Trauma Risk Score Also Predicts Blood Transfusion Requirements in Hip Fracture Patients

Abstract

Introduction The purpose of this study is to determine if the risk of receiving a blood transfusion during hip fracture hospitalization can be predicted by a validated risk profiling score (Score for Trauma Triage in Geriatric and Middle Aged (STTGMA)). Materials and Methods A consecutive series of 1449 patients 55 years and older admitted for a hip fracture at one academic medical center were identified from a trauma database. The STTGMA risk score was calculated for each patient. Patients were stratified into risk groups based on their STTGMA score quantile: minimal risk (0–50%), low risk (50–80%), moderate risk (80–95%), and high risk (95–100%). Incidence and volume of blood transfusions were compared between risk groups. Results There were 562 (38.8%) patients who received a transfusion during their admission. 58.3% of patients in the high risk group received a transfusion during admission compared to 31.2% of minimal risk group patients, 42.6% of low risk group patients, and 50.0% of moderate risk group patients ( p < 0.001). STTGMA was predictive of first transfusion incidence in both the preoperative and postoperative periods. There was no difference in mean total transfusion volume between the four risk groups. Conclusion The STTGMA model is capable of risk stratifying hip fracture patients more likely to receive blood transfusions during hospitalization. Surgeons can use this tool to anticipate transfusion requirements.

No Differences Between White and Non-White Patients in Terms of Care Quality Metrics, Complications, and Death After Hip Fracture Surgery When Standardized Care Pathways Are Used

“…aAll p values have been corrected by the Holm-Bonferroni method to account for multiple comparisons in multivariate regression.bThe score for Trauma Triage In The Geriatric And Middle Aged (STTGMA) is a trauma risk score calculated from age, Glasgow coma scale, abbreviated injury scores for the head and neck and chest, CCI, ASA class, and baseline ambulatory status as input; the STTGMA is scored from 0 to 100% to reflect its original conception as mortality risk during admission and is further described by Konda et al [13]. cThe 5% (70 of 1538) of patients lost to follow-up at 30 days were censored from these calculations.dThe 22% (336 of 1538) of patients lost to follow-up at 1 year were censored from these calculations.eOdds ratios for socioeconomic status are relative to the first, least deprived, quintile of ADI.fOdds ratios for insurers are relative to Medicare insurance.ADI = Area Deprivation Index.…”

“…bThe score for Trauma Triage In The Geriatric And Middle Aged (STTGMA) is a trauma risk score calculated from age, Glasgow coma scale, abbreviated injury scores for the head and neck and chest, CCI, ASA class, and baseline ambulatory status as input; the STTGMA is scored from 0 to 100% to reflect its original conception as mortality risk during admission and is further described by Konda et al [13]. …”

“…Notably, all the endpoints did correlate with the STTGMA trauma risk score confounding variable, but this is not to suggest that components of STTGMA such as injury severity and comorbidities are biologically linked with race; as noted earlier, findings of this sort are more likely related to access-to-care issues like insurance coverage, health literacy, cost-related barriers to care, decreased access to a usual source of care or residual confounding. We do not speculate that the explanation of residual confounding is likely correct, because the STTGMA trauma risk score has been found to correlate with quality and mortality endpoints in populations undifferentiated by race [7, 10-14]. Second, the authors acknowledge the complexities in reporting race and ethnicity as outlined by the editors of this journal [16], and further acknowledge that this study does not report race and ethnicity by definitions provided by the NIH [21] and FDA [29].…”

“…STTGMA is scored from 0 to 100 with higher scores being worse to describe the inpatient mortality risk as a percentage. Recent studies have employed a minimal, low, moderate, and high stratification of the score with corresponding breakpoints from the 0 to 50 th , 50 th to 80 th , 80 th to 95 th , and 95 th to 100 th quantiles of scores within a population of patients with trauma that have demonstrated correlation with need for transfusion among patiens with hip fractures [13].…”

“…Data presented as % (n) or mean ± SD.aThe range of possible CCI scores without age adjustment is 0 to 33, with a higher score representing more comorbidities.bThe Score for Trauma Triage in the Geriatric and Middle Aged (STTGMA) is a trauma risk score calculated from age, Glasgow coma scale, abbreviated injury scores for the head and neck and chest, CCI, ASA class, and baseline ambulatory status as input; STTGMA is scored from 0% to 100% to reflect its original conception as mortality risk during admission and is further described by Konda et al [13]. cThe AO/OTA fracture classification describes fractures with the leading digit designating the fractured bone (3 for femur), the next digit representing the part of the bone (1 for proximal end segment) and the last letter describing fracture morphology; morphology of end segment fractures is designated as A for extraarticular and B for partial articular; as an example, an intertrochanteric hip fracture would be designated 31A and a femoral neck fracture would be designated 31B in this classification system; the classification scheme is further described by Meinberg et al [18].…”