Nottingham Hip Fracture Score and Acute Physiology and Chronic Health Evaluation-II: Predicting 30-day mortality in elderly hip fracture

Abstract

BACKGROUND

Hip fractures are a major cause of morbidity and mortality among older individuals. Accurate prediction of 30-day mortality after hip fracture surgery is crucial for effective resource allocation and patient management.

AIM

To compare the Nottingham Hip Fracture Score (NHFS) and Acute Physiology and Chronic Health Evaluation (APACHE)-II score in predicting 30-day mortality among 182 geriatric patients (≥ 60 years) undergoing elective hip fracture surgery at Tata Main Hospital, Jamshedpur, India.

METHODS

NHFS and APACHE-II scores were calculated preoperatively. Patients were followed up for 30 days post-surgery to determine mortality outcomes. Statistical analysis, including receiver operating characteristic curve analysis, was performed to assess the predictive accuracy of both scores.

RESULTS

Results indicated that APACHE-II demonstrated superior predictive ability compared to NHFS. The study also assessed secondary outcomes such as ventilator and inotropic support, acute kidney injury (AKI), cardiac morbidity, pulmonary embolism, deep vein thrombosis, and length of hospital stay (LOS). APACHE-II showed superior performance in predicting the need for ventilator support and AKI.

CONCLUSION

Both scores showed significant discrimination for ventilator and inotropic support and LOS but not for AKI. The findings highlight the importance of comprehensive risk stratification for managing geriatric patients with hip fracture.

Keywords: Acute Physiology and Chronic Health Evaluation-II; Hip fractures; Scoring methods; Mortality; Geriatrics; Outcome assessment; Receiver operating characteristic curve

Core Tip: This prospective observational study at Tata Main Hospital in Jamshedpur, India, evaluated the Nottingham Hip Fracture Score (NHFS) and Acute Physiology and Chronic Health Evaluation (APACHE)-II score for predicting 30-day mortality in 182 geriatric patients with hip fracture (≥ 60 years). The study assessed the primary (mortality prediction) and secondary objectives, including the requirement for ventilator/ionotropic support and monitoring for acute kidney injury and other complications. Preoperatively, the NHFS and APACHE-II scores were calculated, and patients were followed up for a minimum of 30 days post-surgery. Statistical analyses included receiver operating characteristic curves, area under the curve (AUC), sensitivity, specificity, and P value using Statistica. Results indicated that NHFS showed moderate predictive accuracy (AUC = 0.709, P = 0.006), whereas APACHE-II demonstrated excellent predictive ability (AUC = 0.904, P < 0.001). Significant predictors of mortality included the APACHE-II score, NHFS, mean arterial pressure, pH, respiratory rate, and serum creatinine levels. Although age and gender showed notable trends, they were not statistically significant. The findings indicate that the APACHE-II score is a strong predictor of 30-day mortality following hip fracture surgery, highlighting the importance of incorporating multiple factors for effective prediction.