External validation of the U-HIP prediction model for in-hospital mortality in geriatric hip fracture patients |
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| Affiliation: | 1. Harvard Medical School Orthopedic Trauma Initiative, Brigham and Women''s hospital, Boston, United States;2. St. Antonius Hospital, Dpt. of Trauma Surgery, Utrecht, the Netherlands;3. Leiden University Medical Center, Dpt. of Clinical Epidemiology, Leiden, the Netherlands;4. Leiden University Medical Center, Dpt. of Biomedical Data Sciences, Leiden, the Netherlands;1. Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan;2. Department of Emergency Medicine, Yun-Lin Branch, National Taiwan University Hospital, Yunlin, Taiwan;3. Department of Emergency Medicine, Hsin-Chu Branch, National Taiwan University Hospital, Hsinchu, Taiwan;4. Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan;1. Institute of Jeil Life Engineering, Jeil Medical Corporation, #702 Kolon Science Valley 2nd, 55, Digital-ro 34 gil, Guro-gu, Seoul, Republic of Korea;2. Department of Orthopaedic surgery, Schoole of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongduk-ro, Jung-gu, Daegu 41944, Republic of Korea;3. Department of Orthopaedic Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea;4. Department of Orthopaedic surgery, Gyeongsang national university, college of medicine and Gyeongsang national university Changwon hospital, 11, Samjeongja-ro, Seongsan-gu, Changwon-si, Gyeongsangnam-do 51472, Republic of Korea;1. BG Trauma Center Tübingen, Department for Traumatology and Reconstructive Surgery, Tübingen, Germany;2. BG Trauma Center Murnau, Department of Trauma Surgery, Murnau am Staffelsee, Germany;3. Charité University Medicine Berlin, Center for Musculoskeletal Surgery, Berlin, Germany;1. Department of Obstetrics and Gynecology, Kitasato University Medical Center, Arai 6-100, Kitamoto-shi, Saitama 364-8501, Japan;2. Scientifics Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan;3. Department of Psychiatry, Seichiryo Hospital, Tsurumai 4-16-27, Showa-ku, Nagoya 466-0064, Japan;4. Department of Psychiatry, Nagoya University Graduate School of Medicine, Tsurumai-cho 65, Showa-ku, Nagoya 466-8560 Japan;5. Department of General Medicine, Taragi Municipal Hospital, 4210 Taragi, Taragi-machi, Kuma-gun, Kumamoto 868-0598, Japan;6. Department of Health Research Methods, Evidence & Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada;7. Department of Orthopaedics, Teikyo University School of Medicine, 1-2-11 Kaga, Itabashi-ku, Tokyo 174-0054, Japan |
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| Abstract: | IntroductionIdentification of high-risk hip fracture patients in an early stage is vital for guiding surgical management and shared decision making. To objective of this study was to perform an external international validation study of the U-HIP prediction model for in-hospital mortality in geriatric patients with a hip fracture undergoing surgery.Materials and methodsIn this retrospective cohort study, data were used from The American College of Surgeons National Surgical Quality Improvement Program. Patients aged 70 years or above undergoing hip fracture surgery were included. The discrimination (c-statistic) and calibration of the model were investigated.ResultsA total of 25,502 patients were included, of whom 618 (2.4%) died. The mean predicted probability of in-hospital mortality was 3.9% (range 0%-55%). The c-statistic of the model was 0.74 (95% CI 0.72–0.76), which was comparable to the c-statistic of 0.78 (95% CI 0.71–0.85) that was found in the development cohort. The calibration plot indicated that the model was slightly overfitted, with a calibration-in-the-large of 0.015 and a calibration slope of 0.780. Within the subgroup of patients aged between 70 and 85, however, the c-statistic was 0.78 (95% CI 0.75–0.81), with good calibration (calibration slope 0.934).Discussion and conclusionThe U-HIP model for in-hospital mortality in geriatric hip fractures was externally validated in a large international cohort, and showed a good discrimination and fair calibration. This model is freely available online and can be used to predict the risk of mortality, identify high-risk patients and aid clinical decision making. |
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