Validation and Adaptation of the Nottingham Hip Fracture Score to Predict 30-Day and 1-Year Mortality Among Italian Older Adults Hospitalized Due to Hip Fractures

Background/Objectives: Older people with hip fractures (HF) are highly heterogeneous patients at risk of adverse events, which impacts healthcare and economic systems. Tools for estimating 30-day and 1-year mortality may help optimize patient management decisions. The Nottingham Hip Fracture Score (NHFS) is one of the most reliable tools for assessing 30-day mortality after surgery. The aim is to validate the NHFS in a cohort of Italian patients hospitalized due to HF and enhance its predictive capacity against 30-day and 1-year mortality. Methods: A prospective observational study among older patients with HF who underwent surgery after a comprehensive geriatric assessment (CGA). Data about 30-day and 1-year mortality were gathered from regional registries. Logistic regression analyses were performed to assess the predictive accuracy of the NHFS against 30-day and 1-year mortality. The adapted scores were measured using ROC curves, and a nomogram was developed. Result: Among 1169 patients, 30-day and 1-year mortality rates were 4.3% and 21.3%, respectively. The NHFS was validated and recalibrated in the study sample for 30-day mortality. The recalibrated NHFS showed better predictive capacity for 30-day mortality (AUC 0.693) than the ASA score (AUC 0.547) and remained a significant predictor for 1-year mortality (AUC 0.712). BADL and METs showed an association with mortality, so the modified NHFS was integrated, resulting in a more accurate prediction compared to the original score for 1-year mortality (AUC = 0.747). Conclusions: The NHFS is a reliable tool for estimating 30-day and 1-year mortality in Italian older adults with HF. The revised NHFS, which includes METs and BADL, offers higher predictive power than the original version in our sample, and the nomogram may facilitate its clinical use.