Key result
High Nottingham Hip Fracture Score linked to ~280% greater in-patient mortality risk versus low scores.
Why the study?
The Nottingham Hip Fracture Score (NHFS) was developed to predict 30-day and 1-year mortality, but whether it can also predict other adverse events remained to be evaluated.
Does the Nottingham Hip Fracture Score (NHFS) predict mobility, length of stay, mortality, and discharge destination in patients admitted with a hip fracture?
Cross-Sectional (n=666)
No
Does the Nottingham Hip Fracture Score (NHFS) predict mobility, length of stay, mortality, and discharge destination in patients admitted with a hip fracture?
Odds Ratio: 3.8 (95% CI 1.5–9.9)
Absolute Event Rate: 7.1% vs 2%
p-value: p=0.006
A high Nottingham Hip Fracture Score is associated with increased risk of in-patient mortality, prolonged length of stay, and discharge to residential/nursing care in patients with hip fractures.
May aid hip fracture mortality risk stratification; leaves open prospective validation before guiding care.
The Nottingham Hip Fracture Score (NHFS) has been developed for predicting 30-day and 1-year mortality after hip fracture. We hypothesise that NHFS may also predict other adverse events. Data from 666 patients (190 men, 476 women), aged 60.2-103.4 years, admitted with a hip fracture to a single centre from 1/10/2015 and 7/12/2017 were analysed. The ability of NHFS to predict mobility within 1 day after surgery, length of stay (LOS) find mortality, and discharge destination was evaluated by receiver operating characteristic curves and two-graph plots. The area under the curve (95% confidence interval [CI]) for predicting mortality was 67.4% (58.4-76.4%), prolonged LOS was 59.0% (54.0-64.0%), discharge to residential/nursing care was 62.3% (54.0-71.5%), and any two of failure to mobilise, prolonged LOS or discharge to residential/nursing care was 64.8% (59.0-70.6%). NHFS thresholds at 4 and 7 corresponding to the lower and upper limits of intermediate range where sensitivity and specificity equal 90% were identified for mortality and prolonged LOS, and 4 and 6 for discharge to residential/nursing care, which were used to create three risk categories. Compared with the low risk group (NHFS = 0-4), the high risk group (NHFS = 7-10 or 6-10) had increased risk of in-patient mortality: rates = 2.0% versus 7.1%, OR (95% CI) = 3.8 (1.5-9.9), failure to mobilise within 1 day of surgery: rates = 18.9% versus 28.3%, OR = 1.7 (1.0-2.8), prolonged LOS (> 17 days): rates = 20.3% versus 33.9%, OR = 2.2 (1.3-3.3), discharge to residential/nursing care: rates = 4.5% vs 12.3%, OR = 3.0 (1.4-6.4), and any two of failure to mobilise, prolonged LOS or discharge to residential/nursing care: rates = 10.5% versus 28.6%, 3.4 (95% CI 1.9-6.0), and stayed 4.1 days (1.5-6.7 days) longer in hospital. High NHFS associates with increased risk of mortality, prolonged LOS and discharge to residential/nursing care, lending further support for its use to identify adverse events.
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Lisk et al. (2020) conducted a cross-sectional in Hip fracture (n=666). High Nottingham Hip Fracture Score (NHFS 7-10) vs. Low Nottingham Hip Fracture Score (NHFS 0-4) was evaluated on In-patient mortality (OR 3.8, 95% CI 1.5-9.9, p=0.006). A high Nottingham Hip Fracture Score (7-10) was associated with a significantly increased risk of in-patient mortality compared to a low score (0-4) (OR 3.8) in patients admitted with a hip fracture.
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