One-Year Mortality After Hip Fracture: Development and Validation of a Prognostic Index.
One-Year Mortality After Hip Fracture: Development and Validation of a Prognostic Index.
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DOI：
10.1111/jgs.14237
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发表时间：
2016-09
影响因子：
6.3
通讯作者：
Covinsky KE
中科院分区：
文献类型：
--
作者：
Cenzer IS;Tang V;Boscardin WJ;Smith AK;Ritchie C;Wallhagen MI;Espaldon R;Covinsky KE
建立一个老年人髋部骨折后一年死亡率的预测指数，包括来自广泛领域的预测因子。回顾性队列研究。健康和退休研究（HRS）857名HRS参与者在1992年至2010年期间经历了髋部骨折，如Medicare索赔数据所确定的。结局指标为髋部骨折一年内死亡。预测指标包括参与者的人口统计学、社会经济地位、社会支持健康、老年病症状和功能。我们确定了与一年死亡率独立相关的变量，并使用最佳子集回归来确定最终模型。对选定的变量进行加权，以建立风险指数。该指数通过使用自举估计模型乐观度进行内部验证。髋部骨折时的平均年龄为84岁，76%的参与者为女性。在一年的随访期间，有235例死亡（27%）。最终模型中包括五个死亡率预测因素：年龄超过90岁（2分）;男性（2分）; CHF（2分）;做饭困难（2分）;不能开车（1分）。该指数的得分与一年死亡率相关，0分预测10%的风险，7-9分预测66%的风险。最终模型的c-统计量为0.73，估计乐观惩罚为0.01，表明过拟合的证据很少。预后指数结合了人口统计学、合并症和功能等变量，可用于区分髋部骨折后一年死亡率的低风险和高风险患者。
To develop a prediction index for one year mortality after hip fracture in older adults that includes predictors from wide range of domains. Retrospective cohort study. Health and Retirement Study (HRS) 857 HRS participants who experienced hip fracture between 1992 and 2010, as identified by Medicare claims data. Outcome measure was death within one year of hip fracture. Predictor measures were participants’ demographics, socio-economic status, social support health, geriatrics symptoms and function. We identified variables independently associated with one year mortality and used best subsets regression to identify the final model. The selected variables were weighted to create a risk index. The index was internally validated by using bootstrapping to estimate model optimism. Mean age at time of hip fracture was 84, and 76% of the participants were women. There were 235 deaths (27%) during the one year follow up. Five predictors of mortality were included in the final model: age over 90 (2 points); male (2 points); CHF (2 points); difficulty preparing meals (2 points); and not being able to drive (1 point). The point scores of the index were associated with one year mortality, with 0 points predicting 10% risk and 7–9 points predicting 66% risk. The c-statistic for the final model was 0.73, with an estimated optimism penalty of 0.01 indicating very little evidence of overfitting. The prognostic index combines variables about demographics, comorbidities and function, and can be used to differentiate between patients at low and high risk of one year mortality after hip fracture.
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DOI：
10.1111/j.1532-5415.2011.03362.x
发表时间：
2011-04-01
影响因子：
6.3
作者：
Lee, Sei J.;Boscardin, W. John;Eng, Catherine
通讯作者：
Eng, Catherine
影响因子：
39
作者：
Neuman, Mark D.;Silber, Jeffrey H.;Werner, Rachel M.
通讯作者：
Werner, Rachel M.
影响因子：
158.5
作者：
Gerstein, Hertzel C.;Miller, Michael E.;Friedewald, William T.
通讯作者：
Friedewald, William T.
影响因子：
12.7
作者：
FISHER, ES;BARON, JA;BUBOLZ, TA
通讯作者：
BUBOLZ, TA
影响因子：
39.2
作者：
Justice, AC;Covinsky, KE;Berlin, JA
通讯作者：
Berlin, JA