Predicting survival after treatment for fracture of the proximal femur and the effect of delays to surgery
Predicting survival after treatment for fracture of the proximal femur and the effect of delays to surgery
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DOI：
10.1016/s0895-4356(03)00129-x
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发表时间：
2003-08-01
影响因子：
7.2
通讯作者：
Stevenson, M
中科院分区：
文献类型：
--
作者：
Elliott, J;Beringer, T;Stevenson, M
背景和目标：本研究的目的是评估股骨颈骨折治疗后的预后，评估延迟手术的影响，并制定一个临床预测规则和score.Methods：一项前瞻性观察研究，其中1780例手术治疗的两个教学医院1997年11月1日至1999年10月31日，随后超过12个月。Logistic回归用于区分预测变量对生存的影响。使用概率单位转换的预测后验概率的死亡，预后评分设计的分数限制，使一个名义分数约为90代表一个50：50的生存机会超过12 months.Results：死亡率为30.1%的男性和19.5%的女性。年龄增加、男性、术前延迟时间延长、美国麻醉学会评分较高、精神测试评分较低和日常生活活动（Barthel）评分较低与死亡风险增加相关。在等待手术1 - 5天的患者中，大约8名中等风险和17名高风险患者（预后评分分别为90和120）必须将其延迟减少到
Background and Objectives: The aim of this study was to evaluate the prognosis after treatment for femoral neck fracture, to assess the impact of delay to surgery, and to devise a clinical prediction rule and score.Methods: A prospective observational study was conducted in which 1780 patients treated surgically in two teaching hospitals between 1 November 1997 and 31 October 1999 were followed over 12 months. Logistic regression was used to distinguish the effects of predictor variables on survival. Using a probit transformation of the predicted posterior probabilities of death, a prognostic score was devised with scores constrained so that a nominal score of approximately 90 represented a 50:50 chance of survival over 12 months.Results: Mortality was 30.1% in men and 19.5% in women. Increasing age, male gender, longer pre-operative delay, a higher American Society of Anesthesiology score, a lower Mental Test score, and a lower activities of daily living (Barthel) score were associated with increased risks of death. Of those waiting between 1 and 5 days for surgery, approximately 8 medium-risk and 17 high-risk patients (with prognostic scores of 90 and 120, respectively) would have to have their delay reduced to