Modification of a preoperative risk scoring system for elder patients with hip fracture and its prediction of in-hospital mortality / 中华创伤骨科杂志

ABSTRACT

Objective To evaluate the efficacy of a modified risk scoring system in predicting the mortality during hospitalization in the elderly patients undergoing hip fracture surgery.Methods At the first stage,we retrospectively analyzed the clinical data of 1,562 elderly patients with hip fracture who had been admitted to Department of Trauma and Orthopedics,Peking University People's Hospital from January 2010 to December 2014.A multi-factor risk-adjustment model for surgical risks was constructed by multi-variate logistic regression analysis to obtain a modified preoperative risk scoring system for elderly patients undergoing hip fracture.At the second stage,a cohort of 1,356 elderly patients with hip fracture from January 2015 to December 2018 was included for a prospective evaluation of the modified risk scoring system.The patients included were divided into 5 groups according to their scoresa very low risk group of 0 to 10 points,a low risk group of 11 to 20 points,a moderate risk group of 21 to 30 points,a high risk group of 31 to 40 points and a very high risk group of ≥41 points.The consistency between the scores and the actual outcomes of the patients was observed and the receiver operating characteristic curve (ROC) was drawn accordingly.Results The 1,356 cases included in the study scored 25.12 ± 10.30 points (from 0 to 67 points).The in-hospital mortality was 0％ (0/96) in the very low risk group,0.23％ (1/443) in the low risk group,0.49％ (2/409) in the moderate risk group,2.16％ (6/278) in the high risk group,and 5.38％ (7/130) in the very high risk group.The area under the ROC curve was 0.825 (95％ CI0.728-0.921,P ＜ 0.01).Conclusions As the in-hospital mortality is positively correlated with the scores of the modified preoperative risk scoring system for elderly patients undergoing hip fracture,the modified scoring system can be used to predict the in-hospital morbidity of the patients.The modified scoring system can be further verified and calibrated by multi-center clinical evaluation.