHFS in predicting mortality in hip fractures. Methods We gathered mortality data on hip fracture patients admitted to our unit from January 1, 2020 to December 31, 2020. NHFS was calculated for all patients and the 30-day mortality rate was compared to previously reported hip fracture mortality rates using the standard mortality ratio (SMR). One-year mortality was stratified by placing patients in high and low NHFS groups. The log-rank test was used to compare hip fracture survival at one month and at one year in the high NHFS (NHFS >4) group and low NHFS group (NHFS value 4 or below). Additionally, a log-rank test was used to compare one-month and one-year survival in hip fractures managed with hemiarthroplasty, dynamic hip screw and intramedullary nail. Results In 2020, 388 patients were admitted with hip fractures to our unit. The crude mortality rate was 3.9% at 30 days and 20.88% at one year. Compared to the National Hip Fracture Database report for 2020, the incidence risk ratio for mortality was 0.46 (p-value<0.05). The SMR at 30 days was 0.34 (CI=0.17-0.51) and the SMR at one year was 0.63 (CI=0.49-0.77). The survival rate was higher at 30 days and one year in the low NHFS group compared to the high NHFS group (p-value<0.01). The survival rate at one month and one year were similar in groups managed with hemiarthroplasty, dynamic hip screws, and intramedullary nails (p-value>0.05). Conclusions Hip fracture mortality has been decreasing steadily and we noted a lower rate of hip fracture mortality compared to figures reported previously as per NHFS studies even though the study was conducted during the COVID-19 pandemic period. We also noted lower 30-day mortality in our hospital as compared to the national 30-day mortality rate for hip fracture patients in 2020.

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Nottingham Hip Fracture Score: Does It Predict Mortality in Distal Femoral Fracture Patients?

Cited by 7 publications

References 11 publications

Validation of the Nottingham Hip Fracture Score in Predicting Postoperative Outcomes Following Hip Fracture Surgery

Validation of the Nottingham Hip Fracture Score in Predicting Postoperative Outcomes Following Hip Fracture Surgery

Clinical frailty score: A useful tool in predicting outcomes in patients with fragility fractures

Mortality in Hip Fracture Patients During the COVID-19 Pandemic: A Retrospective Analysis in a District General Hospital in the United Kingdom

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