Predicting 30-day mortality after hip fracture: the G4A calibrated prognostic tool

Introduction: Proximal femoral fracture is common with a high mortality (7% mortality at 30 days). Accurate determination of mortality risk allows better consenting, clinical management and expectation management. Our study aim was to develop a prognostic tool to predict 30-day mortality after proximal femoral fracture, among patients treated within a dedicated hip fracture unit. Materials and methods: We collected data from our hospital concerning 2210 patients with 2287 proximal femoral fractures. The clinical parameters of 97 patients who died within 30 days of surgery were analysed. We used logistic regression to determine if the parameters’ relationship with 30-day mortality was statistically significant or not. The statistically significant parameters were used to create a prognostic model for predicting 30-day mortality. Results: The 5 independent predictors of 30-day mortality were gender, age, admission source, preoperative Abbreviated Mental Test Score (AMTS) and American Society of Anesthesiologists Score (ASA). The highest risk was for males >85 years, admitted from institutional care, with low preoperative mental test score and high ASA grade. Using these predictors, we formulated the G4A score. The Hosmer-Lemeshow ‘goodness of fit’ test showed good concordance between observed and predicted mortality rates. Conclusions: We recommend the use of the G4A score to predict 30-day mortality after surgery for proximal femoral fracture, particularly within dedicated hip fracture units. Further research is needed to establish whether the findings of this study are applicable on a national scale.

Download Full-text

The Abbreviated Mental Test Score; Is There a Need for a Contemporaneous Update?

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/21514593211001047 ◽

2021 ◽

Vol 12 ◽

pp. 215145932110010

Author(s):

Kizzie A. Peters ◽

Thomas J. Howe ◽

Daniel Rossiter ◽

Kirsty J. Hutchinson ◽

Philip A. Rosell

Keyword(s):

New York ◽

Hip Fracture ◽

Test Score ◽

Terrorist Attack ◽

Neck Of Femur ◽

Mental Test ◽

Mental Test Score ◽

Significant Difference ◽

Abbreviated Mental Test ◽

Memorable Event

Introduction: Designed in 1972 the Abbreviated Mental Test Score (AMTS) is widely used to assess a cognition on hospital admission. The Nottingham Hip Fracture Score uses this in predicting morbidity/mortality in neck of femur fracture. The consequences of misappropriating cognitive impairment could have lasting implications. Questions about the monarchy or World War One and Two may be inappropriate for today’s diverse society. Materials and Methods: 100 patients were questioned during routine fracture clinic appointments. Patients were asked: In what year did WWII start? Who is the current monarch? Please state a memorable event in your lifetime that you would not expect another person of the same age to forget. Two-tailed Z-tests were performed between the observed proportions and those from the original AMTS validation study. Results: Only 47% (n = 47) were able to correctly answer the year in which WW2 started. A statistically significant difference when compared to the upper and lower limits from the original study (z = -4.191, p < .001.). Significance was not seen in the second question, with 97% (n-97) identifying the monarch correctly. 51% (n = 51) of participants suggested the terrorist attack on the World Trade Centre in New York as an alternative memorable event. Discussion: Some hospitals now use the 4 “A”s Test (4-AT) as a screening tool for delirium. Without amendments to the Nottingham Hip Fracture Score, AMTS use is likely to continue in orthogeriatric patients. Over time there will be a need for the AMTS to be reviewed so that it remains a true assessment of cognition. Its limitations regarding language and culture is widely acknowledged and several validated variants have been published in the literaure. Conclusions: We highlight a potential future issue with the AMTS and raise considerations for the development of an alternative question to better meet the needs of the orthogeriatric population.

Download Full-text

How nurses' attire affects elderly psychiatric patients' ability to recognise them

Psychiatric Bulletin ◽

10.1192/pb.22.4.236 ◽

1998 ◽

Vol 22 (4) ◽

pp. 236-238

Author(s):

Hugh Joseph McCreedy ◽

Peter William Bentham

Keyword(s):

Elderly Patients ◽

Test Score ◽

Psychiatric Patients ◽

Mental Test ◽

Mental Test Score ◽

Abbreviated Mental Test

The ability of elderly patients to identify a nurse wearing a uniform as opposed to mufti was investigated together with the effect of administrator attire on the Abbreviated Mental Test score (AMT). Thirty-six out of 71 patients identified a nurse wearing mufti increasing to 59/71 when wearing uniform (P < 0.005). Patients rated by a uniformed nurse had significantly higher mean AMT scores (6.1) than when rated by a nurse in mufti (5.6) (P < 0.01), and this also had a significant effect on the sensitivity in predicting an organic diagnosis.

