Some patients who have had a hip fracture will require a prolonged recovery in a nursing home. Steiner et al developed a rule to identify patients at risk for a prolonged disability using clinical factors available around the time of injury. The authors are from the University of Colorado.
Patient selection:
(1) age >= 65 years
(2) not a resident of a nursing home prior to the fracture
(3) discharged to a nursing home after the fracture
Parameters:
(1) marital status
(2) continence
(3) walking ability
(4) cognitive ability, as measured in the Mini-Mental State Exam (MMSE, with scores from 0 to 30; see Chapter on Psychiatry)
|
Parameters |
Finding |
Points |
|
marital status |
married |
0 |
|
|
unmarried |
1 |
|
continence |
continent in stool and urine |
0 |
|
|
incontinent in stool and/or urine |
1 |
|
walking ability |
independent in ambulation |
0 |
|
|
dependent in ambulation |
1 |
|
cognitive ability |
not impaired (MMSE >= 24) |
0 |
|
|
cognitively impaired (MMSE < 24) |
1 |
|
Risk Factor |
Adjusted Odds Ratio in the Development Group (95% CI) |
Adjusted Odds Ratio in the Validation Group (95% CI) |
|
unmarried |
6.7 (2.4 – 19.0) |
3.4 (0.7 – 17.0) |
|
incontinent |
2.3 (1.2 – 4.7) |
5.1 (1.5 – 17.9( |
|
dependent in ambulation |
5.0 (2.1 – 12.3) |
4.4 (1.1 – 17.1) |
|
cognitively impaired |
6.6 (3.3 – 13.2) |
3.3 (1.0 – 11.0) |
from Table 2, page 1513)
number of risk factors =
= SUM(points for the 4 parameters
Interpretation:
• minimum risk score: 0
• maximum risk score: 4
• The greater the number of risk factors, the greater the likelihood that the patient would still be in a nursing home 6 months after the hip fracture.
|
Number of Risk Factors |
Percent of Patients from the Development Group in a Nursing Home |
Percent of Patients from the Validation Group in a Nursing Home |
|
0 |
0% |
0% |
|
1 |
3.7% |
2.4% |
|
2 |
11.3% |
2.6% |
|
3 |
30.4% |
15.4% |
|
4 |
73.2% |
50% |
Performance:
• The area under the ROC curve was 0.84 +/- 0.03 in the development group.
Purpose: To identify an elderly person with a hip fracture who is at risk for a prolonged admission to the nursing home.
Specialty: Sports Medicine & Rehabilitation, Surgery, orthopedic
Objective: severity, prognosis, stage
ICD-10: S72.0,
