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Risk scoring models for predicting peri-operative morbidity and mortality in people with fragility hip fractures: Qualitative systematic review

Marufu, Takawira C.; Mannings, Alexa; Moppett, Iain K.

Authors

Takawira C. Marufu

Alexa Mannings

IAIN MOPPETT iain.moppett@nottingham.ac.uk
Professor of Anaesthesia and Perioperative Medicine



Abstract

Rationale

Accurate peri-operative risk prediction is an essential element of clinical practice. Various risk stratification tools for assessing patients’ risk of mortality or morbidity have been developed and applied in clinical practice over the years. This review aims to outline essential characteristics (predictive accuracy, objectivity, clinical utility) of currently available risk scoring tools for hip fracture patients.

Methods

We searched eight databases; AMED, CINHAL, Clinical Trials.gov, Cochrane, DARE, EMBASE, MEDLINE and Web of Science for all relevant studies published until April 2015. We included published English language observational studies that considered the predictive accuracy of risk stratification tools for patients with fragility hip fracture.

Results

After removal of duplicates, 15,620 studies were screened. Twenty-nine papers met the inclusion criteria, evaluating 25 risk stratification tools. Risk stratification tools considered in more than two studies were; ASA, CCI, E-PASS, NHFS and O-POSSUM. All tools were moderately accurate and validated in multiple studies; however there are some limitations to consider. The E-PASS and O-POSSUM are comprehensive but complex, and require intraoperative data making them a challenge for use on patient bedside. The ASA, CCI and NHFS are simple, easy and inexpensive using routinely available preoperative data. Contrary to the ASA and CCI which has subjective variables in addition to other limitations, the NHFS variables are all objective.

Conclusion:

In the search for a simple and inexpensive, easy to calculate, objective and accurate tool, the NHFS may be the most appropriate of the currently available scores for hip fracture patients. However more studies need to be undertaken before it becomes a national hip fracture risk stratification or audit tool of choice.

Journal Article Type Article
Publication Date 2015-12
Journal Injury
Print ISSN 0020-1383
Electronic ISSN 0020-1383
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 46
Issue 12
Pages 2325-2334
APA6 Citation Marufu, T. C., Mannings, A., & Moppett, I. K. (2015). Risk scoring models for predicting peri-operative morbidity and mortality in people with fragility hip fractures: Qualitative systematic review. Injury, 46(12), 2325-2334. https://doi.org/10.1016/j.injury.2015.10.025
DOI https://doi.org/10.1016/j.injury.2015.10.025
Keywords Fragility hip fracture ; Risk scoring tools ; Risk stratification tools ; Peri-operative ; Elderly
Publisher URL http://www.sciencedirect.com/science/article/pii/S0020138315006270
Copyright Statement Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by-nc-nd/4.0
Additional Information This article is maintained by: Elsevier; Article Title: Risk scoring models for predicting peri-operative morbidity and mortality in people with fragility hip fractures: Qualitative systematic review; Journal Title: Injury; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.injury.2015.10.025; Content Type: article; Copyright: Copyright © 2015 The Authors. Published by Elsevier Ltd.

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by-nc-nd/4.0





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