Validation of the FRAIL model to predict non-vertebral and hip fractures in nursing home residents
Validation of the FRAIL model to predict non-vertebral and hip fractures in nursing home residents
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DOI：
10.1016/j.bone.2019.115050
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发表时间：
2019-11-01
期刊：
影响因子：
4.1
通讯作者：
Kiel, Douglas P.
中科院分区：
文献类型：
--
作者：
Berry, Sarah D.;Zullo, Andrew R.;Kiel, Douglas P.
目标：疗养院（NH）没有评估骨折风险的工具；因此，我们开发了长期护理骨折风险评估 (FRAiL) 模型。这项验证研究的目的是评估 FRAiL 模型的性能，以预测一个单独的大型 NH 居民队列中非椎骨和髋部骨折的 2 年风险。方法：这项回顾性队列研究包括美国大多数长期住院的 NH 居民 (N = 896,840)。使用医疗保险索赔确定髋部和非椎骨骨折。最小数据集 (MDS) 用于识别原始 FRAiL 模型的特征。使用多变量竞争风险回归来模拟骨折风险。结果：平均年龄为 83.8 岁（+/- 8.2 岁），其中 70.7% 为女性。在平均 1.52 年 (SD 0.65) 的随访中，41,531 名居民 (4.6%) 因非椎骨骨折住院（n = 30,356 髋部骨折）。在完全调整的模型中，14/15 模型特征仍然是非椎骨骨折的重要预测因子。女性（HR = 1.55，95% CI 1.52，1.59）、徘徊（HR = 1.30，95% CI 1.26，1.34）和跌倒（HR = 1.28，95% CI 1.26，1.31）与非椎体骨折率密切相关。 ADL 的完全依赖（相对于独立）与非椎体骨折率降低相关（HR = 0.57，95% CI 0.52，0.64）。男性（髋部 C 指数 = 0.68，非椎骨 0.66）和女性（髋部 C 指数 = 0.68，非椎骨 0.65）的歧视程度适中，并且校准效果非常好。结论：我们的模型完全由常规收集的数据组成，能够识别非椎骨骨折风险最高的 NH 居民。
Objective: Tools were unavailable to assess fracture risk in nursing homes (NH); therefore, we developed the Fracture Risk Assessment in Long term care (FRAiL) model. The objective of this validation study was to assess the performance of the FRAiL model to predict 2-year risk of non-vertebral and hip fractures in a separate large cohort of NH residents.Methods: This retrospective cohort study included most long-stay NH residents in the United States (N = 896,840). Hip and non-vertebral fractures were identified using Medicare claims. The Minimum Data Set (MDS) was used to identify characteristics from the original FRAiL model. Multivariable competing risk regression was used to model risk of fracture.Results: Mean age was 83.8 years (+/- 8.2 years) and 70.7% were women. Over a mean follow-up of 1.52 years (SD 0.65), 41,531 residents (4.6%) were hospitalized with non-vertebral fracture (n = 30,356 hip fractures). In the fully adjusted model, 14/15 model characteristics remained significant predictors of non-vertebral fracture. Female sex (HR = 1.55, 95% CI 1.52, 1.59), wandering (HR = 1.30, 95% CI 1.26, 1.34), and falls (HR = 1.28, 95% CI 1.26, 1.31) were strongly associated with non-vertebral fracture rate. Total dependence in ADLs (versus independence) was associated with a decrease in non-vertebral fracture rate (HR = 0.57, 95% CI 0.52, 0.64). Discrimination was moderate in men (C-index = 0.68 for hip, 0.66 for non-vertebral) and women (C-index = 0.68 for hip, 0.65 for non-vertebral), and calibration was excellent.Conclusions: Our model comprised entirely from routinely collected data was able to identify NH residents at greatest risk for non-vertebral fracture.