title: Prediction of early mortality following hip fracture surgery in frail elderly: The Almelo Hip Fracture Score (AHFS).
abstract: BACKGROUND
  Hip fractures are common in the elderly and have a high risk of early mortality. Identification of patients at high risk of early mortality could contribute to enhanced quality of care. A simple scoring system is essential for preoperative identification of patients at high risk of early mortality in clinical practice. Of risk models published, The Nottingham Hip Fracture Score (NHFS) shows the most promising results so far. However, there is still room for improvement.
  
  
  METHODS
  A cohort study including 850 patients was conducted over a period of 5,5 yr. The NHFS was adjusted for cognitive impairment (NHFS-a) and tested. Patients who died within 30days following hip fracture surgery (early mortality group) were compared to survivors. Independent risk factors for early mortality were assessed. A new hip fracture score for frail elderly was developed: the Almelo Hip Fracture Score (AHFS). The NHFS-a and the AHFS were compared for accuracy and predictive validity.
  
  
  RESULTS
  Sixty-four (7.5%) patients died within 30days following hip fracture surgery. The AHFS predicts the risk of early mortality better than the NHFS-a (p<0.05). Using cut-off points of AHFS ≤ 9 and AHFS ≥ 13, patients could be divided into a low, medium or high risk group. The area under the curve improved with the AHFS compared to the NHFS-a (0.82 versus 0.72). The likelihood ratio test reveals a significantly better fit of the AHFS in comparison with the NHFS-a (p<0.001).
  
  
  CONCLUSIONS
  The AHFS can identify frail elderly at high risk of early mortality following hip fracture surgery accurately. With the AHFS, the patient can be classified into the low, medium or high risk group, which contributes to enhanced quality of care in clinical practice.
authors.affiliation: Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo/Hengelo, The Netherlands. Electronic address: nijmeijerwieke@gmail.com.
authors.forename: W S
authors.initials: WS
authors.lastname: Nijmeijer
authors.affiliation: Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo/Hengelo, The Netherlands.
authors.forename: E C
authors.initials: EC
authors.lastname: Folbert
authors.affiliation: ZGT Academy, Ziekenhuisgroep Twente, Almelo/Hengelo, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Vermeer
authors.affiliation: Department of Geriatric Medicine, University Medical Centre Groningen, The Netherlands; Leyden Academy on Vitality and Aging, Leiden, The Netherlands.
authors.forename: J P
authors.initials: JP
authors.lastname: Slaets
authors.affiliation: Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo/Hengelo, The Netherlands.
authors.forename: J H
authors.initials: JH
authors.lastname: Hegeman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D005593:Fracture Fixation, Internal / Q000401:mortality*; D016330:Frail Elderly; D006620:Hip Fractures / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011183:Postoperative Complications / Q000401:mortality*; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors
keywords: Frail elderly; Hip fracture; Mortality; Orthogeriatric; Risk prediction; Surgery