Key result
Higher STTGMA risk scores were significantly associated with greater odds of surgical delay, with moderate-risk patients having 2.70 times higher odds than minimal-risk patients (P=0.001).
Why the study?
This study sought to investigate whether a validated trauma triage risk assessment tool can predict time to surgery and delay to surgery in hip fracture patients.
Does the STTGMA tool predict time to surgery and delay to surgery in geriatric and middle-aged hip fracture patients?
Cohort (n=611)
No
Does the STTGMA tool predict time to surgery and delay to surgery in geriatric and middle-aged hip fracture patients?
Odds Ratio: 2.7
p-value: p=0.001
The STTGMA tool can identify hip fracture patients at risk for surgical delay and higher 30-day mortality, allowing for targeted optimization of surgical timing.
May aid preoperative prioritization in moderate-risk patients; leaves open whether STTGMA-guided timing improves outcomes.
Introduction: This study sought to investigate whether a validated trauma triage risk assessment tool can predict time to surgery and delay to surgery. Materials and Methods: Patients aged 55 and older who were admitted for operative repair or arthroplasty of a hip fracture over a 3-year period at a single academic institution were included. Risk quartiles were constructed using Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA) calculations. Negative binomial and multivariable logistic regression were used to evaluate time to surgery and delay to surgery, respectively. Pairwise comparisons were performed to evaluate 30-day mortality rates and demonstrate the effectiveness of the STTGMA tool in triaging mortality risk. Results: Six hundred eleven patients met inclusion criteria with mean age 81.1 ± 10.5 years. Injuries occurred mainly secondary to low-energy mechanisms (97.9%). Median time to surgery (31.9 hours overall) was significantly associated with STTGMA stratification ( P = .002). Moderate-risk patients had 33% longer ( P = .019) and high-risk patients had 28% longer time to surgery ( P = .041) compared to minimal risk patients. Delay to surgery (26.4% overall) was significantly associated with STTGMA stratification ( P = .015). Low-risk patients had 2.14× higher odds ( P = .009), moderate-risk patients had 2.70× higher odds ( P = .001), and high-risk patients had 2.18× higher odds of delay to surgery ( P = .009) compared to minimal risk patients. High-risk patients experienced higher 30-day mortality compared to minimal ( P < .001), low ( P = .046), and moderate-risk patients ( P = .046). Discussion: Patients in higher STTGMA quartiles encountered longer time to surgery, greater operative delays, and higher 30-day mortality. Conclusion: Score for Trauma Triage in the Geriatric and Middle-Aged can quickly identify hip fracture patients at risk for a delay to surgery and may allow treatment teams to optimize surgical timing by proactively targeting these patients. Level of Evidence: Prognostic Level III.
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Konda et al. (2020) conducted a cohort in hip fracture (n=611). Higher STTGMA risk quartile vs. Minimal risk quartile was evaluated on delay to surgery (OR 2.70, p=0.001). Higher STTGMA risk scores were significantly associated with greater odds of surgical delay, with moderate-risk patients having 2.70 times higher odds than minimal-risk patients (P=0.001).
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