Olsen F, Lundborg F, Kristiansson J, Hård af Segerstad M, Ricksten S, Nellgård B. Validation of the
Nottingham Hip Fracture Score (NHFS) for the prediction of 30-day mortality in a Swedish cohort of hip fractures.
Acta Anaesthesiol Scand 2021;
65:1413-1420. [PMID:
34363201 DOI:
10.1111/aas.13966]
[Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 07/07/2021] [Accepted: 07/21/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND
Hip fracture is a common osteoporotic fracture with great morbidity and mortality. The utility of ASA classification is limited, as most patients are ≥ASA 3. A reliable predictor of mortality risk could support decision-making. We aimed to evaluate Nottingham hip fracture score (NHFS) for the prediction of 30-day mortality and then to recalibrate the formula converting NHFS to risk of 30-day mortality.
METHODS
All patients >60 years with surgically treated hip fracture surgery during 2015-16 were assessed. Data was extracted manually from routinely collected clinical data in registry and medical records. Discriminative performance of NHFS and ASA was assessed with C-statistics. The conversion formula from NHFS to risk of 30-day mortality was recalibrated using logistic binominal regression. Observed vs expected ratios of 30-day mortality were compared with the 2012 NHFS-formula and recalibration was performed in a split dataset.
RESULTS
1864 patients were included, with 213 deaths within 30 days. C-statistic were 0.64 for NHFS and 0.62 for ASA. Comparing expected values from the 2012-revision with our observed deaths gave a ratio of 1.37. Relating predicted levels of 30-day mortality based on 70% of our cohort vs. 30% test portion of our Swedish dataset gave a ratio of 0.97.
DISCUSSION
NHFS underestimated mortality in our cohort and showed poor discrimination. Revision of the formula based on a split dataset improved calibration. We suggest NHFS to be routinely implemented to support clinical judgements, expand preoperative assessment and escalate intraoperative monitoring.
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