The hip fracture assessment tool: A scoring system to assess high risk geriatric hip fracture patients for post-operative critical care monitoring

• Published in: Injury 2024-07, Vol.55 (7), p.111584, Article 111584
• Main Authors: Barchick, Stephen R., Masada, Kendall M., Fryhofer, George W., Alqazzaz, Aymen, Donegan, Derek J., Mehta, Samir
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Critical Care; Female; Geriatric Assessment - methods; Hip fracture; Hip Fractures - surgery; Humans; Intensive Care Units; Male; Orthopedic; Postoperative Care - methods; Retrospective Studies; Risk Assessment - methods; Risk Factors; Scoring system
• ISSN: 0020-1383; 1879-0267; 1879-0267
• DOI: 10.1016/j.injury.2024.111584

•Lines 76–78: identify pre-operative factors associated with post-operative admission to the intensive care unit in geriatric hip fracture patients.•Lines 191–193: includes only pre-operative factors as reliance on intra-operative factors does not permit stratifying a patient to an ICU bed in a timely fashion.•Lines 277–278: the hip fracture assessment tool–can be utilized easily as a checklist to request ICU monitoring for the most frail geriatric hip fracture patients. Intensive care unit risk stratification models have been utilized in elective joint arthroplasty; however, hip fracture patients are fundamentally different in their clinical course. Having a critical care risk calculator utilizing pre-operative risk factors can improve resourcing for hip fracture patients in the peri‑operative period. A cohort of geriatric hip fracture patients at a single institution were reviewed over a three-year period. Non-operative patients, peri‑implant fractures, additional procedures performed under the same anesthesia period, and patients admitted to the intensive care unit (ICU) prior to surgery were excluded. Pre-operative laboratory values, Revised Cardiac Risk Index (RCRI), and American Society of Anesthesiologists (ASA) scores were calculated. Pre-operative ambulatory status was determined. The primary outcome measure was ICU admission in the post-operative period. Outcomes were assessed with Fisher's exact test, Kruskal-Wallis test, logistic regression, and ROC curve. 315 patient charts were analyzed with 262 patients meeting inclusion criteria. Age ≥ 80 years, ASA ≥ 4, pre-operative hemoglobin < 10 g/dL, and a history of CVA/TIA were found to be significant factors and utilized within a “training” data set to create a 4-point scoring system after reverse stepwise elimination. The 4-point scoring system was then assessed within a separate “validation” data set to yield an ROC area under the curve (AUC) of 0.747. Score ≥ 3 was associated with 96.8 % specificity and 14.2 % sensitivity for predicting post-op ICU admission. Score ≥ 3 was associated with a 50 % positive predictive value and 83 % negative predictive value. A hip fracture risk stratification scoring system utilizing pre-operative patient specific values to stratify geriatric hip patients to the ICU post-operatively can improve the pre-operative decision-making of surgical and critical care teams. This has important implications for triaging vital hospital resources. III (retrospective study)