Should Patients with Isolated Hip Fractures Be Included in Trauma Registries?

Bergeron, Éric; Lavoie, André; Belcaïd, Amina; Ratte, Sebastien; Clas, David

doi:10.1097/01.ta.0000158245.23772.0a

Cited by 33 publications

(14 citation statements)

References 37 publications

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“…Similar figures have been reported for other countries in Europe and as the population is growing older the total number of hip fractures is expected to rise 2. Patients suffering hip fractures often have multiple comorbidities and mortality and morbidity is high even though a hip fracture most commonly is a result of a low‐energy trauma 3. Treatment bundles focusing on simple measures to optimize vital organ function, pain relief and early surgical management have been introduced in several countries 4.…”

Section: Introductionmentioning

confidence: 61%

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Accuracy of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity score and the Nottingham risk score in hip fracture patients in Sweden — A prospective observational study

Jonsson

Bentzer

Turkiewicz

et al. 2018

Acta Anaesthesiol Scand

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BackgroundLittle is known about accuracy of common risk prediction scores in elderly patients suffering from hip fractures. The objective of this study was to investigate accuracy of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) score, Portsmouth‐POSSUM (P‐POSSUM) score and the Nottingham Hip Fracture Score (NHFS) for prediction of mortality and morbidity in this patient group.MethodsThis was a prospective single centre observational study on 997 patients suffering out‐of‐hospital cervical, trochanteric or subtrochanteric fracture of the neck of the femur. Calibration and discrimination was assessed by calculating the ratio of observed to expected events (O:E) and areas under receiver operating characteristics curves (ROC).ResultsThe 30‐day mortality was 6.2% and complications, as defined by POSSUM, occurred in 41% of the patients. Overall O:E ratios for POSSUM, P‐POSSUM and NHFS scores for 30‐day mortality were 0.90, 0.98, and 0.79 respectively. The models underestimated mortality in the lower risk bands and overestimated mortality in the higher risk bands. In contrast, POSSUM predicted morbidity well with O:E ratios close to unity in most risk bands. The areas under the ROC curves for the scoring systems was 0.60‐0.67.ConclusionThe POSSUM score and NHFS show moderate calibration and poor discrimination in this cohort. The results suggest that mortality and morbidity in hip fracture patients are largely dependent on factors that are not included in these scores.

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Section: Introductionmentioning

confidence: 61%

“…Treatment bundles focusing on simple measures to optimize vital organ function, pain relief and early surgical management have been introduced in several countries 4. Even so current 30‐day mortality for out‐of‐hospital hip fractures is 6%‐10% 3, 5, 6…”

Section: Introductionmentioning

confidence: 99%

Accuracy of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity score and the Nottingham risk score in hip fracture patients in Sweden — A prospective observational study

Jonsson

Bentzer

Turkiewicz

et al. 2018

Acta Anaesthesiol Scand

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“…The NTDB encourages researchers to use inclusion and exclusion criteria in the data registry to create a more homogeneous group; for example, hip fractures should be excluded or analyzed separately, which is also confirmed by Gomez et al [17,18]. In contrast, others argue that elderly with isolated hip fracture should be included in the trauma registry [20]. Elderly with hip fracture comprise currently 17% of the total Dutch trauma population [2].…”

Section: Discussionmentioning

confidence: 96%

Performance of the modified TRISS for evaluating trauma care in subpopulations: A cohort study

Munter

Polinder

Nieboer

et al. 2018

Injury

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A B S T R A C TIntroduction: Previous research showed that there is no agreement on a practically applicable model to use in the evaluation of trauma care. A modification of the Trauma and Injury Severity Score (modified TRISS) is used to evaluate trauma care in the Netherlands. The aim of this study was to evaluate the prognostic ability of the modified TRISS and to determine where this model needs improvement for better survival predictions. Methods: Patients were included if they were registered in the Brabant Trauma Registry from 2010 through 2015. Missing values were imputed according to multiple imputation. Subsets were created based on age, length of stay, type of injury and injury severity. Probability of survival was calculated with the modified TRISS. Discrimination was assessed with the Area Under the Receiver Operating Curve (AUROC). Calibration was studied graphically. Results: The AUROC was 0.84 (95% CI: 0.83, 0.85) for the total cohort (N = 69 747) but only 0.53 (95% CI: 0.51, 0.56) for elderly patients with hip fracture. Overall, calibration of the modified TRISS was adequate for the total cohort, with an overestimation for elderly patients and an underestimation for patients without brain injury. Conclusions: Outcome comparison conducted with TRISS-based predictions should be interpreted with care. If possible, future research should develop a simple prediction model that has accurate survival prediction in the aging overall trauma population (preferable with patients with hip fracture), with readily available predictors.

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“…Of these, 11 (19%) reported that they excluded patients with IHF and were therefore included in our study. [1112131415161718192021]…”

Section: Resultsmentioning

confidence: 99%

“…Included studies were conducted in Canada ( n = 5)[111217181920] or in the United States ( n = 6)[131415161821] [Table 1]. All were retrospective cohort studies published in English between 1993 and 2007.…”

Section: Resultsmentioning

confidence: 99%

Establishing consensus on the definition of an isolated hip fracture for trauma system performance evaluation: A systematic review

Tiao

Moore

Boutin

et al. 2014

J Emerg Trauma Shock

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Background:Risk-adjusted mortality is widely used to benchmark trauma center care. Patients presenting with isolated hip fractures (IHFs) are usually excluded from these evaluations. However, there is no standardized definition of an IHF. We aimed to evaluate whether there is consensus on the definition of an IHF used as an exclusion criterion in studies evaluating the performance of trauma centers in terms of mortality.Materials and Methods:We conducted a systematic review of observational studies. We searched the electronic databases MEDLINE, EMBASE, BIOSIS, The Cochrane Library, CINAHL, TRIP Database, and PROQUEST for cohort studies that presented data on mortality to assess the performance of trauma centers and excluded IHF. A standardized, piloted data abstraction form was used to extract data on study settings, IHF definitions and methodological quality of included studies. Consensus was considered to be reached if more than 50% of studies used the same definition of IHF.Results:We identified 8,506 studies of which 11 were eligible for inclusion. Only two studies (18%) used the same definition of an IHF. Three (27%) used a definition based on Abbreviated Injury Scale (AIS) Codes and five (45%) on International Classification of Diseases (ICD) codes. Four (36%) studies had inclusion criteria based on age, five (45%) on secondary injuries, and four (36%) on the mechanism of injury. Eight studies (73%) had good overall methodological quality.Conclusions:We observed important heterogeneity in the definition of an IHF used as an exclusion criterion in studies evaluating the performance of trauma centers. Consensus on a standardized definition is needed to improve the validity of evaluations of the quality of trauma care.

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Should Patients with Isolated Hip Fractures Be Included in Trauma Registries?

Cited by 33 publications

References 37 publications

Accuracy of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity score and the Nottingham risk score in hip fracture patients in Sweden — A prospective observational study

Accuracy of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity score and the Nottingham risk score in hip fracture patients in Sweden — A prospective observational study

Performance of the modified TRISS for evaluating trauma care in subpopulations: A cohort study

Establishing consensus on the definition of an isolated hip fracture for trauma system performance evaluation: A systematic review

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