Download Full-text

Regional Density and Survival in Senile Dementia

The British Journal of Psychiatry ◽

10.1192/bjp.147.1.63 ◽

1985 ◽

Vol 147 (1) ◽

pp. 63-66 ◽

Cited By ~ 17

Author(s):

John Colgan

Keyword(s):

Prospective Study ◽

Ct Scan ◽

Test Score ◽

Senile Dementia ◽

Alzheimer Type ◽

Cognitive Measures ◽

Mental Test ◽

Mental Test Score ◽

Senile Dementia Of The

SummaryComputed cranial tomography was performed on 48 patients with Senile Dementia of the Alzheimer Type (SDAT) who have since been followed up in a continuing prospective study. At six-months follow-up, ten patients had died; these did not differ significantly from the survivors either in mean age or duration of dementia, although the latter tended to have been shorter in the deceased. Despite having shorter histories, the deceased had performed worse on initial testing with several cognitive measures, and this was significant for the mental test score; this suggests some patients may have a more rapidly progressive form of SDAT. In a comparison between the CT scan of the deceased and survivors, the deceased were found to have significantly lower mean attenuation densities in the parietal, occipital, and left thalamic regions. The hypothesis that low attenuation density in the parietal regions of the CT scan in SDAT is associated with a more rapid demise is supported for the present period of follow-up.

Download Full-text

Routine cognitive screening in older patients admitted to acute medicine: abbreviated mental test score (AMTS) and subjective memory complaint versus Montreal Cognitive Assessment and IQCODE

Age and Ageing ◽

10.1093/ageing/afv134 ◽

2015 ◽

Vol 44 (6) ◽

pp. 1000-1005 ◽

Cited By ~ 27

Author(s):

S. T. Pendlebury ◽

S. P. Klaus ◽

M. Mather ◽

M. de Brito ◽

R. M. Wharton

Keyword(s):

Cognitive Assessment ◽

Older Patients ◽

Test Score ◽

Cognitive Screening ◽

Subjective Memory ◽

Acute Medicine ◽

Memory Complaint ◽

Mental Test ◽

Mental Test Score ◽

Abbreviated Mental Test

Download Full-text

Correlation between the 37-Item Mental Test Score and Abbreviated 10-Item Mental Test Score by Psychogeriatric Day Patients

The British Journal of Psychiatry ◽

10.1192/bjp.151.2.206 ◽

1987 ◽

Vol 151 (2) ◽

pp. 206-209 ◽

Cited By ~ 20

Author(s):

P. Thompson ◽

G. Blessed

Keyword(s):

Mentally Ill ◽

Test Score ◽

Institutional Care ◽

Mental Impairment ◽

Mental Test ◽

Mental Test Score ◽

Good For ◽

Psychogeriatric Patients

Groups of organically and functionally mentally ill psychogeriatric day patients were assessed by the 37-item Roth-Hopkins test and the abbreviated ten-item Roth-Hopkins test. The scores correlated highly, correlation being equally good for both diagnostic groups. Among the functionally ill and the mild organically ill, scores improved between first and second test. The quicker, better tolerated ten-item test is a useful test of mental impairment for psychogeriatric patients in the community, as well as in institutional care.

