Functional Status Geriatric Scores: Single-Handed Tools for 30-Day Mortality Risk After Hip Fracture

Abstract

Background

The 30-day mortality rate after hip fracture surgery has been considered as an indirect indicator of the quality of care. This work aims to appraise the Barthel Index, Katz Index, Lawton-Brody Index, and Physical Red Cross Scale registered in the Comprehensive Geriatric Assessment at admission on the of 30-day death probability after hip fracture surgery.

Methods

Prospective study including 899 hip fracture patients over 65. Bed-ridden, non-surgically treated patients, and high energy trauma or tumoral etiology fractures were excluded. Variables distribution were assessed by χ², U-Mann Whitney and we performed binary logistic regression and equal tailed Jeffreys 95% CI for risk assessment. P<0.05 was considered statistically significant.

Results

We noted a 30-day mortality rate of 5.9%. We related Barthel Index (OR=0.986 [0.975–0.996], p=0.010), Katz Index (OR=1.254 [1.089–1.444], p=0.002), Lawton-Brody Index (OR=0.885 [0.788–0.992], p=0.037), and Physical Red Cross Scale (OR=1.483 [1.094–2.011], p=0.011) with the 30-day mortality of patients after hip fracture surgery. We also validated the Barthel Index inflection point (0–55) (OR_BI(0–55)=2.428 [1.379–4.275], p=0.002) and Katz Index inflection point (A-B) (OR_KI(A-B)=0.493 [0.273–0.891], p=0.019) for the assessment of the highest risked patients.

Conclusion

The geriatric functional status scores would be useful multifunctional and standalone tools in the assessment of hip fracture patients as singly predictors of 30-day mortality.

Keywords:

• comprehensive geriatric assessment
• hip fracture
• mortality
• geriatric scores

Abbreviations

ADL, Activities of daily living; BI, Barthel index; CI, Confidence interval; CGA, Comprehensive geriatric assessment; FAC, Functional Ambulation Classification; IADL, Instrumental activities of daily living; IP, Inflection point; KI, Katz index; LBI, Lawton-Brody index; OR, Odds ratio; PCRS, Physical Red Cross Scale; UHS, University Hospital of Salamanca.

Data Sharing Statement

The data supporting this study are available from the corresponding author upon reasonable request.

Ethics Approval and Consent to Participate

All participants (or their relatives) have given their written informed consent to participate. The whole study was conducted following the Declaration of Helsinki and was previously approved by the ethics committee for clinical research (CEIm) of the University Hospital of Salamanca.

Consent for Publication

Not applicable.

Author Contributions

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Disclosure

The authors have no conflicts of interest to declare for this work.