Frequency and impact of active clinical issues and new impairments on hospital discharge in patients with hip fracture.
BACKGROUND
Hip fracture is associated with significant mortality and disability. Patients who are discharged from the hospital with active clinical problems may have worse outcomes than those patients without active clinical problems.


OBJECTIVE
To assess the frequency and impact of clinical problems at discharge on clinical and functional hip fracture outcomes.


METHODS
Detailed clinical data were collected from 559 patients in a prospective, multicenter observational cohort study. Active clinical issues (ACIs) on discharge included the following: temperature of 38.3 degrees C or higher, heart rate of more than 100/min or less than 60/min, systolic blood pressure higher than 180 mm Hg or lower than 90 mm Hg, diastolic blood pressure higher than 110 mm Hg or lower than 60 mm Hg, respiratory rate of more than 24/min, oxygen saturation of less than 90%, altered mental status, no oral intake, shortness of breath, chest pain, arrhythmias, or wound infection. New impairments (NIs) included bowel and bladder incontinence, inability to get out of bed, and decubitus ulcer. Outcomes were deaths, readmissions, and functional mobility 60 days after discharge.


RESULTS
Overall, 94 patients (16.8%) had 1 or more ACIs, and 229 (41.0%) had 1 or more NIs on discharge. Both ACIs and NIs on discharge were associated with increased risk-adjusted rates of death (odds ratio, 1.8; 95% confidence interval, 1.2-2.8) or readmission (odds ratio, 1.7; 95% confidence interval, 1.2-2.3). The NIs on discharge were also associated with worse functional mobility (P<.004). These relationships persisted in multivariate analyses that controlled for a previously validated, hip fracture-specific risk adjustment measure.


CONCLUSIONS
Clinicians should consider information about ACIs and NIs when deciding readiness for discharge and planning post-acute care.
Halm
Ethan A
EA
Department of Health Policy, Mount Sinai School of Medicine, New York, NY 10029, USA. ethan.halm@mountsinai.org
Magaziner
Jay
J
Hannan
Edward L
EL
Wang
Jason J
JJ
Silberzweig
Stacey B
SB
Boockvar
Kenneth
K
Orosz
Gretchen M
GM
McLaughlin
Mary Ann
MA
Koval
Kenneth J
KJ
Siu
Albert L
AL
D018806:APACHE; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000453:epidemiology* / Q000401:mortality; D015897:Comorbidity; D005260:Female; D006304:Health Status; D006620:Hip Fractures / Q000150:complications* / Q000401:mortality / Q000628:therapy; D006801:Humans; D015994:Incidence; D008297:Male; D009519:New York City; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D010359:Patient Readmission; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016138:Walking