Key result
The Clinical Frailty Scale demonstrated superior discriminative ability for predicting one-year mortality after proximal femur fracture (AUC 0.699) compared to the ASA score and chronological age.
Why the study?
Hip fractures carry high mortality, but the utility of the Clinical Frailty Scale for predicting 30-day and one-year mortality after proximal femur fractures in older patients was undetermined.
Does the Clinical Frailty Scale (CFS) predict 30-day and one-year mortality better than ASA score or chronological age in older patients with proximal femur fractures?
Cohort (n=509)
No
Does the Clinical Frailty Scale (CFS) predict 30-day and one-year mortality better than ASA score or chronological age in older patients with proximal femur fractures?
Effect estimate: AUC 0.699 (95% CI 0.651 to 0.747)
Absolute Event Rate: 0.699% vs 0.634%
The Clinical Frailty Scale is a superior predictor of 30-day and one-year mortality after proximal femur fracture compared to the ASA score or chronological age.
CFS may aid mortality risk stratification after PFF; leaves open prospective validation before guiding care decisions.
Aims A proximal femur fracture (PFF) is a common orthopaedic presentation, with an incidence of over 25,000 cases reported in the Australian and New Zealand Hip Fracture Registry (ANZHFR) in 2018. Hip fractures are known to have high mortality. The purpose of this study was to determine the utility of the Clinical Frailty Scale (CFS) in predicting 30-day and one-year mortality after a PFF in older patients. Methods A retrospective review of all fragility hip fractures who met the inclusion/exclusion criteria of the ANZHFR between 2017 and 2018 was undertaken at a single large volume tertiary hospital. There were 509 patients included in the study with one-year follow-up obtained in 502 cases. The CFS was applied retrospectively to patients according to their documented pre-morbid function and patients were stratified into five groups according to their frailty score. The groups were compared using t-test, analysis of variance (ANOVA), and the chi-squared test. The discriminative ability of the CFS to predict mortality was then compared with American Society of Anaesthesiologists (ASA) classification and the patient’s chronological age. Results A total of 38 patients were deceased at 30 days and 135 patients at one year. The 30-day mortality rate increased from 1.3% (CFS 1 to 3; 1/80) to 14.6% (CFS ≥ 7; 22/151), and the one-year mortality increased from 3.8% (CFS 1 to 3; 3/80) to 41.7% (CFS ≥ 7; 63/151). The CFS was demonstrated superior discriminative ability in predicting mortality after PFF (area under the curve (AUC) 0.699; 95% confidence interval (CI) 0.651 to 0.747) when compared with the ASA (AUC 0.634; 95% CI 0.576 to 0.691) and chronological age groups (AUC 0.585; 95% CI 0.523 to 0.648). Conclusion The CFS demonstrated utility in predicting mortality after PFF fracture. The CFS can be easily performed by non-geriatricians and may help to reduce age related bias influencing surgical decision making. Cite this article: Bone Joint Open 2020;1-8:443–449.
No takes yet. Share an insight, caveat, or question.
Narula et al. (2020) conducted a cohort in Proximal femur fracture (n=509). Clinical Frailty Scale (CFS) vs. American Society of Anaesthesiologists (ASA) score and chronological age was evaluated on Discriminative ability for one-year mortality (AUC 0.699, 95% CI 0.651 to 0.747). The Clinical Frailty Scale demonstrated superior discriminative ability for predicting one-year mortality after proximal femur fracture (AUC 0.699) compared to the ASA score and chronological age.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: