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Score helps predict mortality risk in first year after intracapsular hip fracture
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U.K. researchers found the Sernbo hip score may help clinicians better differentiate between patients at high vs. low risk of mortality following intracapsular hip fracture, according to the study results, which Edward J.C. Dawe, MBBS, BSc(Hons), MRCS(Lon), MFSEM, is scheduled to present at the 13th EFORT Congress 2012, in Berlin.
Edward J.C. Dawe
Dawe, of the Department of Trauma and Orthopaedics, Royal Sussex County Hospital in Brighton, United Kingdom, and colleagues selected from a database 260 patients older than 65 years who had an intracapsular hip fracture (mean age 83 years) and at least 1.5 years mean postoperative follow-up. After reviewing 22 variables, including blood tests, medical comorbidities, Cox-proportional hazards analysis and operative management to determine which factors most affected mortality rates, they found the most significant predictors of mortality were Sernbo score <15, American Society of Anesthesiologists grade >3, preoperative blood creatinine and nonoperative treatment.
The score was also the best predictor of 30-day mortality in the study vs. other predictors, based on the findings.
Traditionally, surgeons use a Sernbo score >15 to recommend patients for total hip replacement and a score <15 to recommend them for hemiarthroplasty, according to Dawe.
Overall, the patients had a 17% 1-year mortality rate. Dawe and colleagues determined that risk of mortality after 30 days was 1 in 10 for patients with a Sernbo score <15 and 1 in 120 for a Sernbo score >15, according to the abstract.
The Sernbo score lends itself well to clinical use due to its simplicity compared to other hip scoring systems, Dawe told Orthopaedics Today Europe. “Whilst there are many other scores that can be used, this one is fantastically simple and it can be done by almost completely unskilled staff and that is the advantage of it.”
“A lot of the hip fracture scores are very complicated, and the situation we have to imagine ourselves being in is in the middle of the night, with very junior staff and very little expertise available in the hospital,” Dawe said. “At that stage, we are able to divide the patients into ones who need relatively simple levels of preparation for surgery and ones who need really very specialized preparations for surgery, which are the high risk patients.”
Dawe and colleagues anticipate the Sernbo score will eventually be used in hospitals having preoperative optimization areas, where hip fracture patients are seen by an orthopaedic team upon arrival to effectively plan any surgery and then apportioned to either standard ward care or a preoperative optimization area. – by Jeff Craven
Reference:
- Dawe EJC, Lindisfarne E, Singh T, et al. Sernbo score predicts mortality after intracapsular hip fracture. Scheduled to be presented May 25, 9:15-10:45, at the 13th EFORT Congress 2012. May 23-25. Berlin.
For more information:
- Edward J.C. Dawe, MBBS, BSc(Hons), MRCS(Lon), MFSEM, can be reached at Eastern Road, Brighton BN2 5BE, United Kingdom; email: edwarddawe@doctors.org.uk.
- Disclosure: Dawe has no relevant financial disclosures.
Perspective
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Cecilia Rogmark, MD, PhD
When designing our randomized trial (Leonardsson et al, Rogmark, et al) in the early 1990s, the aim was to compare internal fixation and arthroplasty. Literature suggested both total hip arthroplasty (THA) and hemiarthroplasty to be good alternatives, and to ensure that all participating centers did the same selection, a simple score was developed, the Sernbo score. Gradually, researchers have understood that remaining life expectancy is an important factor when choosing arthroplasty type. Even though early mortality is high, some patients survive 10 years to 20 years after hip fracture. These will benefit from a THA. If already restricted by current illness, frail patients will have satisfactory treatment with a hemiarthroplasty and, in case of a short survival, not be at risk of developing acetabulum erosion. The work of Dawe and colleagues validated the Sernbo score to be a useful tool for predicting mortality. Based on routine admission interview (age, habitat, mobility and mental status), the score is easy to use. One might only object to the authors’ standpoint that nonoperative treatment is suitable for patients with severe illness. In patients who are actually dying, yes; but, in those with a couple of weeks left, stabilization of the fracture will reduce pain and facilitate care.
The current study will help clinicians to further improve hip fracture treatment.
References:
- Leonardsson O, Sernbo I, Carlsson A, et al. Long-term follow-up of replacement compared with internal fixation for displaced femoral neck fractures: results at ten years in a randomised study of 450 patients. J Bone Joint Surg Br. 2010;92(3):406-412.
- Rogmark C, Carlsson A, Johnell O, Sernbo I. A prospective randomised trial of internal fixation versus arthroplasty for displaced fractures of the neck of the femur. Functional outcome for 450 patients at two years. J Bone Joint Surg Br. 2002;84(2):183-188.
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