Assessing frailty in elderly patients with hip fractures: A retrospective review comparing geriatrician and orthopedic trainee assessments.

To assess the correlation of orthopedic surgery residents compared with expert geriatricians in the assessment of frailty stage using the Clinical Frailty Scale (CFS) in patients with hip fractures. A retrospective chart review was performed from January 1, 2015 to December 31, 2019. Patients admitted with a diagnosis of hip fracture were identified. Those patients with a CFS score completed by orthopedic residents with subsequent CFS score completed by a geriatrician during their admission were extracted. Six hundred and forty-eight patients over age 60 (mean 80.5 years, 73.5% female) were admitted during the study period. Orthopaedic residents completed 286 assessments in 44% of admissions. Geriatric medicine consultation was available for 215 patients such that 93 patients were assessed by both teams. Paired CFS data were extracted from the charts and tested for agreement between the 2 groups of raters. CFS assessments by orthopedic residents and geriatrician experts were significantly different at P < .05; orthopedic residents typically assessed patients to be one CFS grade less frail than geriatricians. Despite this, the CFS assessments showed good agreement between residents and geriatricians. Orthopaedic surgery residents are reliable assessors of frailty but tend to underestimate frailty level compared with specialist geriatricians. Given the evidence to support models such as orthogeriatrics to improve outcomes for frail patients, our findings suggest that orthopedic residents may be well positioned to identify patients who could benefit from such early interventions. Our findings also support recent evidence that frailty assessments by orthopedic surgeons may have predictive validity. Low rates of initial frailty assessment by orthopedic residents suggests that further work is required to integrate more global comprehensive care.

Mixed-Methods Analysis of a Validated Arthroscopic Knot-Tying Simulator With New Indirect Visualization Condition.

BACKGROUND: Simulation provides low-risk opportunities for surgical trainees to learn and practice fundamental skills. One simulation tool for orthopaedics is the Arthroscopic Knot (ArK) Trainer, which has been validated as an effective simulation tool across multiple methodologies. Previous studies have investigated the ArK Trainer in its basic form using clear plexiglass, which allows direct visualization of tissue anchors. PURPOSE: Using a mixed-methods approach, we assessed and compared junior and senior trainees' Seoul Medical Center (SMC) knot-tying performance under direct and indirect visualization. STUDY DESIGN: Cross-sectional study. METHODS: Fourteen orthopaedic surgery postgraduate trainees at a single medical school were recruited to participate. Trainees tied SMC knots using the Ark Trainer under direct and indirect visualization. A mixed-methods approach was used to evaluate knot-tying proficiency and characterize participants' approach to knot-tying. Knot-tying proficiency was evaluated using validated tools: a task-specific checklist (TSC), a global rating scale (GRS), and a proficiency scale (PS). Participants' approach to knot-tying was characterized using Likert-type questionnaires and semistructured interviews. An α level of .10 was set a priori owing to the small pool of trainees. RESULTS: The 14 participants included 7 junior residents (postgraduate years [PGYs] 1 and 2) and 7 senior residents (PGY ≥3), of whom 3 were fellows (PGY 6). Senior trainees outperformed junior trainees on both versions of the ArK Trainer: clear (GRS, P = .055; PS, P = .075) and covered (TSC, P = .05). Overall, participants performed better under direct visualization conditions (GRS, P = .05). In semistructured interviews, significantly more senior trainees discussed relying on haptic cues while tying knots under direct visualization (P = .021). The majority of trainees agreed that both versions of the ArK Trainer were realistic and appropriate practice formats for their level of training. CONCLUSION: Senior trainees were significantly more experienced than were junior trainees in arthroscopic skill and outperformed them on both configurations: direct (PS and GRS) and indirect (TSC) visualization. Experienced trainees were significantly more likely to report using tactile cues to aid knot-tying under indirect visualization. It is likely that inexperienced trainees rely more heavily on direct visualization and that the use of tactile cues may be an indicator of knot-tying proficiency. Trainees recommended progression from direct to indirect visualization configurations for inexperienced learners.

Why the p Value Alone Is Not Enough: The Need for Confidence Intervals in Plastic Surgery Research.

BACKGROUND: The p value is one of the most used descriptors in statistical analysis; however, when reported in isolation, it does not convey the effect size of a treatment. The reporting of confidence intervals is an essential adjunct to determine the clinical value of treatment, as it permits an assessment of the effect size. The authors assessed the reporting of confidence intervals in clinical trials within the plastic surgery literature. METHODS: The seven highest impact plastic surgery journals were screened using MEDLINE for clinical trials in the years 2006, 2009, 2012, and 2015. Studies were randomized based on a predetermined sample size, and various characteristics (e.g., Jadad quality score, reporting of statistical significance, journal impact factor, and participation of an individual with formal research training) were documented. RESULTS: Two independent reviewers analyzed 135 articles. There was substantial interrater agreement (kappa = 0.78). Although 86.7 percent of studies reported a p value, only 25.2 percent reported confidence intervals. Of all journals assessed, Plastic and Reconstructive Surgery most frequently reported confidence intervals. The quality of the studies had a median Jadad score of 2 of 5. Bivariate analysis revealed that higher Jadad score and involvement of an individual with formal research training were associated with reporting of confidence intervals. Multivariate analysis revealed similar findings, whereas journal impact factor, year of publication, and statistical significance were not correlated with confidence interval reporting. CONCLUSIONS: Confidence intervals are underreported in the plastic surgery literature. To improve reporting quality of clinical trials, results should always include the confidence intervals to avoid misinterpretation of the effect size of a statistically significant result.