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Evaluation of an AI-Driven Risk Stratification System for Clinical Deterioration in Patients With Geriatric Hip
Christopher Q Lin1, Max Ruiz, Maddison McLellan
1Department of Orthopaedic Surgery, Stanford Hospitals and Clinics, Stanford, CA.
Objectives:
To determine whether an artificial intelligence-driven Clinical Deterioration Index (CDI) could identify geriatric patients with hip fracture at risk of early postoperative complications and to establish an orthopaedic-specific cutoff that identified patients at risk of deterioration.
Design:
Retrospective cohort study.
Setting:
Single Level I trauma center.
Patient Selection Criteria:
Patients younger than 65 years of age who underwent fixation of OTA/AO 31-A/B/C hip fractures between June 2022 and December 2023 were included using ICD-10 codes S72.0-, S72.1-, and S72.2-. Exclusion criteria were pathologic fracture, revision surgery, or absence of 30-day follow-up. The CDI uses 31 clinical measures to generate a score from 0 to 100 reflecting risk of rapid deterioration. Patients were separated into 2 groups based on peak CDI in the immediate 48-hour postoperative period: CDI ≥65 and CDI <65. This cutoff of 65 was established by previous institutional validation.
Outcome Measures And Comparisons:
Primary outcomes were in-hospital complications (cognitive changes, cardiac complications, DVT/PE, etc). Secondary outcomes included length of stay, ambulation distance, and 1-year mortality. Outcomes were compared between CDI groups.
Results:
Of 197 patients (age range 65-98, 66% female), 15 (7.6%) exceeded the baseline CDI threshold of 65. This group had higher complication rates (93.3% vs. 26.4%, P < 0.001), prolonged hospital stays (10.1 vs. 5.2 days, P = 0.047), reduced ambulation at discharge (8.8 vs. 42.3 feet, P < 0.001), and increased one-year mortality (20.0% vs. 3.8%, P = 0.02). CDI ≥65 was associated with postoperative complications (OR 37.9). The institutional cutoff of 65 offered high specificity (99.3%) but low sensitivity (22.6%). An optimized threshold (47.7) improved sensitivity (77.4%) with comparable accuracy (75.0%).
Conclusions:
An elevated Clinical Deterioration Index (CDI) ≥ 65 correlated with poor outcomes in geriatric patients with hip fracture. Specialty-specific cutoffs showed potential to improve postoperative risk stratification and identification of higher-risk patients.
Level Of Evidence:
Therapeutic Level III (retrospective cohort study). See Instructions for Authors for a complete description of levels of evidence.
