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

Core Tip

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.