D. William C. Johnston

Development and Initial Validation of a Risk Score for Predicting In-Hospital and 1-Year Mortality in Patients With Hip Fractures†

Our objectives were to better define the rates and determinants of in‐hospital and 1‐year mortality after hip fracture. We studied a population‐based cohort of 3981 hip fracture patients. Using multivariable regression methods, we identified risk factors for mortality (older age, male sex, long‐term care residence, 10 prefracture co‐morbidities) and calculated a hip fracture‐specific score that could accurately predict or risk‐adjust in‐hospital and 1‐year mortality. Our methods, after further validation, may be useful for comparing outcomes across hospitals or regions.

Best practices for elderly hip fracture patients. A systematic overview of the evidence.

OBJECTIVES: To determine evidence-based best practices for elderly hip fracture patients from the time of hospital admission to 6 months postfracture. DATA SOURCES: MEDLINE, Cochrane Library, CINAHL, Embase, PEDro, Ageline, NARIC, and CIRRIE databases were searched for potentially eligible articles published between 1985 and 2004. REVIEW METHODS: Two independent reviewers determined studies appropriate for inclusion using standardized selection criteria, extracted data, evaluated internal validity, and then rated studies according to levels of evidence. Only Level 1 or 2 evidence was included in our summary of clinical recommendations. RESULTS: Spinal anesthesia, pressure-relieving mattresses, perioperative antibiotics, and deep vein thromboses prophylaxes had consistent evidence of benefit. Routine preoperative traction was not associated with any benefits and should be abandoned. Types of surgical management, postoperative wound drainage, and even “multidisciplinary” care, lacked sufficient evidence to determine either benefit or harm. There was little evidence to either determine best subacute rehabilitation practices or to direct ongoing medical issues (e.g., nutrition). Studies conducted during the subacute recovery period were heterogeneous in terms of treatment settings, interventions, and outcomes studied and had no clear evidence for best treatment practices. CONCLUSIONS: The evidence for perioperative practices is relatively robust and evidence-based perioperative treatment guidelines can be easily established. Conversely, more evidence is required to better guide the care of elderly patients with hip fracture during the subacute recovery period and convalescence.

Recovery of Function Following a Hip Fracture in Geriatric Ambulatory Persons Living in Nursing Homes: Prospective Cohort Study

To measure 1‐year post‐hip fracture functional recovery, health‐related quality of life (HRQL), and mortality in nursing home residents.