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Should patients with isolated hip fractures be included in trauma registries?
Eric Bergeron1, Andre Lavoie, Amina Belcaid
1Choc-trauma Montérégie, Hôpital Charles-LeMoyne, Greenfield Park, Canada. eric.bergeron@traumaquebec.org
Insights
Patients with isolated hip fractures (HIP) use more hospital resources and have worse outcomes than other trauma patients. Despite lower injury severity, HIP patients face higher mortality and longer hospital stays, necessitating inclusion in trauma registries.
Area of Science:
- Trauma surgery
- Geriatric medicine
- Public health
Background:
- Isolated hip fractures (HIP) are often excluded from trauma registries.
- This study investigates resource utilization and outcomes for HIP patients compared to the general trauma population.
Purpose of the Study:
- To demonstrate that isolated hip fracture patients have higher resource use and poorer outcomes.
- To advocate for the inclusion of HIP patients in trauma registries for comprehensive data collection.
Main Methods:
- Utilized the Quebec Trauma Registry (1998-2003), excluding patients dead on arrival.
- Defined isolated hip fracture (HIP) based on AIS codes and Injury Severity Score (ISS) of 9-10.
- Compared HIP patients (n=14,426) with other trauma (OT) patients (n=53,996) on length of stay, ICU stay, complications, and discharge status.
Main Results:
- HIP patients accounted for 21.1% of admissions but 42% of total hospital days and 38% of deaths.
- Mean hospital stay was longer for HIP (18.4 days) vs. OT (11.7 days).
- HIP patients had higher in-hospital mortality (8.5% vs. 3.7%) and were more frequently referred for long-term care or rehabilitation.
Conclusions:
- Isolated hip fracture patients experience significantly worse outcomes and higher resource utilization than other trauma patients, despite lower ISS.
- These findings support the inclusion of HIP patients in trauma registries to accurately reflect overall trauma burden.
- Multidisciplinary care, similar to that for other trauma patients, is indicated for HIP patients.
Background:
Patients with isolated hip fractures are frequently excluded from trauma registries. The goal of this study was to show that patients with these injuries have higher resource use and poorer outcomes than the rest of the trauma population.
Methods:
The Quebec Trauma Registry was used to identify all trauma patients from April 1, 1998, to March 31, 2003. Patients who were dead on arrival at the emergency room were excluded. Isolated hip fracture (HIP) was defined as a diagnosis of a single fracture to the neck of the femur (Abbreviated Injury Scale 1990 codes 851808.3, 851810.3, 851812.3, and 851818.3) secondary to a fall and for which the Injury Severity Score was 9 or 10 (no other Abbreviated Injury Scale code higher than 1). Patients with all other trauma diagnosis (OT) were used for comparison. Outcome variables were length of hospital stay, length of intensive care unit (ICU) stay, in-hospital complications, and status and orientation at discharge. Chi-square and Wilcoxon rank-sum tests were used.
Results:
There were 68,422 patients: 14,426 (21.1%) HIP patients and 53,996 (78.9%) OT patients. The median Injury Severity Score was 9 for HIP (range, 9-10) and 9 for OT (range, 1-75). Mean length of hospital stay was 18.4 days for HIP compared with 11.7 days for OT (p < 0.0001). HIP patients represented 29.5% of the total hospital stay. ICU stay was required for 1,353 HIP patients (9.4%) and for 12,395 (23.0%) OT patients (p < 0.0001). Mean ICU stay was 3.9 days for HIP compared with 5.5 days for OT (p = 0.0006). In-hospital mortality was 8.5% in HIP compared with 3.7% in OT (p < 0.0001). HIP represented 62.7% of patients referred for long-term care and 39.3% of patients referred to a rehabilitation center.
Conclusion:
Patients with HIP represented 21.1% of admissions while accounting for 42% of total days of hospitalization and 38% of deaths. Patients with hip fractures have a significantly higher risk of death, prolonged hospital stay, and complication rate, and are more often transferred to a rehabilitation center or to a long-term nursing home than the rest of the trauma population despite lower severity. They require multidisciplinary care typical of the rest of the trauma population and should be included in the trauma registry if the registry is to document the full outcome and resource use of the trauma population.
