Elliott et al developed an "at risk" score for evaluating patients with fracture of the proximal femur at the time of admission to the hospital. This can help identify patients at increased risk for reduced survival who may benefit from more aggressive management. The authors are from Belfast, Ireland.
Parameters:
(1) age
(2) gender
(3) ASA class
(4) abbreviated mini-mental test score
(5) 10-item Barthel index for functional status prior to fracture
(6) marital status
|
Parameter |
Finding |
Points |
|---|---|---|
|
age |
|
1 point for each 2 years of life completed |
|
gender |
female |
0 |
|
|
male |
15 |
|
ASA class |
ASA 1 |
0 |
|
|
ASA 2 |
20 |
|
|
ASA 3 |
25 |
|
|
ASA 4 |
35 |
|
abbreviated mini-mental test score |
|
10 - (score) |
|
10-item Barthel index |
|
20 - (index) |
|
marital status |
married |
0 |
|
|
single |
- 8 |
|
|
divorced |
- 8 |
where:
• The points for age appear be derived from dividing by 2 and rounding down if odd. This involves the TRUNC function in Excel.
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: around 2
• maximum score: around 128
• The higher the score, the lower the chances of surviving 12 months.
• A score of 90 identifies a patient with a 50% chance of survival for 12 months.
• The best chance for survival is for surgery within 24 hours of admission, with delay in surgery resulting in diminished chances.
|
Score |
Interpretation |
|---|---|
|
< 50 |
The patient will almost certainly survive. A small delay in surgery will be of little consequence. |
|
50 to 120 |
The patient will benefit from speedy surgery, especially if score is in range 70 - 100. |
|
> 120 |
The patient's chances of survival are reduced. Speedy surgery will improve chances but benefits diminished compared to other patients. |
|
Score |
Probability of Survival if Operated on within 24 Hours |
|
50 |
96% |
|
60 |
92% |
|
70 |
83% |
|
80 |
70% |
|
90 |
55% |
|
100 |
39% |
|
110 |
24% |
|
120 |
13% |
If this analyzed in JMP, the following equation is derived:
probability of survival as a decimal fraction =
= (0.0000029 * ((score)^3)) - (0.000799 * ((score)^2)) + (0.058178 * (score)) - 0.310727
Purpose: To predict survival at 12 months for a patient admitted to the hospital with a fracture of the proximal femur using the "at risk" score of Elliott et al.
Specialty: Surgery, orthopedic
Objective: risk factors
ICD-10: S72,
