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Efficiently stratifying mid-term death risk in femoral fractures in the elderly: introducing the ASAgeCoGeCC Score
C Trevisan1, G Gallinari2, A Carbone2
1UOC Ortopedia e Traumatologia, Ospedale Bolognini Seriate ASST-Bergamo Est, Via Paderno 21, 24065, Seriate, BG, Italia. carlo.trevisan@tiscali.it.
Insights
A new risk score, ASAgeCoGeCC, effectively predicts mortality in hip fracture patients. This tool stratifies patients into distinct risk groups, aiding in personalized management strategies for better outcomes.
Area of Science:
- Geriatric Medicine
- Orthopedic Surgery
- Epidemiology
Background:
- Risk prediction models are crucial for estimating postoperative mortality in hip fracture patients.
- These models offer prognostic insights and support clinical decision-making.
- Identifying distinct patient subgroups based on risk is essential for tailored management.
Purpose of the Study:
- To develop and validate a predictive model for stratifying hip fracture patients into mid-term risk classes.
- To identify key factors contributing to mortality risk in this patient population.
Main Methods:
- A cohort of 323 hip fracture patients was analyzed for mortality at 30 days, 1, 2, and 4 years.
- Multivariate logistic regression identified ASA score, age, cognitive status, gender, and Charlson Comorbidities Index (CCI) as significant risk factors.
- The novel ASAgeCoGeCC score was developed and validated against CCI and Nottingham Hip Fracture Score (NHFS) using ROC curve analysis.
Main Results:
- The ASAgeCoGeCC score demonstrated excellent discrimination, with Area Under the ROC Curve values ranging from 0.804 to 0.820.
- The model showed good calibration and successfully stratified patients into low, intermediate, and high-risk groups.
- High-risk patients had a 4-year mortality odds ratio of 21.6 compared to low-risk patients.
Conclusions:
- The ASAgeCoGeCC Score is a validated predictive tool for assessing 4-year mortality risk in hip fracture patients.
- It offers superior calibration and discrimination compared to existing scores.
- This score enables effective stratification of hip fracture patients by mortality risk, facilitating informed clinical management.
Abstract:
We evaluated mortality in a cohort of hip fracture patients and implemented a risk prediction score named ASAgeCoGeCC with excellent discrimination. It allowed to separate patients in 3 different risk groups with distinct mortality rates. Recognition of the heterogeneity of patients with femoral fractures may have relevant implications for their management.
Introduction:
Usage of risk prediction models to estimate postoperative mortality risk for hip fracture patients represents a useful tool to give insight in the prognosis and assist in clinical decision-making. The aim of this study was to identify a predictive model able to determine the possible presence of distinct subgroups of hip fracture patients by risk classes in the mid-term.
Methods:
Three hundred twenty-three hip fracture patients were evaluated, and mortality rates at 30 days, 1, 2, and 4 years were calculated. A multivariate logistic regression analysis using mortality 4 years after fracture as a dependent variable found ASA score, age, cognitive status, gender, and Charlson Comorbidities Index (CCI) as significant risk factors. Using these items, a score named ASAgeCoGeCC was implemented and compared with CCI and Nottingham Hip Fracture Score (NHFS) by a receiver operating characteristic (ROC) curve.
Results:
The area under the ROC curve for ASAgeCoGeCC was always greater than that of CCI and NHFS and ranged between 0.804 and 0.820 suggesting an excellent discrimination. The ASAgeCoGeCC logistic model showed also a good calibration. Patients were divided in 3 groups: a low risk group, an intermediate risk group with an odds ratio for 4-year mortality of 5.6 (95% CI 2.9-10.6), and a high risk group with an odds ratio 21.6 (95% CI 10.6-44).
Conclusion:
The ASAgeCoGeCC Score is a predictive tool for mortality after hip fracture with good calibration and excellent discrimination properties. It is the first scoring system stratifying hip fracture patients' mortality at 4 years from fracture.
