title: Risk factors for hospital re-presentation among older adults following fragility fractures: protocol for a systematic review.
abstract: BACKGROUND
  After being discharged from hospital following the acute management of a fragility fracture, older adults may re-present to hospital emergency departments in the post-discharge period. Early re-presentation to hospital, which includes hospital readmissions, and emergency department presentations without admission may be considered undesirable for individuals, hospital institutions and society. The identification of modifiable risk factors for hospital re-representation following initial fracture management may prove useful for informing policy or practice initiatives that seek to minimise the need for older adults to re-present to hospital early after they have been discharged from their initial inpatient care. The purpose of this systematic review is to identify correlates of hospital re-presentation in older patients who have been discharged from hospital following clinical management of fragility fractures.
  
  
  METHODS
  The review will follow the PRISMA-P reporting guidelines for systematic reviews. Four electronic databases (PubMed, CINAHL, Embase, and Scopus) will be searched. A suite of search terms will identify peer-reviewed articles that have examined the correlates of hospital re-presentation in older adults (mean age of 65 years or older) who have been discharged from hospital following treatment for fragility fractures. The Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies will be used to assess the quality of the studies. The strength of evidence will be assessed through best evidence synthesis. Clinical and methodological heterogeneity across studies is likely to impede meta-analyses.
  
  
  CONCLUSIONS
  The best evidence synthesis will outline correlates of hospital re-presentations in this clinical group. This synthesis will take into account potential risks of bias for each study, while permitting inclusion of findings from a range of quantitative study designs. It is anticipated that findings from the review will be useful in identifying potentially modifiable risk factors that have relevance in policy, practice and research priorities to improve the management of patients with fragility fractures.
  
  
  BACKGROUND
  PROSPERO CRD42015019379.
authors.affiliation: School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia. sairaannmathew2@qut.edu.au.|Centre for Functioning and Health Research, Metro South Health, Queensland Department of Health, Brisbane, Australia. sairaannmathew2@qut.edu.au.
authors.forename: Saira A
authors.initials: SA
authors.lastname: Mathew
authors.affiliation: School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia. k.heesch@qut.edu.au.
authors.forename: Kristiann C
authors.initials: KC
authors.lastname: Heesch
authors.affiliation: Centre for Functioning and Health Research, Metro South Health, Queensland Department of Health, Brisbane, Australia. e.gane@uq.edu.au.|School of Health & Rehabilitation Sciences, The University Of Queensland, Brisbane, Australia. e.gane@uq.edu.au.
authors.forename: Elise
authors.initials: E
authors.lastname: Gane
authors.affiliation: School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia. steven.mcphail@qut.edu.au.|Centre for Functioning and Health Research, Metro South Health, Queensland Department of Health, Brisbane, Australia. steven.mcphail@qut.edu.au.
authors.forename: Steven M
authors.initials: SM
authors.lastname: McPhail
mesh_terms: D000368:Aged; D002985:Clinical Protocols; D004636:Emergency Service, Hospital; D005260:Female; D050723:Fractures, Bone / Q000628:therapy*; D016330:Frail Elderly; D006801:Humans; D008297:Male; D010359:Patient Readmission; D012307:Risk Factors; D000078202:Systematic Reviews as Topic