title: Predicting survival after treatment for fracture of the proximal femur and the effect of delays to surgery.
abstract: OBJECTIVE
  The aim of this study was to evaluate the prognosis after treatment for femoral neck fracture, to assess the impact of delay to surgery, and to devise a clinical prediction rule and score.
  
  
  METHODS
  A prospective observational study was conducted in which 1780 patients treated surgically in two teaching hospitals between 1 November 1997 and 31 October 1999 were followed over 12 months. Logistic regression was used to distinguish the effects of predictor variables on survival. Using a probit transformation of the predicted posterior probabilities of death, a prognostic score was devised with scores constrained so that a nominal score of approximately 90 represented a 50:50 chance of survival over 12 months.
  
  
  RESULTS
  Mortality was 30.1% in men and 19.5% in women. Increasing age, male gender, longer pre-operative delay, a higher American Society of Anesthesiology score, a lower Mental Test score, and a lower activities of daily living (Barthel) score were associated with increased risks of death. Of those waiting between 1 and 5 days for surgery, approximately 8 medium-risk and 17 high-risk patients (with prognostic scores of 90 and 120, respectively) would have to have their delay reduced to < 24 hours to yield one additional survivor.
  
  
  CONCLUSIONS
  The application of prediction rules must be guided by ethical, social, and scientific concerns.
authors.affiliation: Department of Trauma and Orthopaedics, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BJ, Ireland.
authors.forename: J
authors.initials: J
authors.lastname: Elliott
authors.forename: T
authors.initials: T
authors.lastname: Beringer
authors.forename: F
authors.initials: F
authors.lastname: Kee
authors.forename: D
authors.initials: D
authors.lastname: Marsh
authors.forename: C
authors.initials: C
authors.lastname: Willis
authors.forename: M
authors.initials: M
authors.lastname: Stevenson
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005265:Femoral Neck Fractures / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D016743:Mental Competency; D008875:Middle Aged; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D012737:Sex Factors; D015996:Survival Rate; D013997:Time Factors