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Published on: August 17, 2017
Goldman score, but not Detsky or Lee indices, predicts mortality 6 months after hip fracture
Paula Schmidt Azevedo1, David Nicoletti Gumieiro2, Bertha Furlan Polegato3
1Internal Medicine Department, Botucatu Medical School, UNESP - Univ Estadual Paulista, Rubião Júnior s/n, ZipCode: 18618-970, Botucatu, SP, Brazil. paulasa@fmb.unesp.br.
Insights
The Goldman score effectively predicts 6-month mortality in hip fracture patients. Detsky and Lee scores did not show predictive capacity in this patient group.
Area of Science:
- Geriatric Medicine
- Orthopedic Surgery
- Cardiology
Background:
- Cardiac risk indices like Goldman, Detsky, and Lee scores are established but their utility in hip fracture patients is unclear.
- Hip fractures are associated with significant morbidity and mortality, necessitating accurate risk prediction.
- Existing cardiac risk scores lack validation for predicting outcomes specifically after hip fracture.
Purpose of the Study:
- To compare the predictive performance of Goldman, Detsky, and Lee cardiac risk scores for 6-month mortality following hip fracture.
- To determine which established cardiac risk index, if any, is most effective in identifying high-risk individuals post-hip fracture.
Main Methods:
- Prospective evaluation of 80 consecutive hip fracture patients over 65 years old.
- Recording of demographic data and scores from Goldman, Detsky, and Lee indices.
- 6-month follow-up to record mortality, analyzed using multiple logistic regression.
Main Results:
- The 6-month mortality rate was 23%.
- Goldman score significantly predicted mortality (OR: 3.025, p=0.046), with each category increase tripling mortality risk.
- Detsky and Lee scores did not demonstrate a significant association with 6-month mortality in this cohort.
Conclusions:
- The Goldman score is a valuable predictor of 6-month mortality in patients with hip fractures.
- Detsky and Lee indices are not effective predictors of mortality in this specific patient population.
- Risk stratification using the Goldman score may aid in managing patients following hip fracture.
Background:
Over the past years, several cardiac risk indices were evaluated and modified, including Goldman, Detsky, and Lee scores. The predictive capacity of these scores in hip fracture patients is lacking. Thus, our objective was to compare the Goldman, Detsky, and Lee scores as predictors of mortality in 6 months after hip fracture.
Methods:
We prospectively evaluated 80 consecutive patients with hip fractures, over the age of 65 admitted to an orthopedic ward at Botucatu Medical School. Patient demographic information, Goldman, Detsky and Lee scores were recorded. All patients were followed for 6 months after hip fracture, and mortality was recorded. Multiple logistic regression analyses were performed for mortality prediction.
Results:
The mortality rate was 23% after a 6-month follow-up period. Patients who died had advanced age and the majority of them were male. They also had lower values of handgrip strength, and higher values of creatinine and urea. In the multiple logistic regression models when adjusted by age, gender, handgrip strength and creatinine, Goldman's score (OR:3.025; 95%CI:1.022-8.953; p:0.046), but not Detsky (OR:2.328; 95%CI:0.422-12.835; p:0.332) and Lee (OR:1.262; 95%CI:0.649-2.454; p:0.494), was associated with mortality 6 months after hip fracture. Each 1 category increase in Goldman score increased the mortality to more than 3-fold.
Conclusions:
In conclusion, our data suggest that Goldman score, but not Detsky or Lee indices, predicts mortality associated with hip fracture at up to 6 months post-injury.
