ABSTRACT
ABSTRACT Objective: Hip fractures in young adults can cause poor functional capacity throughout life because of several complications. The purpose of this study was to prospectively evaluate 1-year mortality and functional outcomes for patients aged 60 years or younger with hip fracture . Methods: We prospectively obtained data for all consecutive patients aged 60 or younger with any type of hip fracture who were treated operatively between 2008 and 2014. After one year, patient outcomes were evaluated according to changes in pain severity, functional status (modified Barthel index), and mortality rate . Results: Of the total of 201 patients, 132 (65.7%) were men (mean age: 41.8 years) and 69 (34.3%) were women (mean age: 50.2 years) (p<0.001). Reduced pain severity was reported in 91.5% of the patients. The mean modified Barthel index was 22.3 in men and 18.6 in women (p<0.001). At the one-year follow-up, 39 cases (19.4%) were dependent on walking aids while only 17 patients (8.5%) used walking aids preoperatively (p<0.001). Seven patients (4 men and 3 women) died during the one-year follow-up period; 2 died in the hospital after surgery . Conclusion: Hip fractures in young adults have a low mortality rate, reduction in pain severity, and acceptable functional outcomes one year after surgery. Level of Evidence II, Prospective Comparative Study.
RESUMO Objetivo: As fraturas de quadril em adultos jovens podem ocasionar capacidade funcional insatisfatória durante toda a vida, devido a várias complicações. A finalidade deste estudo foi avaliar prospectivamente a mortalidade e os desfechos funcionais em um ano, em pacientes com 60 anos de idade ou menos com fratura de quadril. Métodos: Coletamos prospectivamente dados de todos os pacientes consecutivos com idade de 60 anos ou menos, com qualquer tipo de fratura de quadril, que foram tratadas por cirurgia entre 2008 e 2014. Depois de um ano, os desfechos dos pacientes foram avaliados de acordo com as mudanças da intensidade da dor, estado funcional (índice de Barthel modificado) e taxa de mortalidade. Resultados: Do total de 201 pacientes, 132 (65,7%) eram homens (média de idade: 41,8 anos) e 69 (34,3%) eram mulheres (média de idade: 50,2 anos) (p < 0,001). A menor intensidade de dor foi relatada em 91,5% dos pacientes. A média do índice de Barthel modificado foi 22,3 em homens e 18,6 em mulheres (p < 0,001). No acompanhamento de um ano, 39 pacientes (19,4%) dependiam de dispositivos auxiliares da marcha, enquanto apenas 17 pacientes (8,5%) usavam esses dispositivos no pré-operatório (p < 0,001). Sete pacientes (4 homens e 3 mulheres) morreram durante o período de acompanhamento de um ano; dois morreram no hospital, depois da cirurgia. Conclusão: As fraturas de quadril em adultos jovens têm baixa taxa de mortalidade, redução da intensidade da dor e desfechos funcionais aceitáveis um ano depois da cirurgia. Nível de Evidência II, Estudo Prospectivo Comparativo.
ABSTRACT
Background: The high cost of intensive care unit (ICU) services and limitations in health resources can prompt managers to use predictive scoring systems. Objective: To evaluate the role of APACHE II as a scoring system to predict outcomes and to compare actual and expected mortality rates. Methods: This prospective study was conducted in a10-bed, mixed ICU at Namazi University Hospital, a teaching hospital in Shiraz, Iran. All patients were included consecutively and data were collected during the first 24 h of admission. Statistical analyses were done with SPSS v.16 software. The differences were considered statistically significant at a P value of <0.05. Results: From June to November of 2013, data were available for 110 (61.4%) ICU admission. The patients’ mean (SD) age was 55.1 (17.7) years. Mean APACHE II score was 17.85±7.4. The total standardized mortality ratio (SMR) was 0.92, and the ratio ranged from 0.48 in medical patients to 1.22 in post-elective surgery patients. With the sensitivity 18.5% and specificity 92.8%, the highest correct classification was obtained at predicted death risk 0.6 (74.5%). Conclusion: We recommend the use of this outcome prediction score for decision-making and classifying patients based on the degree of severity of their diseases in our setting. Further work is needed with larger sample sizes to more precisely determine the generalisability of our results and evaluate validity of this outcome prediction score.