Implementation of a novel nursing assessment tool in geriatric trauma patients with proximal femur fractures

Abstract

Background Geriatric trauma patients represent a special challenge in postoperative care and are prone to specific complications. The goal of this study was to analyse the predictive potential of a novel nursing assessment tool, the outcome-oriented nursing assessment for acute care (ePA-AC), in geriatric trauma patients with proximal femur fractures (PFF). Methods A retrospective cohort study of geriatric trauma patients aged ≥ 70 years with PFF was conducted at a level 1 trauma centre. The ePA-AC is a routinely used tool that evaluates pneumonia; confusion, delirium and dementia (CDD); decubitus (Braden Score); the risk of falls; the Fried Frailty index (FFI); and nutrition. Assessment of the novel tool included analysis of its ability to predict complications including delirium, pneumonia and decubitus. Results The novel ePA-AC tool was investigated in 71 geriatric trauma patients. In total, 49 patients (67.7%) developed at least one complication. The most common complication was delirium (n = 22, 44.9%). The group with complications (Group C) had a significantly higher FFI compared with the group without complications (Group NC) (1.7 ± 0.5 vs 1.2 ± 0.4, p = 0.002). Group C had a significantly higher risk score for malnutrition compared with Group NC (6.3 ± 3.4 vs 3.9 ± 2.8, p = 0.004). A higher FFI score increased the risk of developing complications (odds ratio [OR] 9.8, 95% confidence interval [CI] 2.0 to 47.7, p = 0.005). A higher CDD score increased the risk of developing delirium (OR 9.3, 95% CI 2.9 to 29.4, p < 0.001). Conclusion The FFI, CDD, and nutritional assessment tools are associated with the development of complications in geriatric trauma patients with PFF. These tools can support the identification of geriatric patients at risk and might guide individualised treatment strategies and preventive measures.

Malnutrition-Related Health Outcomes in Older Adults with Hip Fractures: A Systematic Review and Meta-Analysis

“…Other studies included in our systematic review evaluating postoperative complications such as urinary tract infection, heart failure, surgical site infection, refracture, pneumonia, arrhythmia, enteritis, liver dysfunction, implant failure, acute myocardial infarction, venous thromboembolism, confusion, delirium and dementia, decubitus, and the risk of falls found a significant correlation with GNRI and CONUT score [54,59,73].…”

“…At the end of the selection process, 36 studies were eligible for inclusion in the systematic review [25,28,30,31,33,34,36,[38][39][40][41][43][44][45][46][48][49][50][51]53,54,56,[58][59][60][61]64,[67][68][69][70][71][72][73]75,76] and 14 studies were eligible for inclusion in the meta-analysis [34,36,39,43,49,51,53,56,64,[67][68][69][70]72].…”

Loss of Independence after Index Hospitalization Following Proximal Femur Fracture: A Narrative Review

“…[30] Apart from this, Till Berk et.al study suggest that higher BS (Braden Score) increased the odds of developing decubitus by 6.2 times (95% CI 1.5 to 25.7, p < 0.001) which will limit the daily activities significantly. [31] Additionally Tim Chesser et.al papers emphasize on weight bearing without restriction in the immediate postoperative period and initiation of physiotherapy on the day after surgery unless contraindicated for better functional gain and mobility following PFF surgery. [9] (Table 1) N/A N/A •10% (n = 108) were readmitted <90 days of their discharge.…”

“…[15] Patients have even reported selling possessions to pay for expenses incurred during surgery and care needed at rehabilitation facilities, with others having to reach out to friends and family as a source of financial aid. [31] Patients losing independence also resulted in the ability to work or sustain a job, exponentially increasing their financial burden. Proximal femur fractures also place a patient at a higher risk of sustaining another fracture later as well as increases the chances of other infections in early stage of recovery.…”

Early Posttraumatic Antifibrinolysis Reduces Perioperative Hidden Blood Loss in Elderly Patients with an Intertrochanteric Fracture: A Randomized Controlled Trial

“…Most intertrochanteric fractures need surgery for the purpose of avoiding immobility-related complications, walking ability, and diminished quality of life [2]. Despite great progress having been made in surgical techniques and perioperative management [3][4][5][6], perioperative mortality can still reach 0.8-2%, and 30-day and 1-year mortality can even reach 8% and 25%, respectively [7][8][9]. Research demonstrates that anaemia caused by hip fractures and subsequent surgery is an important risk factor for perioperative mortality, especially when Hb levels are below 80 g/L [10].…”