Evaluation of Nottingham Hip Fracture Score, Age-Adjusted Charlson Comorbidity Index and the Physiological and Operative Severity Score for the enumeration of Mortality and morbidity as predictors of mortality in elderly neck of femur fracture patients

Abstract

Background: This study evaluated the use of several risk prediction models in estimating short- and long-term mortality following hip fracture in an Australian population. Methods: Data from 195 patients were retrospectively analysed and applied to three models of interest: the Nottingham Hip Fracture Score, the Age-Adjusted Charlson Comorbidity Index and the Physiological and Operative Severity Score for enUmeration of Mortality and Morbidity. The performance of these models was assessed with receiver operating characteristic curve as well as logistic regression modelling. Results: The median age of participants was 83 years and 69% were women. Ten percent of patients were deceased by 30 days, 25% at 6 months and 31% at 12 months post-operatively. While there was no statistically significant difference between the models, the Age-Adjusted Charlson Comorbidity Index had the largest area under the receiver operating characteristic curve for within 30 day and 12 month mortality, while the Nottingham Hip Fracture Score was largest for 6-month mortality. There was no evidence to suggest that the models were selecting a specific subgroup of our population, therefore, no indication was present to suggest that using multiple models would improve mortality prediction. Conclusions: While there was no statistically significant difference in mortality prediction, the Nottingham Hip Fracture Score is perhaps the best suited clinically, due to its ease of implementation. Larger prospective data collection across a variety of sites and its role in guiding clinical management remains an area of interest.

Predictive Values of Preoperative Characteristics for 30-Day Mortality in Traumatic Hip Fracture Patients

“…The association between the CCI and postoperative mortality has been observed in numerous studies [ 7 , 8 , 9 , 38 , 43 , 44 ]. The ability of the CCI to predict postoperative mortality in hip fracture patients has also been compared to the NHFS and POSSUM in prior studies [ 45 , 46 ]. In some, the NHFS performs slightly better and in others POSSUM performs marginally worse, but overall, these indices have a comparable predictive ability when all studies are taken into consideration [ 45 , 47 , 48 ].…”

“…This seems to indicate that the RCRI has the same level of predictive ability as the CCI. Consequently, the RCRI should also be comparable to the NHFS and POSSUM as they both have an equivalent predictive power to the CCI [ 45 , 46 ]. It might therefore be argued that the RCRI is preferable to all of these indices.…”

Predicting 30-Day and 180-Day Mortality in Elderly Proximal Hip Fracture Patients: Evaluation of 4 Risk Prediction Scores at a Level I Trauma Center

“…A similar performance for 180-day mortality of the CCI was found by Boddaert et al [ 26 ] (AUC 0.64), whereas Hautamäki found better results (AUC 0.77) for 180-day mortality [ 27 ]. An age-adjusted developed score might be more suitable, but further studies are needed to verify its prediction power [ 28 ].…”

“…Compared to the literature, the POSSUM, as well as the P-POSSUM, performed poorly in general, being similar to the 30-day mortality findings of Ramanathan et al (AUC 0.62) in particular when compared to the AUC values for POSSUM in general surgery of >0.9 and general orthopedics of >0.85 [ 29 , 30 ]. Burgos et al [ 31 ], Nelson et al [ 28 ] and Karres et al [ 32 ] also evaluated different scoring systems in hip fractures in a frail population, including the CCI and POSSUM. The authors came to different values for the CCI or POSSUM, showing a big range in the results for 30-day mortality, whereas Karres et al [ 32 ] reported an AUC for the CCI of 0.69 and 0.71 for the POSSUM, Burgos et al [ 31 ] had an AUC of 0.64 for the CCI and 0.59 for POSSUM and Nelson et al had an AUC of 0.77 for CCI and 0.76 for POSSUM for 30 day-mortality.…”

“…The authors came to different values for the CCI or POSSUM, showing a big range in the results for 30-day mortality, whereas Karres et al [ 32 ] reported an AUC for the CCI of 0.69 and 0.71 for the POSSUM, Burgos et al [ 31 ] had an AUC of 0.64 for the CCI and 0.59 for POSSUM and Nelson et al had an AUC of 0.77 for CCI and 0.76 for POSSUM for 30 day-mortality. Nelson et al also reported a better AUC of 0.74 for the POSSUM and a better AUC of 0.75 for the CCI for 180-day mortality [ 28 ].…”