Download Full-text

Association of ABO blood group with fracture pattern and mortality in hip fracture patients

Annals of The Royal College of Surgeons of England ◽

10.1308/003588414x13946184902604 ◽

2014 ◽

Vol 96 (6) ◽

pp. 442-445 ◽

Cited By ~ 3

Author(s):

CE Uzoigwe ◽

RP Smith ◽

A Khan ◽

D Aghedo ◽

M Venkatesan

Keyword(s):

Hip Fracture ◽

Blood Group ◽

Femoral Fracture ◽

Intertrochanteric Fracture ◽

Proximal Femoral Fracture ◽

Fracture Pattern ◽

Abo Blood Group ◽

Blood Group A ◽

Fracture Configuration ◽

Group A

Introduction The mechanism of falling has been proposed as the exclusive explanation for hip fracture pattern. Evidence exists that other genetic factors also influence proximal femoral fracture configuration. The ABO blood group serotype has been associated with other pathologies but any role in hip fracture has yet to be definitively characterised. Methods Our National Hip Fracture Database was interrogated over a four-year period. All patients had their blood group retrieved, and this was compared with hip fracture pattern and mortality rates. Confounding factors were accounted for using logistic regression and the Cox proportional hazards model. Results A total of 2,987 consecutive patients presented to our institution. Those with blood group A were significantly more likely to sustain intracapsular fractures than ‘non-A’ individuals (p=0.009). The blood group distribution of patients with intracapsular fractures was identical to that of the national population of England. However, blood group A was less common in patients with intertrochanteric fractures than in the general population (p=0.0002). Even after correction for age and sex, blood group A was associated with a decrease in the odds of suffering an intertrochanteric fracture to 80% (p=0.002). Blood group A had inferior survivorship correcting for age, sex and hip fracture pattern (hazard ratio: 1.14, p=0.035). This may be due to associated increased prevalence of co-morbid disease in this cohort. Conclusions Blood group is an independent predictor of hip fracture pattern, with group A patients more likely to sustain an intracapsular fracture and non-A individuals more likely to sustain an intertrochanteric fracture. The determinants of fracture pattern are likely to be related to complex interactions at a molecular level based on genetic susceptibility. The mechanism of fall may not be the only aetiological determinant of proximal femoral fracture configuration.

Download Full-text

Is it time to replace the Abbreviated Mental Test Score as a screening tool for dementia?

Clinical Medicine ◽

10.7861/clinmedicine.15-3-s9 ◽

2015 ◽

Vol 15 (Suppl 3) ◽

pp. s9-s9 ◽

Cited By ~ 1

Author(s):

Michelle Willmott

Keyword(s):

Test Score ◽

Screening Tool ◽

Mental Test ◽

Mental Test Score ◽

Abbreviated Mental Test

Download Full-text

Perioperative pain management in elderly patients with а proximal femoral fracture: evidence review

Pain medicine ◽

10.31636/pmjua.v4i4.2 ◽

2020 ◽

Vol 4 (4) ◽

pp. 42-49

Author(s):

Anastasiia Romanenko ◽

Юрій Кучин ◽

Катерина Бєлка ◽

Ігор Токар

Keyword(s):

Hip Fracture ◽

Pain Management ◽

Elderly Patients ◽

Femoral Fracture ◽

Adverse Drug Events ◽

Perioperative Period ◽

The Elderly ◽

Proximal Femoral Fracture ◽

Nerve Blocks ◽

Number Of Patients

The purpose of this article is to compare different methods of analgesia during perioperative period in elderly patients with а proximal femoral fracture. The incidence of hip fracture is high and also rises with the age, for example, In Great Britain, number of patients with a hip fracture will be approximately 100 000 in 2033, and it’s also associated with significant healthcare financing. Nevertheless, effective pain management is a big challenge for clinicians because of considerable problems in geriatric patients, including age, physiological changes in the elderly, preexisting comorbidities, cognitive impairment, high risk of delirium, problems with rehabilitation and probability of an independent life [12]. Opioids are still the main option for hip fracture pain management, despite differences in pharmacokinetics and pharmacodynamics in elderly patients, which are correlated with high frequency of side effects. Opioid-related adverse drug events are associated with worse patient outcomes such as morbidity, mortality and length of stay increase. Therefore, peripheral nerve blocks as part of multimodal analgesic technique can provide more effective pain control after hip fracture. Comprehensive literature searches focus on the use of peripheral nerves blocks as preoperative analgesia, as postoperative analgesia or as a supplement to general anesthesia for hip fracture surgery.

Download Full-text